Although there are several types of ED, we have focused on three main types:
- Anorexia nervosa.
- Bulimia nervosa.
- Binge eating disorder.
Anorexia nervosa, bulimia nervosa and binge eating disorder are characterised by a dysfunctional system of self-evaluation, which, rather than being based on personal qualities and achievements across several domains – such as academic or athletic accomplishments, work achievements, or relationship qualities – is disproportionately focused on weight, size, shape and appearance [159–161]. Binge eating episodes (described in Table 15) are present in bulimia nervosa and binge eating disorder. However, the compensatory behaviours to prevent weight gain, such as strenuous exercise, self-induced vomiting, or misuse of laxatives, that follow episodes of binge eating in bulimia nervosa, are not a feature of binge eating disorder. The types of eating disorders included in these Guidelines are described in Table 16.
Table 15: Binge eating episode
| Binge eating episode |
An episode of binge eating is characterised by both of the following:
- Eating, within a two-hour period, an amount of food that is definitely more than what most people would eat in a similar period of time, under similar circumstances.
- A sense of lack of control regarding eating behaviours during the episode (i.e., a person feeling that they are unable to stop eating or control what or how much they are eating).
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A case study example of how a person experiencing co-occurring ED and AOD use disorder may present is illustrated in Box 8.
Table 16: Types of feeding and eating disorders (ED)
| Disorder |
Symptoms |
| Anorexia nervosa |
There are three primary features of anorexia nervosa:
- Persistent restriction of energy intake.
- Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain.
- Disturbance in self-perceived weight or shape, disproportionate influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Maintained body weight is below minimally normal for age, sex, development, and physical health. |
| Bulimia nervosa |
Bulimia nervosa is characterised by three essential features, which must occur on average at least once a week for three months:
- Recurrent episodes of binge eating.
- Recurrent inappropriate compensatory behaviours to prevent weight gain (e.g., vomiting, use of laxatives or other medication, fasting, excessive exercise).
- Distorted self-image that is disproportionately influenced by body shape or weight.
People with bulimia nervosa are typically ashamed of their eating problems, may attempt to hide their symptoms, and may be within a normal weight range. |
| Binge eating disorder |
The predominant feature of binge eating disorder is recurrent episodes of binge eating that occur at least once a week for three months. The episodes of binge eating cause significant distress to the person. |
Box 8: Case study H: What does co-occurring ED and AOD use look like? Kai’s story
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Case study H: Kai’s story
Kai is a 26-year-old who identified as non-binary, and was referred to their local AOD service after being discharged from hospital. Kai had attempted to overdose at home by taking some of their mother’s sleeping pills, some non-prescribed opioids along with a bottle of vodka. Kai’s mother found Kai unconscious and called an ambulance. Kai managed to convince the very busy staff at emergency that their overdose had been an accident. Though hesitant to believe them, the doctor reluctantly agreed to discharge Kai, provided they would contact their local AOD service the next day. Kai agreed and Kai’s mother promised to take them.
On assessment, the AOD worker noted Kai’s loose clothing. Kai told the AOD worker that they wore baggy clothing to not draw attention to themselves and said they came from a traditional and conservative family. Kai said their family loved them a lot but they have struggled to understand their non-binary identity. They have had difficulties with pronouns and have been awkward when speaking about Kai to family or friends, which has led to increased discomfort and distance in their relationship. Kai has struggled with feelings of shame and guilt, which have been compounded by their family’s discomfort around them. They told the AOD worker they had been drinking a bottle of wine every day, been taking non-prescribed opioids for at least the past few years, and smoking cigarettes.
The AOD worker also noted that Kai seemed to be lacking in energy, appeared to be slight and fragile, and looked very cold. Kai told the AOD worker that they had previously been diagnosed with anorexia nervosa and had been hospitalised several times in the past for refeeding and monitoring. Kai said that their mother had always been extremely weight conscious as far back as they could remember, constantly dieting and monitoring her own food intake as well as the intake of the rest of the family. Kai said they had struggled with feelings of perfectionism their whole life, and felt they could control being thin. Kai said that they were aware things ‘weren’t great’ at the moment and alcohol had been the primary caloric intake for the past few months. They told the AOD worker that they were extremely tired, felt isolated and alone and wanted it to stop.
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Key Points
- What are the primary concerns for Kai?
- Where to next?