Signs, types, symptoms of an eating disorder; causes, diagnosis and treatment of eating disorders; impact on the family; social work role in multidisciplinary team
This page has three sections:
Background Material that provides the context for the topic
A suggested Practice Approach
A list of Supporting Material / References
Feedback welcome!
Background Material
Key facts
https://www.healthdirect.gov.au/eating-disorders Last reviewed May 2020
An eating disorder is a serious mental health condition that involves an unhealthy relationship with food.
Eating disorders can have a significant physical and emotional impact on the person affected, and their family.
Eating disorders include binge eating disorder, bulimia nervosa, anorexia nervosa and other specified feeding or eating disorder (OSFED).
Anyone can have an eating disorder but it is more common in adolescents and young adults.
Optimal treatment and recovery outcomes occur in the first three years of the illness, providing compelling evidence for early intervention.
It's important to seek help for eating disorders as early as possible.
What is an eating disorder?
An eating disorder is a serious mental health condition that involves an unhealthy preoccupation with eating, exercise or body shape.
Anyone can develop an eating disorder, regardless of cultural background, gender or age. Eating disorders are estimated to affect approximately 4 in every 100 people in Australia (or about 1 million people in Australia). About 1 in 7 people experience disordered eating in their lifetime.
A person with an eating disorder may experience any the following:
A preoccupation and concern about appearance, food and gaining weight.
Extreme dissatisfaction with one's body — seeking to lose weight even though friends or family worry that the person is underweight.
A fear of gaining weight.
The person lets people around him or her think they have eaten when they haven't.
Keeping eating habits secret.
Eating makes the person feel anxious, upset or guilty.
Lack of control around food.
Constant checking by, for example, weighing oneself or pinching one's waist.
Vomiting or using laxatives in order to lose weight.
DSM-5 eating disorder classifications
Classifications are made based on the presenting symptoms and how often these occur. Presentations and therefore diagnoses are not necessarily static, and people can move from one diagnosis to another.
Anorexia nervosa
Anorexia nervosa is characterised by restriction of energy intake leading to significantly low body weight accompanied by an intense fear of weight gain and body image disturbance, or behaviours that reflect that.
Avoidant/restrictive food intake disorder (ARFID)
ARFID is characterised by a lack of interest, avoidance and aversion to food and eating. The restriction is not due to a body image disturbance, but a result of anxiety or phobia of food and/or eating, a heightened sensitivity to sensory aspects of food such as texture, taste or smell, or a lack of interest in food/eating secondary to low appetite.
ARFID is associated with one or more of the following: significant weight loss, significant nutritional deficiency, dependence on enteral feeding or supplementation, and a marked interference with psychosocial functioning.
Binge eating disorder (BED)
BED is characterised by recurrent episodes of binge eating, which involves eating a large amount of food in a short period of time. During a binge episode, the person feels unable to stop themselves eating, and is often associated with marked distress and guilt. A person with BED will not use compensatory behaviours such as self-induced vomiting or overexercising after binge eating.
Bulimia nervosa
Bulimia nervosa is characterised by recurrent episodes of binge eating followed by inappropriate compensatory behaviours, such as self-induced vomiting, laxative misuse or overexercising, intended to prevent weight gain, and body image disturbance.
Other specified feeding or eating disorder (OSFED)
A person with OSFED may present with many of the symptoms of other eating disorders such as anorexia nervosa, bulimia nervosa or binge eating disorder, however, will not meet the full criteria for diagnosis of these disorders. This does not mean that the eating disorder is any less serious or dangerous. The medical complications and eating disorder thoughts and behaviours related to OSFED are as severe as other eating disorders.
Atypical anorexia nervosa is one of the subtypes of OSFED. A person with atypical anorexia nervosa will meet all of the criteria for anorexia nervosa, however, despite significant weight loss, the person’s weight is within or above the ‘normal’ BMI range. Atypical anorexia nervosa is serious and potentially life-threatening and will have similar impacts and complications to anorexia nervosa.
Remember, you can’t tell from the outside if someone has an eating disorder. You have to delve further into the situation.
Other
Other DSM-5 eating disorder classifications not listed here include Rumination Disorder, Pica and Unspecified Feeding or Eating Disorder.
