REVIEW OF EATING DISORDERS - NOT JUST A TEENAGE PHENOMENON N. Chevalier, A. O’Rourke, A.M. Gaynor, E. Garvey, S. Fox. Department of Nursing & Health Sciences, AIT
EPIDEMIOLOGY OF EATING DISORDERS
According to bodywhys.ie, eating disorders are considered to be complicated and potentially life-
threatening conditions. In Ireland, it is predicted that there is roughly 200,000 individuals affected by
an eating disorder, with the presentation of 400 new cases per annum with an annual mortality of 80
(Vision for Change 2006). As shown in Figure 3, less than 1% of those suffering from an eating
disorder, whether diagnosed or not, require or present for admission in an inpatient facility. This
suggests that many people live with the disorder without seeking medical assistance.
As shown in Figure 3, it is evident that eating disorders are not “just a teenage phenomenon”. The
number of inpatients aged over 25 is just less than the number of inpatients under 25. According to
the Health Research Board data for child and adolescent psychiatric admissions in Ireland in 2008,
eating disorders represented the second highest level of diagnosis at 18%. This represents 71 people
(8 male & 63 female) of the 138 people under 25 years presenting for inpatient admission in 2008
(Figure 3). As with most disorders the problem manifests itself in the child and adolescent years and
from there it develops.
It should also be highlighted that eating disorders are predominantly a female disorder as shown in
Figure 1.
AETIOLOGY OF EATING DISORDERS
Like all other psychiatric illnesses, eating disorders have a multitude of factors which can cause the
disorder; no single aetiological factor on its own can be linked to the development of the disorder in
the individual, nor can it be used to distinguish different classifications of the disorder between
individuals (Cooper, 1995). As to whether the individual actually develops an eating disorder depends
on many risk and protective factors, whether he or she is biologically predisposed to it or whether it
be other predisposing factors such as vulnerabilities, resilience or traumatic events (Nice, 2004).
The main factors can be classified under the following:
• Biological factors - genetic predisposition
• Family factors - current studies have yet to confirm although it has suggested dysfunctional
family relationships (Stice, 2002)
• Individual factors - physical complaints / feeding difficulties at young age, impulsivity and
distorted self concepts
• Environmental and traumatic events - media “idealism” and stressful events
THE EFFECTS EATING DISORDERS HAVE ON THE INDIVIDUAL
Other Disorders
17,974 people
Eating Disorders
199 people
186 Females
13 Males
FIGURE 1 - TOTAL NUMBER OF ADMISSIONS IN 2012 WITH A DIAGNOSED DISORDER (HRB 2013)
0
20
40
60
80
100
120
140
160
under 25 years 25-45 years 45-65 years 65+ years
FIGURE 3 - AGE GROUPS ADMITTED TO HOSPITAL WITH A EATING DISORDER FROM 2004-2010 (DOHC 2011)
2004 2005 2006 2007 2008 2009 2010
Atypical eating disorders
Anorexia nervosa
Bulimia nervosa
FIGURE 2 - SCHEMATIC REPRESENTATION OF TEMPORAL MOVEMENT BETWEEN EATING DISORDERS. THE SIZE OF THE
ARROW INDICATES LIKELIHOOD OF MOVEMENT IN SHOWN DIRECTION.ARROWS THAT POINT OUTSIDE OF THE CIRCLE
INDICATE RECOVERY. (FAIRBURN & HARRISON 2003)
References Bodywhys. (2008) “Bodywhys-The Eating Disorders Association of Ireland”.[Online]. Available at:
http://bodywhys.ie/aboutED/general-information. [Accessed 5th February 2014]
Cooper, P.J. & Steere, J.A. (1995). “Comparison of two psychological treatments for bulimia nervosa: Implications for
models of maintenance.” Behaviour Research and Therapy 33: 875–885.
Department of health and children.(2014) “vision for change 2006.” [online]. Available at:
http://www.dohc.ie/publications/vision_for_change.html.[Accessed 4th February 2014]
Department of health and children.(2014) “Department of Health - Health Statistics 2011.” [online]. Available at:
http://www.dohc.ie/statistics/pdf/stats11_psyc.pdf?direct=1.[Accessed 4th February 2014]
Fairburn, C.G & Harrison, P.J (2003). “Eating Disorders.” The Lancet 361(9355): 407-416
Health and Research Board. (2013) “Activities of Irish Psychiatric Units and Hospitals 2012.” [Online]. Available at:
http://www.hrb.ie/publications/hrb-publication/publications//622/ [Accessed 5th February 2014]
National institute of clinical excellence .(2004) “Eating Disorders Core interventions in the Treatment and management of anorexia nervosa,
bulimia nervosa, and related eating disorders.” [online]. Available at: http://www.nice.org.uk/nicemedia/pdf/CG9FullGuideline.pdf.
