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CLINICAL: MENTAL HEALTH


Dr Ciarán Newell PhD BA Dip CBT RMN Associate Nurse Director Consultant Nurse


Dorset Healthcare University NHS Foundation Trust


Recognising and dealing


with eating disorders Eating disorders can be difficult to identify and diagnose, but early intervention in primary care can be crucial


A


n eating disorder (ED) is a serious mental illness which can have a devastating impact on those with the disorder as well as people close to them. Clinicians in primary care have an important role in identifying, treating and referring on those with EDs. However, the identification of


individuals with EDs in primary care can be difficult for a number of reasons, and this article will provide some guidance on how to address this.


WHAT ARE EATING DISORDERS? Despite their name, these disorders are not just about food; rather, they are about coping with emotional distress and gaining a sense of control where none is felt.1


Those with EDs often have physical


and psychiatric complications running significant risks, with anorexia nervosa having the highest mortality rate of any psychiat- ric illness.2,3


Sometimes EDs can be misunderstood as a ‘dieting


disorder’ or a ‘phase’ the person is going through, leading to inadequate treatment. Sometimes the obvious physical signs and symptoms of EDs can cause them to be mistaken for other diseases and may lead to extensive investigations as a result. The two most recognisable EDs are anorexia nervosa (AN),


usually characterised by restriction of food intake and resulting marked weight loss, and bulimia nervosa (BN), characterised by the consumption of large amounts of food in a short period and behaviours to avoid weight gain, such as vomiting and/or laxative use. Excessive exercise can also be part of the presenting picture. However, over half of the referrals to eating disorders services do not meet the full criteria for AN or BN and are referred to as ‘atypical’ or as ‘eating disorder not specified.’ This pattern of diagnosis spread contributes to the difficulties in identifying EDs. Binge eating disorder (BED), where an individual eats an excessive amount of food and has a sense of loss of control whilst eating, is also recognised. In this disorder, the individual does not employ


any weight control strategies, so the disorder is often associated with obesity. There are other disorders of eating, including night eating syndrome, and disorders associated with eating in childhood (such as food refusal and eating a limited range of foods) which are not covered in this article. The total prevalence of AN in the population is estimated at approximately 0.3%, with BN estimated to affect 1% of young women.4 of total cases.


Men make up about 10%


WHAT CAUSES EATING DISORDERS? Most specialists agree that the causes of EDs are complex and that many factors contribute to their emergence. Factors such as body dissatisfaction, a poor sense of self-worth, or situations where an individual is highly self-critical or has a strong desire for control can all contribute. Social factors including the strong focus on appearance in our society and the association between being thin and being successful contribute to conditions that promote control of our bodies as solutions to problems. Genetics also have a major contribution in the development of an ED. It is difficult to determine exactly when an ED starts, as early


stage behaviours can resemble ‘normal’ behaviour, such as dieting and mood fluctuations. However those with an ED usually trace the


BOX 1. THE ‘SCOFF’ QUESTIONAIRE


Do you ever make yourself Sick because you feel uncomfort- ably full? Do you worry you have lost Control over how much you eat? Have you recently lost more than One stone in a three month period? Do you believe yourself to be Fat when others say you are too thin? Would you say that Food dominates your life?


70 Nursing in Practice March/April 2012


www.nursinginpractice.com


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