Prevalence of eating disorders
More than a million Australians are currently experiencing an eating disorder (i.e. 1 in every 25 people). This is similar to the prevalence of diabetes with 1.2 million, or 1 in 20 Australians having diabetes in 2017–18. Eating disorders can affect people of all different socioeconomic and cultural backgrounds. While females comprise approximately 80% of people with anorexia nervosa and 70% of people with bulimia nervosa, recent data suggests that the prevalence of BED may be nearly as high in males as in females. Emerging research suggests that people who identify as gender non-binary or transgender are at two-to-four times greater risk of eating disorder symptoms or disordered eating behaviours than their cisgender counterparts.
Impact of eating disorders
Eating disorders are associated with serious medical and psychological complications. The mortality rate for people with eating disorders is up to six times higher than that for people without eating disorders with suicide being the major cause of mortality (up to 31 times more likely to occur for someone with anorexia nervosa and 7.5 times higher for someone with bulimia nervosa than the general population). The impact may lead to family and supports experiencing caregiver stress, loss of family income, disruption to family relationships and a high suicide risk.
What are the symptoms of eating disorders?
It is not always easy to tell if someone has an eating disorder, since they may try to hide it because of shame or guilt. However, some of the behaviours associated with eating disorders include:
Dieting: this could mean calorie (kilojoule) counting, fasting, skipping meals, avoiding certain food groups or having obsessive rituals related to eating.
Binge eating: including hoarding of food or the disappearance of large amounts of food from the kitchen.
Purging: vomiting or using laxatives to rid the body of food. People who purge often make trips to the bathroom during or after eating.
Excessive exercise: a person may refuse to disrupt their exercise routine for any reason, insist on doing a certain number of repetitive exercises or become distressed if unable to exercise.
Social withdrawal: the person may avoid social events and situations that involve eating, or they prefer to eat alone.
Body image: the person may focus on body shape and weight.
Change in clothing style: the person may start wearing baggy clothes, for example.
There are also physical signs that a person may have an eating disorder, such as:
Weight changes: fluctuations in weight or rapid weight loss.
Disturbed menstrual cycle: loss of or disrupted periods.
Dizziness: feeling light-headed or faint.
Fatigue: constantly feeling tired.
Being cold: sensitivity to cold weather.
Inability to concentrate (or think rationally).
Some of the emotional signs of an eating disorder include:
Obsession with weight: preoccupation with weight, body appearance or food.
Low self-esteem: feelings of low self-worth or a negative body image.
Negative emotions: anxiety, depression and feeling that life is out of control.
Meal-time anxiety: feeling anxious, upset or guilty in relation to food.
Mood changes: depression or anxiety, moodiness or irritability.
High-risk groups for developing eating disorders
Females, especially during biological and social transition periods (e.g. onset of puberty, change in relationship status, pregnancy and postpartum, menopause, change in social role)
Children and adolescents; although eating disorders can develop at any age, risk is highest between 13 and 17 years of age
Competitive occupations, sports, performing arts and activities that emphasise thin body shape/weight requirements (e.g. modelling, gymnastics, horse riding, dancing, athletics, wrestling, boxing)
Minority groups (e.g. LGBTQIA+)
Neurodiversity (e.g., autism spectrum disorder).
High-risks presentations
These are people who:
are seeking to lose weight
are experiencing weight loss, intentional or unintentional
are following a diet that limits energy intake, requires calorie counting or eliminates a food or food group
are on restrictive diets due to food intolerances or allergies (e.g., coeliac disease, irritable bowel syndrome)
are experiencing co-occurring conditions which cause weight loss or gain/focus on body, weight, shape and eating (e.g., type 1 and type 2 diabetes), polycystic ovary syndrome, coeliac disease)
are experiencing mental health conditions including anxiety and depression
are experiencing low self-esteem
are experiencing substance misuse
have a history of trauma
have current or historical experience of food insecurity
have perfectionist or compulsive personality traits.
What causes eating disorders?
It is unlikely that an eating disorder has one single cause. It's normally due to a combination of many factors, events, feelings or pressures. A person might use food to help them deal with painful situations or feelings without realising it.
These factors may include low self-esteem, problems with friends or family relationships, problems at school, university or work, high academic expectations, lack of confidence, concerns about sexuality, or sexual or emotional abuse.
Traumatic events can trigger an eating disorder, such as the death of someone special (grief), bullying, abuse or divorce. Someone with a long-term illness or disability (such as diabetes, depression, vision impairment or hearing loss) may also have eating problems.
Studies have shown that genetics may also be a contributing factor to eating disorders.
How are eating disorders diagnosed?
