undiagnosed eating disorder

by Matt C
(London)

13 April, 2010

I saw a client in my Health Improvement clinic today, and her case well illustrated why I became interested in Binge Eating problems and other eating disorders.

This lady had seen my leaflet in a local doctor’s waiting room and had contacted me for weight control and healthy eating advice. It turned out she also had long-term problems with depression for which she was seeing a counsellor. And she also had low blood sugars (hypoglycaemia).

As the discussion progressed, she mentioned that because of her very busy job she would go for long periods of time without eating anything. Literally days with nothing more than a couple of pieces of toast.

She recognised that she also ate for emotional reasons and that this had been discussed with her counsellor but not specifically in any depth. She was well aware of all the basics of good nutrition and healthy eating, and some of the implications of her low blood sugars.

I was interested by the fact that all her ‘trigger foods’ were the classic high sugar and fat foods – chocolate, cakes, biscuits and the rest. She had made the decision not to have these in her house at all and she seemed to be maintaining this, although her work place proved to be problematic for her.

I explained in more detail about the effect on her blood sugars and suggested that because she has naturally LOW blood sugars, she may be more sensitive to the effects of such sugary foods.

I asked about the long periods of not eating; what the effect that has on her; and asked… “because some other people find this happens to them”… whether she ever binge eats as a result.
This simple questioning then opened a door to a life story of food restriction, binge eating, self-induced vomiting and laxative abuse going back on and off over a period of some 20 years!

I asked whether she had mentioned this to her doctor or ever seen a specialist about it. She said that she had mentioned aspects of it occasionally but never discussed it in detail due to her feeling very embarrassed talking about it.

After exploring this a little further, I suggested that what she was describing was eating disorder type behaviour. She then said something that I found very interesting: “But I’ve told a couple of my really close friends and they say that I can’t have an eating disorder because I’m too fat”.

I bet that’s far from an uncommon situation! I wonder just how many people with binge eating disorder, compulsive eating problems and even bulimia have felt that way, or been told something similar (even by health professionals I wonder?). The public conception of an eating disorder is so often based around understandings of Anorexia Nervosa because that traditionally has got so much more media attention. Or with Bulimia Nervosa, the image is usually of an anorexic bulimic, not someone of normal or over-weight.

Hopefully this is where having Binge Eating Disorder recognised by the psychiatric profession in the proposed DSMV diagnostic manual will help to increase awareness of the wide range of eating disorders.

So I explained more about the continuum of eating disorders (and ‘disordered eating’) and when I mentioned that I could report to her GP and suggest a referral to an ED specialist, she seemed relieved and very motivated to try to turn things around. She had in fact already been binge and purge free for a month, but wanted a referral to make sure that she recovers for the long term.

I also suggested that she find and read ‘Overcoming Binge eating’ by Dr Christopher Fairburn, an excellent book that a nearby NHS eating disorder unit use in their group therapy sessions. I also provided the website and contact details for BEAT (the eating disorder association in the UK).

She agreed to start eating regular meals throughout the day even if she does binge or purge (to bring some much needed stability to her blood sugars), and she took away a food diary sheet to start monitoring her progress.

She also planned to go swimming again regularly, something she said she always used to enjoy. I encouraged this by referring to the positive effect exercise and activity can have on the endorphin system, and this was especially relevant considering her problems with depression.

I really look forward to seeing this lady for her follow up appointment, to see how she is progressing.

All fingers crossed!


Matt C