Just as diseases inside our bodies announce themselves with symptoms such as fever, cough and pain, diseases of the mind can manifest in various ways. Eating disorders are one such group of illnesses of the mind and have the ability to greatly affect a person’s physical health in the long-term. Just as we need help curing diseases of the body with medication and bed rest, etc. our minds sometime need help to regain a healthy status. In today’s issue of Health Capsule we have consulted Dr. Udena Attygalle, Consultant child and adolescent psychiatrist, Colombo South Teaching Hospital, Kalubowila, to obtain information regarding eating disorders. Below are excerpts of an interview conducted with Dr. Attygalle.
About Eating disorders
Rather than labelling and categorising eating disorders into groups, they can better be described as a spectrum of disorders. Some of the disorders that belong to the spectrum are anorexia nervosa, bulimia nervosa and binge eating disorder. A patient can be anywhere in this spectrum, with varying severity of the illness, sometimes suffering from an overlapping of several eating disorders, rather than a single disease.
Main characteristic feature of patients with anorexia nervosa is that they starve themselves, usually because they have a very negative image of their bodies. They still think of themselves as ‘fat’ even when they are severely emaciated due to prolonged starvation. In addition to this, they have an intense fear of weight gain, making them concerned about every morsel of food that they put into their mouth.
This long term starvation will in turn give rise to many adverse medical consequences. Reduced immunity to diseases, stopping of menstruation in girls; called amenorrhea, and even organ failure can occur as a result of anorexia nervosa going on for a long time. This is one of the most serious psychiatric disorders, because patients suffering from anorexia nervosa suffer considerable mortality due to the complications of the illness.
In this disorder, as opposed to anorexia nervosa, the patients cannot control their meal taking behavior and instead find themselves binge eating on occasion. Following the consumption of these large meals, they feel guilty and resort to compensatory behaviors to lose the additional calories taken into the bodies. These behaviors may range from purging through induced vomiting, use of laxatives or intense exercising.
Since eating disorders are a fairly recent introduction to the field of psychiatry, not much is known about their causative factors. It’s believed that several causes such as genetic predisposition, stress and depression, over and under attention from parents can all play a role.
Eating disorders are usually found in the adolescent age group and are more common among girls when compared to boys. In the past, eating disorders used to be more popular in the western culture, but now are becoming increasingly common in Sri Lankan set up too. One reason for this is believed to be the western society’s view on ‘perfect’ body shape, which in this day and age tends to be more favorable towards ‘thin’, rather than ‘curvy’. These ideas, spread around by various media, taking root in the minds of young girls who are at an impressionable age, may force them to achieve the society’s idea of perfectness rather than focusing on attaining a healthy body.
Presentation and treatment
Patients with eating disorders usually present to the health services with complaints such as severe loss of weight, lethargy, and feeling of intense coldness, and are usually brought in by an adult. In addition, they may have other physical symptoms like calluses in the fingers from inducing vomiting, bad breath and delayed menstrual periods as well.
Since the severity of the condition varies from patient to patient, treatment for eating disorders should be individualized to match each patient’s requirements. Some patients with advanced disease who refuse food even when severely wasted may need hospital admission and even supplying of nutrition to the body artificially. The majority of the patients will be managed in the clinic as out-patients.
Due to the seriousness of the condition, treatment of eating disorders needs participation of various medical specialties. Psychiatrists, medical doctors, nutritionists, occupational therapists are some of the specialties involved. Treatments include therapy and medication focusing on weight gain to reach an adequate weight for the patient’s height, psychotherapy to make the patient understand that he/she is having an illness and what they are doing is harmful to their body, and family therapy, involving the patient as well as the parents.
While a percentage of patients recognize that they are having an eating disorder and work to get healthy on their own by taking adequate nutrition, many with eating disorders refuse to recognize that they have a problem, due to the distorted image that they have of their bodies. Therefore treating a person with eating disorders can be particularly difficult. Around 50% patients with eating disorders who seek treatment will get completely cured, while around 30% will have relapses, going back to previous unhealthy patterns of eating later in life. Around 20% do not get cured at all, despite treatment.
Many patients with eating disorders tend to have other co existing psychiatric disorders such as depression and anxiety disorders as well and are also have an increase risk of committing suicide when compared to their peers.
Responsibility as parents
Eating disorders are treatable and identifying that your child is having an eating disorder is the first step in the path to healing. Being aware of the child’s eating patterns, undue concern about calories in food, and purging behaviors; which may go unnoticed for years at a time, is crucial. Being attentive to the child’s emotional state is also important, especially during their teenage years, which is a time of transformation and emotional turmoil.
With the busy lives that many parents are leading today, the bond between them and the children gets frayed at times. While love for their children motivates parent’s every action, it’s important to let them feel that love, so that children are able to open up to their parents about the issues in their lives.
But, while attention is important, not smothering them with excessive attention is equally important. It is found that children of over attentive and restrictive parents are more likely to develop eating disorders when compared to other children. Therefore, respecting a teenager’s individuality, letting them experience life, while being available when they need your support, will reduce the risk of them developing unhealthy coping mechanisms like eating disorders.
Take home message
Eating disorders are a group of serious, but treatable psychiatric disorders, found increasingly common in today’s society. Early identification is the key to successful treatment in eating disorders. Parents can minimize the risk of their child succumbing to eating disorders through improved bonding with children while giving them freedom to grow. We as a society can contribute to minimise the number of teenagers who succumb to eating disorders through promoting ‘healthy body’, in place of ‘model thin’ body.