MHM Magazine

Issue 4 | 2022 | MENTAL HEALTH MATTERS | 17 MHM It is likely that there is usually a combination of genetic, physical, social and psychological factors that lead to the development of an eating disorder in most individuals. • Genetic factors: A family history of an eating disorder may be due to genetic or environmental factors. • Social factors: One of the most significant factors appears to be the prevailing social ideal of what constitutes a beautiful or attractive female body. In Western society, a very slim or thin body is considered desirable, and is a figure that many women strive to attain. • Physical factors: Dieting in order to lose weight is ubiquitous prior to the development of anorexia nervosa. Certain sports or activities are associated with an increased risk for the development of an eating disorder (dance, modelling and certain high-performance sports where there is an advantage to being underweight). Medical conditions where there is a focus on food/food choices, such as diabetes, • Psychological factors: The fact that eating disorders commonly develop in young adolescent girls suggests that there may also be issues around identity formation and individuation at a time of life transition. Early life trauma and stressful life events may also be contributing factors to the development of an eating disorder. Clinical features of anorexia nervosa: • Restriction of food intake, leading to significantly low body weight in relation to age, gender, developmental trajectory, and physical health. • Intense fear of gaining weight or of becoming fat • Body image disturbance or persistent lack of recognition of seriousness of low body weight. • There are two subtypes: restricting subtype or binge-eating/purging subtype Clinical features of bulimia nervosa: • Recurrent episodes of binge-eating. A binge is defined as: Eating, in a discrete period, an abnormally large amount of food, usually eaten very quickly, with a feeling of loss of control • Recurrent inappropriate compensatory behaviours in order to prevent weight gain, including self-induced vomiting, misuse of medication, excessive exercising • Body image disturbance • Episodes occur at least once a week over a period of three months. Complications of eating disorders: Anorexia Nervosa: • Amenorrheoea (multiple endocrine abnormalities) • Impact on bone development in female adolescents, leading to osteoporosis, which may be permanent • Atrophy of cardiac muscle. In combination with electrolyte abnormalities, this may lead to cardiac arrythmias and cardiac failure (greatest risk is during rapid refeeding) • Brain atrophy with cognitive impairment that may persist after treatment/recovery Bulimia Nervosa • Electrolyte abnormalities, especially metabolic alkalosis and hypokalemia, leading to cardiac arrhythmias • Dental erosions • Oesophageal tears • Parotid gland enlargement Binge eating disorders • Metabolic syndrome and chronic non-communicable diseases (hypercholesterolemia, hypertension, diabetes) • Sleep apnoea and other sleep disorders • Musculoskeletal conditions due to obesity, with decreased mobility • Bariatric surgery may result in further medical complications Management: Management must be holistic, with attention to physical, psychological, and social/family factors. In adults, the treatment with the strongest evidence base is Cognitive Behavioural Therapy for Eating Disorders (eCBT). This treatment may be provided in an inpatient or an outpatient setting depending on the severity of the condition, as well as the presence of associated physical complications. Individuals who are very underweight, or who have physical complications associated with bulimia nervosa may need admission to specialized treatment facilities. The initial focus of treatment is usually weight- restoration in the case of individuals with anorexia nervosa, and the regulation of eating patterns and assistance with the prevention of compensatory behaviours in those with bulimia nervosa or binge-eating disorder. Along with dietetic intervention, attention is paid to distorted thinking and body image disturbances, as well as helping the individual to develop an understanding of predisposing, precipitating and perpetuating factors. In adolescents with anorexia nervosa, family-based treatment (FBT) has the strongest evidence base. This approach involves the whole family, and parents take responsibility for re-feeding their child. Once weight restoration has been achieved, the focus shifts to assisting the adolescent to take responsibility in an age-appropriate manner and to helping the adolescent to individuate within the family. The role of medication: There is no evidence that medications are helpful in treating the core symptoms of anorexia nervosa. There is some evidence that high doses of fluoxetine (60mg/day) may be helpful in reducing binge-purge cycles. However, the benefits reverse on stopping treatment. The main role of medication is in the appropriate management of comorbid psychiatric disorders such as mood and anxiety disorders, and in the management of associated medical conditions or complications.