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Eating Disorders

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:

  1. Background Material that provides the context for the topic

  2. A suggested Practice Approach

  3. A list of Supporting Material / References

Feedback welcome!


Background Material

Key facts

  • 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):

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:

  1. Are you satisfied with your eating patterns?

  2. Do you ever eat in secret?

  3. Does your weight affect the way you feel about yourself?

  4. Have any members of your family suffered with an eating disorder?

  5. 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/



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


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