[Accessed on 6th February 2014]
Stewart,T & Williamson, D.A. (2004). “Multidisciplinary Treatment of Eating Disorders—Part 2: Primary Goals and Content of Treatment.”
Behav Modif 28: 831
Stice, E. (2002). “Risk and maintenance factors for eating pathology: A meta-analytic review.” Psychological Bulletin 128: 825–848
Treasure, J., Gavan, K., Todd, G. & Schmidt, U. (2003). “Changing the environment in eating disorders: Working with carers/families to improve
motivation and facilitate change.” European Eating Disorders Review, 11: 25–37
MANAGEMENT AND TREATMENT OF EATING DISORDERS
From taking a look at the different classifications referred to previously, one can now understand the diversity and
complexity of eating disorders. Therefore, best practices recommend that it should warrant specialist
multidisciplinary teams (MDTs), as discussed by (Stewart & Williamson, 2004). The MDT should contain specialists
from all disciplines within the health sector, catering for the patient’s biological, psychological and sociological
needs. This includes psychiatrists, psychologists, nursing staff / specialists, social workers / family therapists,
dieticians, activity therapists and eating disorder therapists.
The two main types of treatment for eating disorders are pharmacological and psychological. Unlike a lot of other
psychiatric disorders pharmacological interventions are not seen as the first line treatment for patients with eating
disorders. However, they are useful to augment psychological therapies and in a lot of cases treat comorbid
conditions such as depression (nice, 2004).
When it comes to selecting the most suitable psychological treatment for the patient, a number of variables must be
taken into account. The facilitator must assess many variables including the age of the person, motivation,
comorbidity, social supports, actual diagnosis and many other risk factors. By accounting for these variables, the
facilitator is able to use the individuals preferences to select the best therapy to suit, which in turn will enable the
examiner to explore the core attitudes that underlie the eating disorder and increase the likelihood of a better
outcome (Treasure & Schmidt, 2003).
Some of the main therapies which are used in the psychological treatment of eating disorders:
• Individual therapy – cognitive behavioural therapy, interpersonal psychotherapy, cognitive analytic therapy
• Family therapy – family group
• Group therapy – mindfulness, psycho-education, body image group , recovery building group
• Nutritional counselling – nutrition education, plan and prescribe meals for patients and expert guidance
• Exercise counselling – exercising education, plan for patients and expert guidance (Stewart & Williamson,
2004)
BIOLOGICAL PSYCHOLOGICAL SOCIAL
Death Depression Loss of friends
Heart disease Poor self esteem/ self concept Loss of job/drop out of college
Dehydration and kidney failure Anxiety Withdrawal
osteoporosis Guilt, self disgust Stigma
THE MAIN CLASSIFICATIONS OF EATING DISORDERS
Eating disorders are complex in nature therefore classifying them into sub-categories was always going to be difficult.
If we look at the American diagnostic statistical manual V (DSM-V) and compare it to the international classification of
diseases 10 (ICD-10) (European), the sub categories differ in each. The only two classifications that hold across both
publications are anorexia nervosa (AN) and bulimia nervosa (BN). The rest are either accounted for under a further
sub-grouping or as eating disorder not otherwise specified (EDNOS). The DSM-V now recognises binge eating as a
category of its own.
If we look at Figure 2 from Fairburn and Harrison 2003, eating disorders are divided into three diagnostic categories;
anorexia nervosa, bulimia nervosa and the atypical eating disorders. They explain that many of the disorders have
many common features and that individuals frequently move between them. This is represented by the arrows on the
diagram. So by using this adaptive perspective it should be easier to understand the unspecified disorders.
• AN - characterized by deliberate weight loss, induced and sustained by the patient.
• BN - a syndrome characterized by repeated bouts of overeating and an excessive preoccupation with the control of
body weight, leading to a pattern of overeating followed by vomiting or use of purgatives
• Binge eating - recurring episodes of eating significantly more food in a short period of time than most people would
eat under similar circumstances, with episodes marked by feelings of lack of control
• Atypical disorder / EDNOS - Disorders that fulfil some of the features of AN/BN and binge eating but not all of them.
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