Eating Disorders and Treatment
They usually develop in adolescence and young adulthood and are often associated with a whole host of distressing thoughts and emotions.
There is a common misconception that only women are prone to suffering from eating disorders – but this is untrue. Both men and women may suffer from eating disorders which can affect people of all body types regardless of their gender identity.
Some types of eating disorders include:
- Anorexia Nervosa
– An eating disorder characterised by weight loss (or lack of appropriate weight gain in children), unhealthy eating patterns, intense fear of gaining weight and significant body image concerns. This condition is extremely dangerous as it can lead to malnutrition, starvation, and death.
- Bulimia Nervosa
– Bulimia is characterised by a cycle of bingeing and purging, where the individual eats large amounts of food (larger than what most people would eat in a similar period of time) in a way that feels out of their control, and then engages in purging which involves self-induced vomiting, fasting, or excessive exercise, Individuals with Bulimia also tend to have significant body image concerns.
- Binge-eating Disorder
– Binge-eating disorder involves periods of consuming unusually large amounts of food in a discrete period of time, accompanied by a sense of loss of control over eating. Binge-eating episodes are commonly associated with difficult emotions such as guilt, disgust and shame.
- Avoidant/Restrictive Food Intake Disorder (ARFID)
– An eating/feeding disorder characterised by a persistent and disturbed pattern of feeding or eating that leads to a failure to meet nutritional/energy needs. ARFID is often associated with an apparent lack of interest in eating of food, avoidance based on sensory characteristics of food (e.g. texture and smell), and fear of consequences related to eating such as choking and vomiting.
One common misconception is that eating disorders are a lifestyle choice and are just a “passing phase”. This is not true – nobody chooses to have an eating disorder.
Unhealthy eating and exercise patterns can spiral out of control and become driven in ways that appear similar to an addiction.
Eating disorders can be very serious and dangerous conditions as they can directly affect physical health, as well as psychological and social functioning.
As they are commonly associated with a myriad of medical complications, eating disorders have one of the highest mortality rates amongst all psychiatric illnesses.
What Should I Look Out for?
While there are a variety of eating disorders, listed below are some of the more common signs and symptoms.
If you or one of your loved ones shows several of these symptoms, we strongly suggest seeing a professional for an assessment and treatment.
Some Symptoms and Warning Signs of Eating Disorders include:
- Dramatic weight loss/gain or fluctuations in weight
- Excessive and rigid exercise behaviours
- Increased preoccupation with food, body weight and body shape (e.g. weighing self excessively)
- Restrictive eating (e.g. skipping meals, choosing only “healthy” food)
- Picky eating unresolved by late childhood
- Purging behaviours (self-induced vomiting and/or use of laxatives)
- Non-specific gastrointestinal complaints (e.g. constipation, acid reflux etc)
- Social withdrawal
- Decreased mood and concentration
- Hair loss
- Feeling cold all the time
- Feeling dizzy or faint
- Loss of menses in females
Indicators for increased and urgent medical attention:
- Irregular heart rate
- Low weight
- Low blood sugar
- Low and/or postural drop in blood pressure
- Electrolyte imbalances
When Should I Seek Treatment?
If your loved one is your child, you should strongly consider seeking out treatment with by specialist on their behalf. Studies have shown that early intervention is key as prompt and intensive treatment significantly improves the chances of recovery.
What Does Treatment Look Like?
As eating disorders affect both mind and body, treatment commonly involves a coordinated team of specialists – a GP or Specialist Doctor, a Psychologist, a Psychiatrist and a Dietician or Nutritionist.
A first visit with the clinical psychologist usually entails them making a detailed assessment of the presenting issues and taking relevant background history.
If you are the patient, you will be asked a number of questions about your eating habits, behaviours and other details including your medical history.
If a child or adolescent is the patient, their parents will also be interviewed and the initial session may take 1.5 to 2 hours. If the patient has a caregiver, they may also be interviewed.
At the end of the first session, your psychologist will provide you with some information on your diagnosed condition, including some knowledge on how you can help manage your symptoms and behaviour.
Your psychologist will discuss some of the potential treatment options and plans. Depending on the assessment made by your clinician, they may recommend involving other specialists such as a dietician or doctor in your treatment. They may also recommend either individual or family-based therapy.
Based on the current research, Family-Based Treatment (FBT; sometimes also known as the “Maudsley Method”) is the most effective model of treatment for anorexia nervosa in children and adolescents. It has also been shown to be effective in the treatment of Bulimia Nervosa as well as ARFID.
FBT is a manualised treatment delivered by trained professionals. It differs from traditional treatments that involve waiting for the child to develop insight and motivation to get better. The problem with such traditional treatments is that they waste precious time and the physical consequences associated with malnutrition continue to affect the child’s health and development. Children and adolescents with eating disorders often lack the motivation to eat and get better. FBT can work around the resistance by leveraging on parents as agents of change and has been shown to be faster and more cost-effective compared to other treatments.
FBT requires active participation by parents and focuses on supporting and empowering parents to actively renourish their children until they resume normal development and are able to make appropriate food, eating and exercise choices.
In FBT, sessions are usually weekly at the start and then decrease in frequency, and the family is invited to attend every session together with the child. The child is also weighed and seen individually at the beginning of each session. The clinician will work with the family to discuss the impact of the eating disorder and help to understand the child’s fear and distress during meals. One of the initial sessions typically includes at least one family meal in the clinic room. This provides the clinician with an opportunity to observe the behaviours of each family member during a meal and to assist and guide parents in helping their child eat.
There are 3 distinct phases in FBT:
- Phase 1: Due to the impact of starvation on the brain, the child is not able to make healthy and appropriate decisions surrounding eating at this point, hence parents are empowered to take charge of meals to help the child re-establish regular eating patterns. Physical exercise is limited at this stage.
- Phase 2: This phase begins when most weight is restored and meals are going more smoothly. The child is gradually given more independence over their own eating and exercise.
- Phase 3: The focus in the phase is to help the child develop a healthy and balanced life and to catch up on other developmental issues. Other comorbid mental health difficulties can also be addressed. The treatment ends with relapse prevention.
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