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According to Australian and International data up to 10% of women may be affected by an Eating Disorder of some kind. Eating Disorders such as Anorexia Nervosa and Bulimia Nervosa primarily involve a preoccupation with control over body weight, eating and food. Eating Disorders have the highest mortality rate for any of the mental illnesses. Depression, anxiety and substance abuse commonly co-occur and need to be treated in their own right. The majority of people with an eating disorder (around 80%) will recover although typically it may take around five years for full recovery. Partial recovery can often by achieved after a year of treatment. The earlier treatment is sought and the younger the person, the better the prognosis.
Three features need to be present to make a diagnosis of anorexia nervosa:
- Over-evaluation of shape and weight and their control; that is, judging self-worth largely, or even exclusively in terms of shape and weight and the ability to control them
- Active maintenance of an unduly low body weight (typically defined as maintaining a body weight less than 85% of that expected (or a Body Mass Index of 17.5 or below)
- Amenorrhea in post pubertal females can also be an indicator but emphasis is placed on the above two criteria.
Three features also need to be present to make a diagnosis of bulimia nervosa:
- Over-evaluation of shape and weight and their control, as in anorexia nervosa
- Recurrent binge eating . A “binge” is an episode of eating during which an objectively large amount of food is eaten, given the circumstances, and there is a sense of loss of control at the time.
- Extreme weight-control behaviour(e.g sustained dietary restriction, recurrent self-induced vomiting or laxative misuse)
In addition, there is an exclusionary criterion, mainly that the diagnostic criteria for anorexia nervosa should not be met. This criterion ensures that it is not possible for patients to receive both diagnosis at one time.
Bulimia Nervosa is the second most common diagnostic category within Eating Disorders.
Eating Disorder Not Otherwise Specified
This is a residual category for eating disorders of clinical severity that do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa. This is the most common form of diagnostic category within eating disorders.
Recurrent binge eating in the absence of the extreme weight-control behaviour seen in bulimia nervosa.
Body shape dissatisfaction refers to the dislike of one’s appearance and is widespread in the general population. In fact a 2007 survey of young Tasmanians found that body image was their number one concern. However, it is possible to have body dissatisfaction but still judge self worth on a number of life areas such as sporting prowess, work performance, family relationships and so on.
Body dissatisfaction is different from an overevaluation of shape, weight and their control. Overevaluation is when people with an eating disorder judge their self-worth largely, or even exclusively, in terms of their shape, weight and their ability to control them.
The causes of an eating disorder are unknown. However, there are many patterns that are similar within the various eating disorders. Approximately 90% of people with an eating disorder are women, and eating disorders typically develop in adolescence. It seems that the different eating disorders have more in common than they do differences and in fact sometimes the eating disorder may over time “morph” into various categories of an eating disorder. This has led researchers to focus on the underlying factors within eating disorders which are common across the board. Thus, an eating disorder is essentially seen as a “cognitive disorder” with core features around the over-evaluation of shape and weight and their control. Fairburn (2008) suggests the following model which looks at how an eating disorder may be maintained:
Treatment for children and adolescents
Currently, the best evidence based treatment for children and adolescents up to around age 19 who have anorexia nervosa, is the Maudsley Model of Family Based Intervention. With this intervention, the whole family is engaged in the treatment and the parent’s involvement is vital for success. The parents are temporarily put in charge to help reduce the hold this disorder has on the child or adolescent’s life and then control is returned as recovery progresses. This approach views the adolescent as being controlled by the eating disorder, not the adolescent being in control of her own behaviour. Therefore the adolescent is not functioning on an adolescent level but much younger and requires a great deal of help from her parents. As recovery occurs, adolescent development can recommence, including assistance with negotiating developmental tasks for the whole family. The Maudsley Model involves three distinct phases of treatment. Phase 1 involves “refeeding” the child or adolescent and focuses on supporting the family to increase weight towards a healthy level and take charge of the recovery process. Phase 2 involves continuing to focus on healthy weight but other issues that have an impact can now be addressed. Phase 3 occurs when a stable weight has been achieved and there is no self-starvation. Adolescent issues can now be addressed.
The best practice and evidence based approach for treating adults with an eating disorder is an enhanced form of Cognitive Behaviour Therapy. This involves regular therapy sessions with a practitioner over an extended length of time, often between 3-12 months, depending on the nature of the disorder. The strategy is for the therapist and person with the eating disorder to construct an understanding, or formulation, of the processes that are maintaining the eating disorder and that need to be targeted for treatment. Depending on the formulation, the therapy will collaboratively address the necessary issues which may include regular eating, the role of emotions in eating, strategies for managing binge eating, self esteem issues, body checking and feeling fat.
Treatment availability on the North West Coast of Tasmania
There are a range of services that can assist people and families with an eating disorder. A number of specialists may need to be involved such as a Pediatrian, Psychologist, Social Worker, Dietitian and Psychiatrist. The GP plays an important role is the first port of call for assistance with an eating disorder.
For information on local service providers click here.
» GPNW Eating Disorder Bochure
GPNW Mental Heath Clinical Services Resources (directs you to Mental Health Clinical Services Resources)
» AGPN
» RACGP
For further information about our Mental Health Clinical Services click here .