Many people who suffer from eating disorders keep their condition a secret or won't admit they have a problem. However, it's important to get help early (see, 'Where to get help').
The first step is to see your GP, who can refer you to the appropriate services. A doctor or mental health professional will make a diagnosis.
There is no single test to determine whether someone has an eating disorder, but there is a range of evaluations that lead to a diagnosis, including:
Physical examinations: Disordered eating can take a toll on the body, so the doctor must first check the person is physically OK. The doctor is likely to check height, weight and vital signs (heart rate, blood pressure, lung function and temperature). They may also check blood and urine.
Psychological evaluations: A doctor or mental health professional may talk to the person about eating and body image. What are their habits, beliefs and behaviours? They may be asked to complete a questionnaire or self-assessment.
Diagnostic instruments that could help include (Bosco-Ruggiero, 2020):
Eating Disorder Inventory (EDI-3) (https://www.parinc.com/Products/Pkey/103)
SCOFF Screening Tool (http://www.cedd.org.au/hne/other/scoff_questionnaire.pdf)
Eating Attitudes Test (EAT-26) (https://insideoutinstitute.org.au/assets/eating%20attitudes%20test%20eat-26.pdf )
Eating Disorder Examination Questionnaire (EDE-Q) (https://insideoutinstitute.org.au/resource-library/eating-disorder-examination-questionnaire-ede-q)
Treatments for eating disorders (Source: Butterfly Foundation https://butterfly.org.au/eating-disorders/eating-disorders-treatment/)
Starting treatment as early as possible is important because there can be long-term health consequences for people with chronic eating disorders.
Person-centred, stepped care is the most effective way to treat someone with an eating disorder. This approach means that treatment is specifically customised to suit that person’s illness, situation and needs and also recognises that people with eating disorders may need to move up and down variously through these levels of care over the duration of their illness.
When considering treatment approaches for an eating disorder, it is important to understand that different people respond to different types of treatment, even if they are experiencing the same eating disorder.
These evidence-based treatments have been found to be effective in the treatment of eating disorders. Typically, these treatments are not stand-alone treatments and a person with an eating disorder will usually receive a combination of treatments as part of their recovery program.
Some treatments are better suited to specific eating disorders than others and a multidisciplinary approach to treatment is often the best way to treat an eating disorder.
Multidisciplinary treatment includes psychology, psychiatry, dietetics, nutrition, general medicine, family therapy as well as self-help and various complementary or allied treatments.
Psychotherapy utilises a variety of techniques to manage and treat someone with an eating disorder. Emphasis during psychotherapy is placed on thoughts, emotions, behaviours, patterns of thinking, motivations and relationships. It can include models such as Cognitive Analytic Therapy, Cognitive Behavioural Therapy and Dialectical Behavioural Therapy.
Psychotherapy will usually be conducted by a psychologist. However, other professionals such as psychiatrists, psychotherapists and counsellors can use certain aspects of psychotherapy to treat someone with eating disorder.
Family approaches are most common when adolescents, young adults and children are suffering from an eating disorder.
Family approaches will involve the whole family or support network of the person with the eating disorder during treatment. The aim of a family approach is to treat the person with the eating disorder, while also supporting and educating the entire family about how to care for the person with the eating disorder. Focus can also be placed on strengthening family relationships and improving the family dynamic.
Self-help approaches are carried out by the person who is suffering from the eating disorder and often involves forms of Cognitive Behavioural Therapy.
Self-help treatments can be useful; however, they are most effective when combined with other treatment approaches that are provided by professionals and clinicians. Patients who only adopt self-help approaches and ignore or reject other forms of medical treatment may not recover from their eating disorder and may also be at high risk of recurrence or relapse.
Nutritional management approaches are provided by a dietician or nutritionist during treatment. They can also sometimes be provided by a GP. This approach has been designed to ensure that the person with the eating disorder is receiving the right level of vitamins and minerals throughout the treatment process and to help the person with the disorder develop normal and beneficial eating habits and behaviours.
Medication-based approaches are often vital when someone with an eating disorder also has another type of disorder or illness, such as depression, anxiety, insomnia or psychosis. This is known as a co-morbid disorder. Medications can be prescribed by psychiatrists or by medical doctors and GPs and should only be used in conjunction with another treatment approach.
With the right professional, social and emotional support, a person with an eating disorder can recover.
