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Eating Disorders FAQ’s- see links to B-eat for further information
Q. What are eating disorders? What causes them? Aren’t they just attention seeking behaviours?
Eating disorders have a higher risk of death than any other psychiatric condition. They are serious and sometimes life threatening conditions in which the sufferer expresses distress through behaviours such as over or under- eating.
Food is essential for our health and development and It’s not unusual to experiment with different eating habits, for example many people may have decided to become a vegetarian or tried changing their diet to improve your health. However, some eating patterns can be damaging.
Problems with food can begin when it is used to cope with those times when a person feels bored, anxious, angry, lonely, ashamed or sad. Food becomes a problem when it is used to help to cope with painful situations or feelings, or to relieve stress. Sometimes without the person even realising it food becomes a way of dealing with emotions and feelings.
It is unlikely that an eating disorder will result from a single cause. Research has shown that genetic make-up may have a small impact upon the risk of development of an eating disorder, as can the attitude of other family members towards food, early feeding difficulties, and charater traits such as perfectionism, and low self esteem.
It is usually a combination of many factors, events, feelings or pressures that lead to the development and maintinance of eating disorders. These can include those above, plus : family relationships, problems with friends, the death of someone special, problems at work, college or at university, lack of confidence, sexual or emotional abuse, a long-term illness or disability - such as diabetes, depression, blindness or deafness. Individuals may also associate feelings of ‘not being good enough’ with feeling fat.
Often people with eating disorders say that the eating disorder is the only way they feel they can stay in control of their life, but as time goes on it it is the eating disorder that is really in control. Some people also find they are affected by an urge to harm themselves or misuse alcohol or drugs. They may find that they experience feelings of despair and shame, or lack of control because they cannot overcome these feelings about food on their own.
- How do I know if someone has an eating disorder?
An eating disorder is characterised by severe disturbance in eating behaviour, weight and body shape.
Anorexia NervosaRefusal to maintain body weight over a minimal normal weight for age and height (BMI of less than 17.5)
An intense fear of gaining weight or becoming fat, even though underweight
A disturbance in the way one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation; or denial of the seriousness of the current low body weight
In females, absence of at least three consecutive menstrual cycles when otherwise expected to occur
Bulimia NervosaRecurrent episodes of binge eating, characterised by:
- Eating, in a discrete period of time an amount of food that is larger than most people would eat during a similar time period or under similar circumstances
- A sense of lack of control over eating during the episode
Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas or other medications, fasting or excessive exercise
The binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for three months
Self-evaluation is unduly influenced by body shape and weight
Binge Eating DisorderRecurrent episodes of binge eating, characterised by:
- Eating, in a discrete period of time an amount of food that is larger than most people would eat during a similar period or under similar circumstances
- A sense of lack of control over eating during the episode
There is marked distress about binge eating behaviour
The binge eating occurs on average, at least two days a week for six months
Binge eating is not associated with regular use of inappropriate compensatory behaviours
Eating Disorder Not Otherwise Specified (EDNOS)EDNOS is a disorder where individuals have significant eating disorder symptoms but do not meet the criteria for any specific eating disorder listed. The majority of individuals presenting at eating disorder clinics have a diagnosis of EDNOS
Q. Who do eating disorders affect and when? They are all young females aren’t they?Anyone can develop an eating disorder, regardless of age, sex, cultural or racial background, although the people most likely to be affected tend to be young women, particularly between the ages of 15-25. However, now It is not unusual, for an eating disorder to appear in middle age. Men make up a much smaller percentage Gender and sexual orientation are significant factors. Approximately 10% of people with eating disorders are men and approximately 20% of men with eating disorders identify as gay, which is double the proportion of gay men in the population
Q What's the connectionbetween dieting and eating disorders?
Most people diet at some point in their lives, under the false belief that weight loss will make us happier and more attractive. Dieting success gives us a sense of accomplishment and feeling in control, it attracts compliments and positive feedback from other people.
Research tells us that in most cases eating disorders follow the onset of dieting behaviours. Restrictive dieting is poor at keeping weight off, with 97% of dieters regaining lost weight plus a little more. Physical changes make it hard to keep weight off. Chemicals released in the brain lead to massive cravings for food and abnormal hungers, which may persist for many months following a diet. The body defends its natural weight by resisting attempt at weight reduction. This fight-back process against our attempts to create a perfect body shape can also show up as abnormal cravings for forbidden foods. Also, with extended periods of dieting, the body may act to protect itself against future famines by promoting fat storage and reducing metabolism.
Emotional changes may make it hard to keep weight off as well. It is only human to feel deprived and irritable when we cannot have foods which have become “taboo”; they become much more desirable than they need to be. Breaking dietary rules leads to feelings that you have “blown it” and you binge on those forbidden foods in the expectation that you will start again tomorrow. Cycles of guilt and remorse usually follow from breaking these rules.
For bulimics and compulsive eaters, their attempts to restrain their eating has become undermined by reactive overeating and intensified efforts to compensate by more dieting just keeps them trapped in the vicious cycles of their disorder. People with anorexia hold out against the hunger from dieting. But their hunger becomes so intense that they believe that if they were to start eating at all, they will never ever stop.
Not everyone who diets develops an eating disorder. Most people do break their diets and binge to some extent after dieting. But you are most likely to become trapped in a battle with food and weight if self-confidence is poor, they are not coping well with life in general, and if weight is perhaps the most single important issue.
