There’s more to eating disorders than teenage anorexia and bulimia. Angela Tufvesson looks at why atypical disorders are affecting older women



Think eating disorder and anorexia and bulimiaimmediately come to mind. Impressionable teenage girls hiding dangerous binging and purging habits from their parents until waif-thin limbs indicate that something is very wrong.

But while research shows one in 10 Australian girls aged 15 to 17 exhibit symptoms of an eating disorder , older women are at increased risk of developing this type of illness. In a culture where celebrity weight gain (and loss) is a spectator sport and the Australian weight loss industry is worth almost $800 million, it’s not surprising that older women are susceptible to eating disorders.

Plus, the eating disorder duopoly – anorexia and bulimia – falls well short of encompassing the many aspects of disordered eating. Eating disorders not otherwise specified (EDNOS) describes atypical presentation of an eating disorder and is the most common diagnosis, surpassing anorexia and bulimia. Then there’s the increasing prevalence of lesser known binge eating disorder and orthorexia.

Beyond the norm

For decades, we watched a two-horse race between anorexia and bulimia, but modern research shows eating disorders have a greater number of manifestations than the two headliners.

The next Diagnostic and Statistical Manual – the psychiatrists’ bible – will include an additional listing for binge eating disorder. The illness, which affects four per cent of people, is characterised by periods of binge eating without compensatory behaviours such as those experienced by sufferers of bulimia, like vomiting and overexercising. The bingeing normally involves eating excessive amounts of food, often when not hungry, followed by intense feelings of guilt, depression and shame. It often serves as a distraction for someone to avoid thinking about underlying emotional difficulties.

“Binge eating disorder has the bingeing and behavioural aspects of bulimia nervosa but without the purging,” says Christine Morgan, CEO of The Butterfly Foundation.
EDNOS is a term used to describe atypical presentation of an eating disorder that does not meet all of the diagnostic criteria for anorexia, bulimia or binge eating disorder. But it’s just as serious as the other conditions.

“Just because EDNOS sufferers don’t meet the full criteria for bulimia or anorexia, they’ve still got as serious eating disorders,” says clinical psychologist Dr Anthea Fursland, president of the Australia New Zealand Academy for Eating Disorders. “They have as many psychiatric and medical problems.”

Dr Fursland says the EDNOS category comprises half of all patients with an eating disorder – yes, half! – and includes conditions such as purging disorder, atypical anorexia and atypical bulimia. The diagnostic criteria for anorexia, bulimia and binge eating disorder are very strict – for example, people are classified as bulimic if they binge and purge at least twice a week for three months, and not any less. The EDNOS umbrella allows for eating disorders that are just as serious, but much less consistent and label-friendly.

While not technically an eating disorder, orthorexia is an unhealthy obsession with healthy eating. Sufferers fixate on eating foods that make them feel healthy to the extent that they avoid foods with additives, pesticides or the trio of fat, sugar and salt.

What tips the balance from healthy eating to orthorexia is the extreme obsession with healthy eating that stops sufferers from taking part in everyday activities. Little is known about this condition but it’s thought to be a predicting factor in the development of an eating disorder.

“Orthorexia a belief that you’re eating healthily but you’re not eating healthily at all,” says Dr Fursland. “Someone might think they want to eat healthily, so they’ll give up foods with fat in them. But a low-fat diet is healthy and having a diet with no fat is not healthy. Orthorexia can lead to all sorts of eating disorders,” says Dr Fursland.

Where do they come from?

Dieting is the number one risk factor in the development of any type of eating disorder , including EDNOS and binge eating disorder. According to Eating Disorders Victoria, women who diet severely are 18 times more likely to develop an eating disorder. Women who diet moderately are five times more likely to develop an eating disorder.

Morgan says women in their 20s, 30s and 40s are likely to suffer from body dissatisfaction that may have originated in adolescence. Career demands and pregnancy are also thought to play a part in the emergence of an eating disorder.

“If you are pregnant during these years, we know that the physiological changes that happen to your body, the weight gain, can be quite triggering for a number of women because there’s a societal pressure on yummy mummies and losing your baby weight quickly,” says Morgan.

“I suspect there’s also a lot of pressure on women in their 20s beginning their careers in the workforce. I’ve noticed recent press articles talking about the number of dollars the big corporates are so-called investing to ensure their employees have the right body image.”

Dr Fursland says the health problems associated with an eating disorder are likely to have a long-term impact on overall wellbeing. Bone density, teeth enamel and even the heart, via electrolyte imbalance, are effected.

While the stigma of eating disorders remains, Morgan says the perception of it being the fault of the sufferer is changing. “We’re beginning to see people recognising that this isn’t an illness they’re responsible for. It’s a very serious psychiatric illness and they can get help, but they need to reach out for it.”

If you’re concerned about your health or that of a friend or family member, phone The Butterfly Foundation helpline 1800 ED HOPE (1800 33 4673) or [email protected].