Where to get help
It is important to seek professional help as early as possible: visit the doctor. Other sources of help include the Butterfly Foundation Helpline (1800 33 4673) and Eating Disorders Victoria (1300 550 236).
Practice Approach
Source: NEDC (2023)
The National Practice Standards for eating disorders (NEDC, 2020) present an evidence-based consensus on the key requirements of health and other professionals across the system of care for eating disorders in Australia. The Standards are informed by research evidence, clinical expertise and lived experience. Under the Standards, a mental health professional’s role covers five functions. Each of these functions is associated with key clinical tasks and core competencies.
At minimum, eating disorder treatment must include a mental health professional who can deliver an appropriate evidence-based, eating disorder-specific therapeutic treatment along with a medical practitioner who can provide treatment and management for the medical consequences of the eating disorder. The support of a dietitian may also be required. Other referrals may be made according to the person’s individual needs.
People with eating disorders require access to a stepped-care system of services able to deliver the right treatment at the right time and respond flexibly to changes in the person’s psychological, physical, nutritional and functional needs. Many people can recover by using well-coordinated outpatient services; however, some also require access to acute medical or psychiatric services/hospital services.
1. Early identification
Proactively engage people at risk of eating disorders, identify warning signs, promote early help seeking and support prevention.
Identify warning signs of eating disorders and disordered eating
Have general knowledge of the clinical features of eating disorders and evidence-based treatments (see above)
Engage the person and their family and/or supports, and motivate engagement with relevant health services
Warning Signs
Psychological Difficult to detect psychological warning signs usually only come to light through changes in behaviour or through discussion and conversation and may include:
Preoccupation with eating, food (or activities relating to food), body shape and weight
Intense fear of weight gain
Heightened anxiety or irritability around mealtimes
Feeling of being ‘out of control’ around food
Disturbed body image
Extreme body dissatisfaction/negative body image
Rigid 'black and white’ thinking
Heightened sensitivity to comments or criticism (real or perceived) about body shape or weight, eating or exercise habits
Depression, anxiety, non-suicidal self-injury or suicidality
Low self-esteem or shame
Using food as self-punishment
Behavioural Being often difficult to detect because the person is unaware they are doing them, not see them as a problem, or feel concerned about letting you know as they may feel ambivalent about wanting to stop them, behavioural warning signs may include:
Constant or repetitive dieting behaviour
Evidence of binge eating
Evidence of vomiting or laxative use for weight-control purposes
Compulsive or excessive exercise patterns
Patterns or obsessive rituals around food, food preparation and eating
Changes in food preferences
Having rigid food rules
Avoidance of, or change in behaviour in social situations involving food
Social withdrawal or isolation from friends and family
Avoidance of eating
Changes in behaviour around food preparation and planning (e.g., may involve cooking, researching food, reading nutritional labels etc.)
Strong focus on weight and body shape
Repetitive or obsessive body checking behaviours
Changes in clothing style or wearing more layers than necessary for the weather
Covert or secretive behaviour around food
Inappropriate hydration behaviours
Continual denial of hunger
Physical Restricting food or fluid intake, nutritional deficiencies, binge eating and compensatory behaviours and lead to physical signs which may include:
Sudden weight loss, gain or fluctuation
In children and adolescents, an unexplained change in growth curve or body mass index (BMI) percentiles
Frequent changes in weight
Sensitivity to the cold
Delayed onset, loss or disturbance of menstrual periods or reduced morning tumescence
Signs of frequent vomiting
Lanugo – fine hairs covering the body or face
Fatigue or lethargy
Fainting or dizziness
Hot flashes or sweating episodes
Gastrointestinal disturbances with no clear cause
Cardiorespiratory complications
Osteoporosis or osteopenia
2. Initial response
Screening, completing a comprehensive assessment, making an opinion on diagnosis and completing referral to appropriate services.
Conduct initial screening
Conduct a comprehensive eating disorders assessment using relevant clinical tools, relevant to scope of practice
Provide an opinion on diagnosis, provisional formulation and make treatment recommendations
Screening tools
Several are listed in the Background Material section. Screening tools are not diagnostic tools, but rather, are used to detect the possibility of an eating disorder and identify when a comprehensive assessment is warranted. An example is the Eating Disorder Screen for Primary Care (ESP). It consists of five questions:
Are you satisfied with your eating patterns?
Do you ever eat in secret?
Does your weight affect the way you feel about yourself?
Have any members of your family suffered with an eating disorder?
Do you currently suffer with, or have you ever suffered in the past, with an eating disorder?