The treatment of an eating disorder will involve giving up dieting and eating a regular balanced diet containing a little of everything. This, together with work on emotional eating, will help to overcome food cravings.
Q. I'm worried that someone I know has an eating disorder. What can I do to help?
It is troubling to recognise that someone you care about nay be suffering from an eating disorder. The decision to approach the individual can provoke much anxiety since it is difficult to know what to say and what to expect from the situation. Perhaps you have broached the subject and got a negative response.
It is important to understand that they might not welcome your expression of concern, either because they are ashamed to admit their behaviour, or they feel “in control” and don't want anyone to “make them fat again.” It will, therefore, be important for you to be as well educated as possible about eating disorders. Part of this knowledge understands the many reasons why people are reluctant to get help.
- An eating disorder is often a way of coping with deeper problems , and so giving up a “solution” to other problems , that makes you feel better, is not easy
- They don't really trust anyone to be able to help them
- They may not want their problem to be out in the open for other people to track
- They might feel they “should” be able to do it by themselves
Each case is different and each situation unique. It is therefore really hard to give advice that is correct for each individual case. There are ways of speaking, words and attitudes that can be helpful and those that can drive someone into greater denial and secrecy. Admitting a problem and seeking to recover is a very individual decision and timing varies greatly.
Friends must be helped not to pretend that behaviour is normal, to show concern, but not to get over-involved or take responsibility for the health of the sufferer. Parents or partners need specialist advice from an expert, both in finding the best way to approach the sufferer, and also in managing the illness step by step once it is out in the open. There is no quick fix advice. Sometimes a concerned carer, friend or colleague may need continued professional help and support in order to handle their own emotional responses to the individual with an eating problem.
- How long will it take for someone to recover from an eating disorder?
This varies considerably from individual to individual. Recovery can take months, and even years, particularly for someone with anorexia nervosa, which has an average of 7 years for recovery. However, usually the earlier someone seeks support and treatment, the more quickly the situation can be turned around. If someone is motivated and keen to make changes, this greatly affects treatment outcomes for the better. Eating disorders are developed as a solution to underlying problems, and are not usually viewed as problems in themselves by the sufferer. Therefore they can be hard to treat.
Q. Will medication help?
Help for eating disorders is patchy at best. GPs are not formally trained to understand or treat eating disorders, although their help in managing physical risk is invaluable. Most NHS trusts provide a service only with serious cases of anorexia or bulimia and, due to demand, there may be long waiting lists or only help in non specialist mental health units.
Help is available in many forms. The NICE 2004 Guidance on eating disorders advised self help for less severe cases of binge eating disorder and bulimia nervosa. Other forms of self help are to be found in books and manuals or CDs. Check that they are recommended by the eating disorders association (b-eat) or based on CBT and are not unproven by research and proper evidence.
A form of therapy called CBT adapted for eating distress is recommended for bulimia and compulsive eating. Many counsellors and psychotherapists claim to treat eating problems and may do so with success, however we urge you to check the credentials of any therapist who advertises eating disorder treatment skills. The treatment of anorexia is more complex, as there is not one proven treatment, but a range of treatments that may help. Family therapy is regarded as helpful for younger patients. Some people are more comfortable with groups, either as therapy groups or support groups, which help people to come together, find friendship and normalise their feelings around food and weight.
Under certain conditions, where an individual's eating problems have led to physical or emotional crisis, a more intensive approach may be needed such as being in hospital or in a more structured treatment programme. You can access these services through a GP or directly through a Hospital Treatment Service.
Q. What happens after seeking help?
All referrals must come via General Practitioners or another medical professional within the NHS.
In the first instance you will need to book an appointment with your General Practitioner (GP) to discuss your concerns. Your GP will decide if it is appropriate to make a referral to the Service. Your GP would usually provide information about you including your current height, weight, Body Mass Index (weight in kg/height in m2), history of eating problems, current eating behaviour and type of eating disorder. Your GP will decide on the best treatment. Mild to moderate cases can be seen at GP practices by trained councillors, Moderate to severe will be treated by more specialist mental health services.
Q. What happens after a referral to mental health services?
You will usually be offered an assessment appointment. You will be allocated to your nearest clinic, geographically. There is usually a waiting list for an assessment, and if so, you will be placed on this. An assessment usually takes about 90 minutesto2 hours. The purpose of the assessment is to determine whether you have a clinical eating disorder and to see if we can offer you appropriate treatment for this. You will be asked a series of questions about the history of your eating behaviour; current eating patterns; body image and weight issues; and will also have physical checks carried out (including weight, height, Body Mass Index, pulse, blood pressure and squat test). At the end of the assessment you will know if you have a clinical eating disorder and what treatments are recommended.
Q. What are the different treatment options?
Treatment for people on is on an outpatient or inpatient basis. The NICE Guidelines recommend psychological therapy for eating disorders and aim to work with people on an outpatient basis if possible. As an outpatient you might receive Cognitive Behaviour Therapy (CBT), Cognitive Analytic Therapy (CAT), Motivational Enhancement Therapy (MET), and/or Family Work. If appropriate, an appointment with the Dietitian might also be an option alongside psychological therapy.
In addition to therapy, the inpatient wards offer patients a comprehensive support programme including group work, activities and help with re-feeding.
Q. What can be expected from an inpatient stay?
An inpatient stay can last from a few weeks to several months in length. Treatment plans are tailored for people on an individual basis. The inpatient ward provides a relaxed and friendly setting for treatment and is managed by an expert team of staff.
© The Mental Health Group 2007 |
