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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