A ‘no’ to question 1 is classified as an abnormal response.
A ‘yes’ to questions 2-5 is classified as an abnormal response.
Any abnormal response indicated that the patient needs further assessment.
The conversation could broaden into discussion around a usual day of eating, frequency of eating, recent changes in eating patterns, feeling out of control around food.
Assessment
A comprehensive eating disorder assessment should include a person-centred approach to understanding the following:
Get to know the person (family, activities outside work/school, typical day)
Eating disorder symptoms (typical day of eating, recent weight changes, compulsion after binge eating, rules followed with meals, feeling out of control around food, importance of person weight and shape); the EDE-Q can be used at this stage – online available at https://insideoutinstitute.org.au/assessment/?started=true).
Context (triggers, support networks, strengths and challenges, trauma history, treatment history)
Mental health assessment (mood, family history, social connections, MSE, risk of harm)
Medical assessment (completed by a medical practitioner)
Diagnosis
Conducting a comprehensive eating disorder assessment should enable you to make a provisional eating disorder diagnosis. The following table, based on the DSM-5, will assist with this.
3. Shared care
Understanding the system of care, making appropriate referrals, organising and working within the treatment team, and engaging family and/or supports in treatment and recovery.
Capacity to refer people with eating disorders to relevant services and systems to address medical, psychological, nutritional and functional aspects of eating disorders
Organise and work within the multidisciplinary treatment team
Engage family and supports in treatment and recovery
Under the stepped system of care for eating disorders, a person could be referred for:
1. Community-based treatment: The person has been diagnosed with an eating disorder or is experiencing disordered eating. They are medically stable, and any psychiatric risk is contained. The person requires eating disorder-specific intervention delivered in a community or outpatient setting. Referral options include:
Private mental health and dietetic practitioners
Child and Adolescent Mental Health Services (CAMHS), Child and Youth Mental Health Services (CYMHS)
Adult Mental Health Services (AMHS)
Community Mental Health Service (CMHS)
Community-based eating disorder-specific services
Headspace centres
Peer workers alongside community-based treatment
2. Community-based intensive treatment: The person has been diagnosed with an eating disorder. They are medically stable, and any psychiatric risk is contained. The person requires more frequent and intensive outpatient treatment. Referral options include:
Intensive outpatient programs
Day programs
Peer workers alongside community-based intensive treatment
3. Hospital treatment: The person has been diagnosed with an eating disorder but are either not medically stable and/or present with a psychiatric risk. Referral options include
Emergency department where a decision will be made about admission to medical, psychiatric or eating disorder-specific inpatient unit.
The care team consists of all people involved in providing care and/or treatment to a person experiencing an eating disorder. Coordination of the care team (very important to establish) could be an important function of the social workers. The care team includes:
Person experiencing an eating disorder
Family and supports, who play a significant role in the care, support and recovery of people experiencing an eating disorder.
Minimum treatment team: medical practitioner and mental health professional
Dietitian, psychiatrist and paediatrician as needed
Other health professionals and medical specialists as needed
Lived experience workforce as needed
4. Treatment
Recommended for mental health professionals with the appropriate training, treatment involves using evidence-based treatment modalities and understand the medical and nutritional care required for people with eating disorders.
Knowledge and application of current clinical practices and standards in the treatment of eating disorders
Capacity to provide mental health treatment using an evidence-based treatment model for people experiencing an eating disorder
Understand the medical and nutritional care required for a person experiencing an eating disorder, and work within the multidisciplinary team
Mental health professionals who provide eating disorder treatment must have completed introductory eating disorder training and treatment provision training in at least one evidence-based treatment model for eating disorders. This is a requirement of the National Eating Disorders Collaboration (NEDC) and the Australia and New Zealand Academy for Eating Disorders (ANZAED). There are several general principles that guide treatment:
Early intervention is important
Coordination of services is fundamental to all service models
Services must be evidence-based
Involvement of family and supports in service provision is highly desirable
A personalised treatment approach is required for all people
Education and/or psychoeducation is included in all interventions
Multidisciplinary care is required
A skilled workforce is necessary
Non-negotiable aspects of treatment include:
Attending regular sessions with a mental health professional for treatment.
Attending regular appointments with a medical practitioner for medical monitoring.
Incorporating regular checking of a person’s weight and open discussion about this with them as aligned with the specific evidence-based treatment.
Eating at regular intervals including nutritionally adequate main meals and snacks.
