Eating disorders are characterised by abnormal eating practices which are a result of negative body perceptions.
The Eating disorders covered in the DSM-V-TR are:
Aetiology of eating disorders
Eating disorders are complex and often not a single cause is sufficient to develop an eating disorder.
Sociocultural
Sociocultural norms of slim bodies being ideal is often found in countries where food is plentiful, (developed western countries), and this slim ideal can be a factor in developing an eating disorder
Additionally epidemiology and research can be misleading in western cultures as lots of people can have a challenging relationship with food. This can still lead to more developement of eating disorders though
Family factors
These family characteristics can lead to eating disorders more often: overprotecting, controlling, critical, with mother-daughter conflict (mother projects struggles with weight or food).
Paradoxically these can often follow ED rather than precede it. Parenting a child with eating disorders are hard.
Individual factors
These individual factors can lead to eating disorders:
- Traumatic or stressful background: abuse bullying teasing about weight or reinforcing weight loss
- Negative emotionally: low mood high anxiety, low self esteen
- Body dissatisfaction: Low mood high anxiety, low self esttem
- Personality: perfectionism, need for control, obsessive tendencies, impulsiveness (for BN not AN)
- Emergence of genetic componentS to AN
Behaviours of eating disorders
when someone fails a diet in a day they usually give up for the rest of the day and try extra hard tomorrow this instability can turn into an issue
Impact and outcomes of eating disorders
| Physical | Impact of role function | Outcomes | ||
|---|---|---|---|---|
| AN | 1. Loss of periods and low bone density 2. Cardiorespiratory symptoms (hypotension dysregulated heart rhythm) 3. Abnormal renal and liver function 4. electrolyte imbalance 5. hair loss and Lanugo | profound but not admitted by sufferer severe disruption to cognitive social functioning,:major impact of education and development | After 10 years 30% recovered 30-50% partial, 20-40% enduring | |
| BN | 1. Dental issues from vomiting 2. electrolyte imbalance | often hidden to observer for years - not so disruptive | 50% make good recovery 50% make partial recovery | |
| BED | 1. Obesity | least disruptive of all 3 EDs | Unknown but probably similar to BN | |
Treatment priciples
Psychoeducation and medical monitoring
- Education about the disorder, thinking feelings and physical health
- Medical monitoring when required (severe starvation)- electrolytes, renal, cardiac function etc
Target underlying psychological issues
- Address body dissatisfaction and low self esteem
- Address other psychological factors
Monitor weight and eating behaviour
- Using daily records and food diaries
- Use education and CBT to re-establish normal eating
- Establish a normal amount of food to eat which can be weird for an AN person
- The behaviour of eat when hungry is often unrecognised in ED people
- In BED and BN distinguishing physical hunger from emotionally fuelled hunger.
- Medical admission for AN if weight drops below 65-75% of expected
Target binge eating and dietary restraint.
- Identify cognitive and emotional triggers to bingeing and help develop alternative responses
Relapse prevention.
Key points for doctors
- AN is relatively rare, but can be life threatening. Medical oversight becomes critical as BMI drops.
- BN and BED – tend to be hidden – need to consider these possibilities in people presenting with dental enamel erosion, electrolyte disturbances, GI problems, cardiac irregularities. Note association with vegetarian and vegan diets.
- EDs require referral to specialist service, or a clinical psychologist/psychiatrist plus medical monitoring.
- All EDs can have long term medical impact and may take years to resolve.
- Typically tremendously stressful for families – need to rally all available support and services.