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Explainer: anorexia and bulimia

Eating disorders are more than fad diets gone wrong. Flickr -S

Eating disorders are an increasing problem in children and adolescents. Recent Australian studies have indicated eating disorder behaviour has increased twofold in Australia in the last five years and 9% (men and women) will suffer from one at some point in their lives.

An analysis by the American Agency for Healthcare Research and Quality shows that hospitalisations for eating disorders increased most sharply (119%) for children aged 12 and younger between 1999 to 2006.

Eating disorders are not just a concern for girls but for boys as well. One in four sufferers of eating disorders are male.

Anorexia nervosa is the third-most common chronic adolescent problem and the psychiatric condition that causes the most number of deaths. While the incidence of bulimia nervosa is estimated to be as high as one in five in the student population.

The combined prevalence of eating disorders in the Australian community is estimated to be 7%. Dieting is the greatest risk factor for the development of an eating disorder and, disturbingly, it’s thought about 70% of 15-year-old girls are on a diet. Out of these, 8% are severely dieting.

Adolescent girls who diet only moderately, are five times more likely to develop an eating disorder than those who don’t diet at all. And those who diet severely are 18 times more likely to develop an eating disorder.

Anorexia nervosa

Anorexia is a serious psychological eating disorder with “starvation symptoms”. Sufferers develop an intense fear of becoming overweight, even if they are severely underweight. Often, their perception of their body weight or shape is skewed, or they deny the implications of their low body weight. It’s not uncommon for women and girls suffering from anorexia to stop having their periods.

Globally about 1% of the population suffer from anorexia and, in Australia, 2% to 3% of adolescent and adult women satisfy the diagnostic criteria for anorexia or bulimia. Research suggests 8% of Australian women have suffered a serious eating disorder at some point in their lifetime, and 23% of young Australian women aged between 22 and 27 year have disordered eating in their recent past.

Anorexia is a very serious condition and the death rate is five times more for sufferers compared to others of the same age.

There’s no single cause for eating disorders although family and cultural pressures such as the media promoting an “ideal” weight, as well as emotional and personality factors (such as being perfectionist, having very high standards, and suffering from anxiety), are thought to play a role.

Bulimia nervosa

Bulimia is the more common eating disorder, and its sufferers are usually near average weight or even slightly overweight. Bulimics engage in periods of binge eating (more food than most people would eat in the same time), and purging (to rid their bodies of the food). Purging includes intense exercise, vomiting, fasting, and using laxatives.

About 5% of the population suffer from bulimia but the true incidence is estimated to be as high as one in five in the student population. The lifetime prevalence in Australia is 2.9%.

The media promote unhealthy body types. Insert Magazine


Eating disorders can be linked to low self-esteem and psychological issues can result from the practise of an unhealthy relationship with food. Anorexia and bulimia are very serious illnesses, not merely fad diets gone wrong. They require specialised treatment for recovery.

There are three recommendations from the UK National Institute for Clinical Excellence (NICE) for the treatment of anorexia in sufferers who are not yet adults:

  • For children and adolescents still living at home who’ve been anorexic for less than three years, a family-based treatment called the Maudsley Approach is suggested.
  • Outpatient services for those going to see a psychiatrist or a psychologist for individual counselling.
  • Inpatient service which combines re-feeding and counselling interventions.

Unfortunately, there’s insufficient evidence to make data-based recommendations regarding the treatment of adults with anorexia although new therapies such as acceptance and commitment therapy are showing promise.

For bulimia, the strongest evidence for successful treatment are the enhanced versions of cognitive behavioural therapy, which helps sufferers by showing them how to recognise negative thoughts and feelings and how to change them. There are also self-help books based on this type of therapy, which are considered effective. Antidepressant medication may also be useful for those suffering depressive symptoms.

There are also strategies for parents to help prevent the development of eating disorders in children and teenagers.

First, avoid talking negatively about your body because as it gives the message that it’s okay to dislike it. If you’re overweight and need to diet, let your child know you are trying to lose weight to improve your health rather than to be a certain weight or shape. If you must diet, do so by eating healthy, balanced meals, and avoid fad diets, skipping meals or diet pills. Finally, model good exercise habits. Moderate, regular exercise will help you stay healthy and help your child see an example of a balanced lifestyle.


About 45% to 50% of anorexia and bulimia sufferers return to a healthy weight with appropriate treatment. Another 30% make a partial recovery.

Of those who remain chronically unwell, newer approaches, such as mindfulness and acceptance training, are being explored. Mindfulness meditation aims to focus attention on the present moment, helping people disengage from habitual, unsatisfying behaviours. Acceptance approaches aim to increase psychological flexibility in how people think.

When sufferers are empowered to believe in themselves, recovering from an eating disorder is possible.

See more Explainer articles on The Conversation.

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