If treatment is not progressing, the mental health professional may need to discuss stepping up the intensity of eating disorder treatment by either having more frequent appointments or accessing a higher level of care.
If health deteriorates or the person is at medical or psychiatric risk, they will require review by a medical professional and/or hospital emergency department. Admission to hospital may be required.
Some of the evidence-based treatment models for eating disorders include:
Family-therapy for eating disorders Family therapy for eating disorders includes family-based treatment (FBT), sometimes known as The Maudsley Model, family therapy for anorexia nervosa (FT-AN) or bulimia nervosa (FT-BN), parent-focused family therapy, systemic family therapy or multi-family therapy.
Family-based treatment (FBT) for eating disorders FBT is recommended for the treatment of adolescents experiencing anorexia nervosa and young people with bulimia nervosa.
Adolescent-Focused Therapy (AFT) for eating disorders AFT is recommended for adolescents experiencing anorexia nervosa.
Enhanced Cognitive Behaviour Therapy for eating disorders (CBT-E) CBT-E is a manualised psychological treatment recommended as treatment for adults with anorexia nervosa, bulimia nervosa, BED and OSFED.
Specialist Supportive Clinical Management (SSCM) for eating disorders SSCM is recommended as treatment for adults with anorexia nervosa.
Maudsley Model of Anorexia Treatment in adults (MANTRA) MANTRA is recommended as treatment for adults with anorexia nervosa.
Interpersonal Psychotherapy (IPT) for bulimia nervosa and BED IPT is recommended as treatment for adults with bulimia nervosa and BED, and adolescents with BED.
Dialectical Behaviour Therapy (DBT) for bulimia nervosa and BED DBT is recommended for adults with bulimia nervosa and BED.
Focal Psychodynamic Therapy for eating disorders Focal Psychodynamic Therapy is recommended as treatment for adults with anorexia nervosa
Cognitive Behavioural Therapy-Guided Self Help (CBT-GSH) CBT-GSH is recommended as treatment for adults with mild to moderate presentations of bulimia nervosa and BED, and adolescents with BED
5. Recovery support
Continue to provide ongoing mental health treatment and support for people who are being supported in or learning to self-manage their recovery.
Recognise indications of relapse and refer people to re-access treatment services
Refer to appropriate community-based supports, services and resources to promote connection and wellbeing
The mental health professional’s role in recovery support may include:
normalising relapse and pre-empting support needs as part of recovery
providing information and resources, including psychoeducation about relapse and recovery
developing a relapse prevention plan as part of treatment
monitoring for signs of relapse
re-referral to the treatment team for ongoing support as required
referral to support groups
referral to intensive or hospital treatment as required.
Full recovery from an eating disorder is possible, regardless of the length or nature of a person’s eating disorder. In general recovery involves nutritional, physical, psychological, functional and social elements.
Nutritional recovery involves eating a variety of different foods from all food groups and eating at regular intervals with main meals and snacks.
Physical recovery is typically associated with restoration or stabilisation of weight and improvement of the physical complications associated with an eating disorder. Physical recovery may also be defined by improvements in physical observations such as heart rate and blood pressure within the normal range, appropriate body temperature, and improved gastrointestinal function.
Assessing psychological recovery may include measures of quality of life, or a reduction in comorbid conditions such as depression and anxiety, as well as the person’s own reflections about how they feel.
Functional recovery may include higher energy levels, better sleep, better concentration and memory, and an ability to be more engaged with study, work and social activities.
Social recovery can include being able to engage in more social activities with friends in a flexible and spontaneous way, including eating out or going to see a film instead of sticking to a strict exercise regime. People may also begin to feel able to connect with friends and family more easily in a present and authentic way.
Relapse
In the context of an eating disorder, relapse is defined as a return of some thoughts, feelings or behaviours relating to an eating disorder, or the development of new ones, after a period of recovery in which these were not present. Relapse is a common part of the recovery process with approximately one-third of people who have recovered or are in recovery from an eating disorder experiencing a relapse.
The development of a relapse prevention and response plan is an essential part of treatment for anyone who is recovering from an eating disorder. The plan can be developed by the person experiencing an eating disorder in collaboration with the treatment team and family and/or supports (as appropriate) involved in recovery.
Signs of relapse include
Decreased ability to maintain appropriate food intake including difficulty sustaining regular eating patterns and behaviours, and difficulty maintaining a stable weight.
