Not just a 'teenage issue' - discussing age and eating disorders
Last month saw National Eating Disorders Awareness Week, so we spent some time with David Waller, Eating Disorders Therapist at Life Works, to discuss this complex mental health disorder.
In this article, we focus particularly on age and the misconception that an eating disorder is just a ‘teenage issue’, as well as discussing the signs, symptoms and most appropriate treatment.
Eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder, are complex mental health conditions which can result in sufferers interacting with food in unhealthy ways. This can have a profoundly negative impact on physical and psychological wellbeing, even resulting in death.
What a GP can look out for
Eating disorders don’t discriminate against age and no matter how old you are, the seriousness of the condition does not diminish. We know that eating disorders often develop as a maladaptive way of coping, so any life stage change can be a potential trigger.
Perimenopause – the stage leading up to the menopause in a woman’s life – has been found to be a high-risk period for the development or return of an eating disorder.
This is a time of immense physical and hormonal change and considering the age at which perimenopause occurs, it can clash with other significant changes in a person’s life, such as children growing up and leaving home, marital breakdown, illness or the challenges of looking after ageing parents.
During this daunting stage of someone’s life, what may have just been a mild eating difficulty could then develop into a full-blown eating disorder whilst trying to cope with these burdens. As is the case at any age, the eating disorder can provide a feeling of control in an otherwise unstable environment.
Puberty is also a significant time in a person’s life which involves large hormonal shifts; in a similar way to the menopause, this can also trigger an eating disorder.
Particularly for this age range, research has shown that social media is also currently playing a part in the increase of teenagers with body dissatisfaction, low self-esteem, identity confusion and a need for constant validation, which in turn are all risk factors for developing the condition.
Social media restricts quiet and private time for teenagers and makes developing personally in regards to appearance, friendships and interests, very difficult. The relentless scrutiny that young people are under is unprecedented and we need to understand its impact in the context of treatment strategies.
The key message
During Eating Disorders Awareness Week, many charities echoed the above and their key message was ‘these conditions do not discriminate and they shouldn’t be stigmatised at any age’. Providing support as soon as possible to any patient you are concerned about, whatever the age or gender, is vital to ensure that the specialist treatment available is the most effective for that patient.
Does your patient have an eating disorder?
Eating disorders can be characterised by severely disrupted eating behaviours and a preoccupation with weight, appearance and body shape. Unhealthy eating habits in a person with an eating disorder may include:
- Limiting the amount of food that they consume
- Eating large quantities of food in one sitting
- Developing unhealthy behaviours to influence food and weight e.g. induced vomiting, laxative abuse, excessive exercise
- A combination of the above
It’s also important to recognise that eating disorders can be very secretive conditions and individuals will often go to great lengths to conceal their eating difficulties. The associated feelings of guilt and shame around some of the behaviours that sufferers may engage in, particularly with bulimia nervosa and binge eating disorder, can lead to a desire to keep problems a secret, which makes receiving help and support difficult in the beginning.
Other signs and symptoms to look out for in your practice include:
- Obsessing about food
- The avoidance of socialising
- Too much exercise
- Strict habits or routines
- Dramatic mood swings, low mood or anxiety
You may also notice physical signs, including:
- Tiredness and dizziness
- Feeling cold
- Irregular or absent menstrual cycle for females
It can often be very difficult to identify if someone has developed an eating disorder. Some warning signs to look out for include:
- Dramatic weight loss
- Going to the bathroom a lot, often returning looking ‘flushed’
- Excessive or obsessive exercise
- Development of rules or rituals around food such as cutting food into small pieces or eating very slowly
- Loose or baggy clothes to hide weight loss
What causes an eating disorder?
There is no single known cause for somebody developing an eating disorder and it tends to be a complex mix of predisposing factors (which may include genetics, attachment issues, trauma) and precipitating factors (often the introduction of dieting), followed by various perpetuating factors which maintain the behaviours.
Social media and diet culture, along with factors such as habit, low self-esteem, lack of healthy coping skills, poor body image, lack of assertiveness and the associated development of a strong ‘eating disorder mind-set’ may all play a part.
How to treat an eating disorder
A combination of group work and one-to-one therapy seeks to address the main aims of treatment. This can include:
- Normalisation of eating, body image, human distress and emotions
- Physical recovery, which may include returning to a healthy weight
- Psychological recovery including:
- Understanding the nature of eating disorders
- Develop healthy coping mechanisms and skills
- Relapse prevention
- Emotion regulation and distress tolerance
- Identify and challenge unhealthy cognitive processes
- Reintegration of mind with body, relationships, work and studies, etc.
If you think a patient needs to be referred to specialist therapeutic approaches, it would be useful to discuss the following with them:
- Dance and movement psychotherapy
- Body acceptance groups
- MANTRA treatment for anorexia nervosa
- Cognitive behavioural therapy (CBT)
- Dialectical behaviour therapy (DBT)
- Art-based therapy
- Relapse prevention
- Experiential groups including food shopping and cafe outings
- Family therapy
Priory has a nationwide network of treatment centres that specialise in eating disorders. For details of how Priory can provide you with assistance regarding mental health and wellbeing, please call 0800 840 3219 or click here to submit an enquiry form. For professionals looking to make a referral, please click here.