In this section you can find out:
You can also find out about other people's experience of eating disorders
There are two interrelated eating disorders: bulimia nervosa and anorexia nervosa. Of these, anorexia nervosa has the highest mortality. The diagnosis is made in patients with:
Low body weight
Intense fear of weight gain
Over-evaluation of shape and weight
Lack of menstrual cycles in women or reduced libido in men
Subclinical eating disorders
Some people have some, but not all, of the symptoms of anorexia nervosa and bulimia described above. These can be very disabling, but limited resources mean that many specialist services are only able to offer treatments to the most extreme cases.
Much more information on eating disorders is available from the following websites:
Who gets them?
Eating disorders affect women more than men. However, men are more likely to be under-diagnosed, misdiagnosed, under-referred and less likely to then be referred to specialist services for treatment than women. They not restricted to a particular ethnic group.
Present estimates suggest that the average general practitioner with a list of 2,000 patients is likely to have 1-2 patients with anorexia nervosa and 18 with bulimia nervosa. Five to ten per cent of the adolescent girls on the list will have some degree of disordered eating.
Eating disorders can run in families, and personality traits of low self esteem and perfectionism raise vulnerability.
People with eating disorders will have mixed feelings about ‘getting better’. The decision to seek professional help is therefore a ‘water shed’. Most people with eating disorders will approach their family doctor. They can offer you the opportunity to receive an accurate diagnosis of your condition. They may carry out a physical examination, to establish any medical complications resulting from your eating disorder. Some milder eating disorders are then managed within the family doctor’s practice. In other instances, the family doctor may suggest a referral to a community mental health service for further therapy.
Mental health services can seem quite complicated, with lots of different types of professionals and lots of different types of services. Unfortunately in the UK some parts of the country lack formal access to eating disorder services. Therefore treatments are carried out by general psychiatric services, or by referral to another geographical area. One way of navigating this bureaucracy is through local self help groups. Attending a self help group puts you in touch with other people who have experienced similar difficulties. In the UK, the beat (formally known as the Eating Disorder Association) is the umbrella organisation for self help groups, and their website http://www.b-eat.co.uk/ provides invaluable information, as well as advising on access to treatment. That website includes a list of statutory organisations providing treatment for eating disorders.
There are many different forms of therapy for eating disorders. You need someone who will show you empathy and respect. Empathy is different to sympathy. Some good therapists can be quite challenging, and rightly so. Therapy isn’t about having a shoulder to cry on. It is about someone who can engender change. What all effective treatments of eating disorder have in common is a joint emphasis on thoughts and feelings behind the disorder, and the need to change behaviours. Therapy that simply addresses behaviours tends not to produce lasting change. Equally limited is therapy that does not require any change in behaviour, such as weight gain or cessation of vomiting.
If you have very severe physical symptoms, such as low weight or abnormal blood results due to vomiting, it may be necessary for you to receive medical treatment before therapy can commence. Ultimately however, you are likely to be offered some form of ‘talking therapy’.
The various different types of talking therapy are described in the National Institute for Clinical Excellence (NICE) guidelines, and these can be accessed free via the NICE website at www.nice.org.uk . Different versions include cognitive behaviour therapy (CBT), a variant form of CBT known as mindfulness CBT, cognitive analytic therapy, psychodynamic psychotherapy, group therapy, interpersonal therapy, motivation enhancement therapy and couple therapy. For some people with eating disorders, creative therapy such as art therapy, music therapy and drama therapy can be very helpful, particularly when your immediate feelings are ‘beyond words’.
It is important that you understand the rationale for the type of therapy that you are offered, and you should feel free to discuss, and even challenge, the approach suggested by health care professionals. Sometimes, it is appropriate to suggest medication (tablets) in addition to psychotherapy. For example, many people with eating disorders and body image problems also suffer from depression, and the level of depression can be a barrier to being able to work in psychotherapy.
It is a sad fact that accessing specialist services can be difficult for some people with eating disorders. In the UK, if you experience difficulties you can contact the Patient Advice and Liaison Service (‘PALS’) in your area and they can act as your advocate, giving you assistance in resolving disputes with health care professionals.
Therapy for eating disorders is usually provided on an outpatient basis for mild and moderate cases. Inpatient treatment is advocated for people whose illnesses are particularly severe, where outpatient treatment has been tried unsuccessfully, where there are issues of medical or emotional risk, where there are additional emotional problems such as depression, or where there are bad social problems at home. For some people with severe medical complications, it is necessary to receive treatment on a medical ward or an eating disorder unit with sufficient expertise to manage medical complications. The guidelines for the treatment of eating disorders provided by NICE recommend that every region should have identified a physician with special expertise in eating disorders.
The role of the family doctor is crucial in co-ordinating care and referring you to an appropriate agency.
Accessing specialist services can be tricky, and the more you are informed about the process through self help organisations such as the Beat, the more likely you will succeed.
There are many different therapies for eating disorders, but the best of them combine a non-dogmatic approach with the requirement of addressing thoughts, feelings, and behaviours
The best forms of therapy are challenging, and may indeed make you feel uncomfortable at times. That is why it is so important you find someone you trust
Self help books
Bulimia Nervosa - A Guide to Recovery. P. Cooper. Robinson 1993
Getting Better Bit(E) by Bit(E). U Schmidt and J Treasure. Lawrence Erlbaum Associates, 1993.
Overcoming Binge Eating. C Fairburn. The Guildford Press, 1995.
Overcoming Anorexia Nervosa, Christopher Freeman and Peter Cooper 2002.
The Anorexia workbook: How to Accept Yourself, Heal Your Suffering, and Reclaim Your Life (New Harbinger Self-Help Workbook) by Michelle Heffner & Georg Eifert, 2004.
Skilled-based Learning for Caring for a Loved One with an Eating Disorder: The new Maudsley Method by Janet Treasure, Grainne Smith and Anna Crane. Routledge 2007.