Decreased engagement in activities previously enjoyed including isolating from family and supports, and purposefully avoiding activities and social situations
Neglecting self-care including regular hygiene and self-care activities (e.g. missing doctor/therapy appointments)
Re-emergence of eating disorder behaviours including restriction, rigid eating, binge eating, compulsive exercise and compensatory behaviours such as excessive exercise and purging.
Thoughts about eating, weight and shape are becoming increasingly persistent and obsessive.
Response to relapse should occur in a warm and non-judgemental manner and include revisiting the relapse prevention and response plan already devised and implementing it.
Supporting Material
(available on request)
My summary of Anorexia and Bulimia (criteria and treatment)
Bosco-Ruggiero, S. (2020). How social workers can help with eating disorders. Retrieved from https://www.socialworkdegreecenter.com/study/social-workers-help-with-eating-disorders/
Butterfly Foundation website: https://butterfly.org.au/get-support/helpline/
Eating Disorders Victoria website: https://www.eatingdisorders.org.au/
Health direct website: https://www.healthdirect.gov.au/eating-disorders
Kendal, S., Kirk, S., Elvey, R., Catchpole, R., & Pryjmachuk, S. (2016). How a moderated online discussion forum facilitates support for young people with eating disorders. Health Expectations, 20, 98-111. doi: 10.1111/hex.12439
Mental Health First Aid: Eating Disorders (2008)
National Eating Disorders Collaboration (NEDC) https://nedc.com.au/
NEDC is an initiative of the Australian eating disorder sector funded by the Australian Government and dedicated to developing and implementing a nationally consistent, evidence-based system of care for the prevention and treatment of eating disorders. NEDC is a national collaborative platform for experts in lived experience, clinical services, and research to generate unified, evidence-based sector positions and consistent national standards that are translated into practical action for prevention, identification, and treatment.
Contents
The website is organised into seven main headings listed below. An outline of the content of some of these is provided.
Eating Disorders
Eating disorders explained
Types of eating disorders and related experiences
Early intervention
Support and treatment options
Professional Development
NEDC eLearning
Core skills for Fertility Care Professionals
Webinars and videos
Eating disorders training in Australia
Podcasts
Digital resources
Resources
Fact Sheets (36)
NEDC eLearning, e.g. Eating Disorder Core Skills: eLearning for Mental Health Professionals
Digital, interactive, and training resources
Health Professionals
General Practitioners: A Professional Resource
Screening and assessment
Cognitive Behavioural Therapy Guided Self-Help (CBT-GSH) fact sheet
Eating Disorders and the Dietitian Decision-Making Tool
Pharmacy and Eating Disorders
Pregnancy: A Guide for Assessment and Referral
Dentistry and Eating Disorders
Eating Disorders in Schools
Eating Disorders: Identification and response fact sheet
Eating Disorder factsheets
Online digital resources
Resources from other organisations
CCI Eating Disorders & Disordered Eating Workbook
ANZAED Online Consultation Program
Australian Dental Association
NSW Health eating disorders and oral health brochure
Key national and state/territory organisations, policies and guidelines
Peer Work
People with lived experience
Families and Supports
Higher weight clinical practice guideline
Research
Primary Health Networks
Support and Services
Stepped System of care
Service locator
Treatment options
Eating disorder organisations
Peer support work and support groups
People with lived experience
Families and supports
How to have a conversation
Warning signs
Tips for Carers
NEDC: National Eating Disorder Collaboration. (2020). National practice standards for eating disorders. https://www.nedc.com.au/assets/NEDC-Resources/national-practice-standards-for-eating-disorders.pdf
NEDC: National Eating Disorder Collaboration. (2023). Eating disorder core skills: eLearning for mental healthpProfessionals. https://nedc.com.au/professional-development/elearning/eating-disorder-core-skills-elearning-for-mental-health-professionals/
Wang, T., Brede, M., Ianni, A., & Mentzakis, E. (2018). Social interactions in online eating disorder communities: A network perspective. PLoS ONE 13(7): e0200800. https://doi.org/10.1371/journal. pone.0200800
Wientge, D. (2018). The power of relationships in eating disorder recovery. Retrieved from https://www.socialworktoday.com/archive/exc_0419_2.shtml
Williams, L., Wood, C., & Plath, D. (2020). Parents’ experiences of family therapy for adolescent anorexia nervosa. Australian Social Work, 73(4), 408-419. doi: 10.1080/0312407X.2019.1702707