Anorexia consists of:
- Restriction of food leading to extremely low weight
- Intense fear of gaining weight, despite being very underweight
- Disturbed perception of one’s own weight or shape
- Lack of awareness of seriousness of very low weight
Eating disorders affect 2-3% of the population, 80-90% of whom are female.
People with anorexia nervosa can be difficult to engage in treatment, and can feel angry, frustrated, helpless and hopeless when interacting with their carers, and treating team.
There are strong links with other psychiatric illnesses, such as anxiety, obsessive-compulsive disorder, social phobia and depression.
Physical complications of starvation include:
- low body temperature, low blood pressure and pulse
- bowel upset
- loss of bone minerals
- irregular, or absent periods, and infertility
- skin and hair changes
- decreased brain grey matter
- Early recognition and intervention may help to limit progression of the condition.
Common presentations of Anorexia Nervosa are:
- Changed attitude to food or cooking
- Avoiding meals
- Slow eating, picking at food
- Eating in secret
- Cooking for family but no self
- Eating low calorie foods
- Changing food choices, e.g. vegetarian or vegan diet
- New food intolerances, e.g. lactose intolerance; food “allergies”
- Medical problems (from being underweight)
- Fractures from minimal force
- Menstrual irregularity
- Abdominal problems, such as bloating, constipation, abdominal pain
- Low blood glucose causing dizzy spells
- Behavioural and psychological problems
- Low mood
- Poor concentration
- Excessive training
Parents may be concerned that their child could be harming themselves. Often the child is a reluctant patient. They may use anorexia as a life solution to an internal problem, and be reluctant to change their behavior. They may be masking the intensity of their fear, anger and sadness. This requires a great deal of tact to manage from the treating team, so as not to create even more of a barrier to change. At the heart of the condition is that the sufferer has low self-esteem and self-worth, which has become linked to their perception of their weight and shape.
A simple screening set of questions – SCOFF:
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you lost more than One stone (6kg) in 3 months?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say Food dominates your life?
(2 or more Yes’s gives a high index of suspicion – requiring further assessment)
- All sufferers should have a dietician, a psychologist (+/- psychiatrist) and ongoing contact with their GP.
- If good progress is made, their treatment may stay at this level.
- The next step would be referral to the local area Mental Health services, or a specialist treatment program (such as the Eating Disorders Program at Princess Margaret Hospital), for a higher level of support.
- Family Based Therapy is more effective for sufferers under 18 years of age; it is better accepted by the patient and their parents, easing the cycles of guilt and shame.
- Hospitalization may occasionally be necessary for short term rescue, intensive treatment or respite for the family.
- The aim of management is to assist the sufferer to maintain a maximum tolerable weight, deal with psychological distress without resorting to weight loss, and focus on improving their (and their carer’s) quality of life.
- Recovery may take years. Your GP is integral to long term management, based on a strong, trusting therapeutic relationship.