This is second first of three articles in the Westmeath Topic on anorexia nervosa, better known simply as anorexia.
Differences between anorexia and bulimia
People with anorexia are usually underweight while people with bulimia can often have a normal weight. Anorexia often starts earlier than bulimia. Anorexia can start early to mid-teens while bulimia may start in late teens or early twenties. People with bulimia are more likely to seek help than those with anorexia. Anorexia is associated with anxiety, obsessive compulsive disorder and depression while bulimia is associated with depression, self-harm and substance misuse. More people recover from bulimia than anorexia. Bulimia is five times more common than anorexia; bulimia affects approximately 1% of the population and bulimia is 30 times more common in women than men.
The level of physical risk should be assessed at diagnosis. However there is no exact guidance available for safe cut off weight or body mass index. Studies show death is unusual where low weight is maintained by starvation alone. Death is more likely if the patient’s weight fluctuates rapidly rather than being stable, even if the body mass index is consistently less than 12. Risk is also increased if the patient frequently purges or misuses substances to lose weight. Compulsory treatment for anorexia nervosa is clearly indicated by mental health legislation in acute emergencies where the patient is unable to accept treatment and immediate danger of death or irreversible deterioration is close. In most countries this means detention in hospital. Legal responsibility is not clear when there is an immediate danger of death or irreversible physical damage has occurred. Longer detention orders may be invoked to continue compulsory re-feeding to a healthier weight.
Tips for family members
Recovery takes years rather than weeks or months. Psychological treatment is core to treatment as patients must be convinced that they need to attain a normal weight. Progress should be monitored by weighing; monitoring needs to be managed skilfully so it does not become a battleground. Substance misuse (including alcohol, deliberate overdoses, use of laxatives or misuse of prescribed insulin) greatly increases risk. Weight fluctuations and binge-purge methods rather than pure starvation alone increases risk. Depression, anxiety, and family arguments are usually caused by the disorder (rather than these factors causing the eating disorder); therefore the eating disorder must be treated before tackling other issues. Medication has little benefit in anorexia and the risk of dangerous side effects is higher in malnourished patients (Medication has more success in helping bulimia). Involving the family in treatment and care encourages calm firmness and assertive care. Family involvement increases the chances of recovery.
Structured individual treatments are usually offered as a weekly one hour session with a therapist trained in the management of eating disorders and in the therapy model used. Therapies available include:
Cognitive analytic therapy
This psychotherapy uses letters and diagrams to examine habitual patterns of behaviour around other people and to experiment with more flexible responses.
Cognitive behaviour therapy (CBT)
A form of therapy that emphasises the important role of thinking in how we feel and what we do. CBT challenges the automatic thoughts and assumptions behind behaviour in anorexia.
A talking therapy that focuses on relationship based issues and aims to provide new techniques in dealing with distress.
Motivational enhancement therapy
This psychotherapy uses interviewing techniques derived from work with substance misuse to reframe “resistance” to change as “ambivalence” about change, and to nurture and amplify healthy impulses.
Dynamically informed therapies
These therapies will only provide weight gain if the patient can be convinced of the risk of irreversible physical damage or death and acknowledges that certain boundaries (for example, that they must be weighed weekly, examined regularly by a doctor, and admitted to hospital if weight continues downwards) are observed. Therapies involved include talking, art, music, and movement.
Group therapy is not recognised as an effective therapy type for anorexia
Bodywhys is a national voluntary organisation supporting people affected by eating disorders. They aim to ensure support, awareness and understanding of eating disorders amongst the wider community as well as advocating for the rights and healthcare needs of people affected by eating disorders including the families of those affected. They provide support and education through volunteers as well as providing support and advice through their helpline as well as online support through their website (www.bodywhys.ie). For more help and information, you can lo-call Bodywhys at 1890 200 444 or e-mail firstname.lastname@example.org.
References for this article are available on request. More comprehensive and detailed advice and information on anorexia and bulimia is available in Whelehans pharmacy; ask our staff for details. Also detailed information on anorexia and bulimia is available at www.whelehans.ie.
If you want more information or support (for yourself, a loved one or a friend living with the condit Iion), log on to www.bodywhys.ie; their LoCall helpline is 1890 200 444 or e-mail email@example.com.
Disclaimer: Information given is general; please ensure you consult with your healthcare professional before making any changes recommended