Summer stress - identifying an eating disorder
The summer can heavily influence the way a person feels about their body. Hotter weather and more ‘revealing’ clothing can make some people feel more uncomfortable in their own skin. There may be the added pressure to fit into summer clothes or to gain the ’perfect beach body.’
But what can often be disguised as a typical summer diet can sometimes be more serious. With 60% of teenagers regularly dieting to lose weight for their holiday and over 50% exercising in order to change their body shape for summer clothing, this season can be an important time for spotting the signs and symptoms of an eating disorder. Other summer influencers can include:
- Pressures of family life/spending more time as a family on holiday
- Eating together as a family more often during the school holidays
- Sudden lack of structure in the day causing stress to the individual
- Pressures of exam results causing further anxiety
Spotting the signs and symptoms
It can be hard for family and friends to spot the difference between ‘normal dieting’ and abnormal eating behaviours. Ultimately the person's weight and the severity of weight loss may be the only final determinant that allows loved ones to know when to worry. However, for a patient coming into a GP practice, there are a range of symptoms which could indicate an eating disorder:
- Poor memory and concentration
- Feeling sad and low in mood
- Irritability and quick changes in mood
- Thinning hair that breaks easily and has become dull
- Fainting and dizzy spells
- Slowed heart rate and low blood pressure
- Weak muscles/thinning of the bones (osteoporosis) resulting in an increase in injuries
- Constipation/painful defecation and a bloated abdomen
- Periods stopping
- Dry skin which bruises easily
- Feeling the cold easily/wearing layers in hot weather
Dental erosion or sore gums, a sore throat, dehydration and discoloured fingers are also additional signs of bulimia.
Emotional signs and symptoms include the individual being quiet, shy, being afraid to take risks, being over controlling and displaying a lack of expression or emotion. They may also struggle to display anger appropriately, to communicate their needs well, and are often perfectionists. Young people with eating disorders are often academically bright and despite creating strict routines and rituals surrounding food and exercise, they will continue to perform at a high academic level until the illness is well-established.
People suffering from an eating disorder may struggle to engage with services that can help them, or they may be afraid to ask for help. Therefore it is important to know how best to approach an individual you suspect may need further care:
Questions a GP, parent or teacher could ask to initiate a conversation
- Do you always think about food?
- Do you worry about how your body looks and how much you are eating?
- How do you feel after you eat?
- Do you find yourself counting calories?
- Do you ever exercise to compensate for what you have eaten?
- Do you have to exercise before you will allow yourself to eat?
- How many times a week do you exercise?
- Do you think of some foods as good or bad?
- Are there things that you won't eat?
- Tell me about the food you eat in a normal day?
- Do you ever make yourself sick or use medication after eating in an attempt to control your weight?
Advice a GP can offer family and friends
If a family member is concerned about a young person, they may wish to sit with them at mealtimes and encourage and help them. In this way they can observe that they are eating their meal but also offer emotional support and reassurance. The use of distraction can also be helpful at these times.
If there are concerns about purging behaviour then it can be useful to sit and watch a DVD together after a meal, for example, this can help to prevent the use of compensatory behaviours such as self-induced vomiting.
If family members or teachers are concerned a young person may have an eating disorder then a frank and open discussion can be helpful. Offering help in a non-confrontational manner offering a variety of options can help a young person feel less alone with the condition. Adopting a non-judgemental stance is essential.
Treatment for eating disorders
Firstly, a GP may want to take a blood test to check for any physical signs of an eating disorder, such as anaemia – the effects of poor nutrition on the body. School nurses can also check and monitor height and weight of pupils under their care, to calculate body mass index (BMI).
Psychological work and talking therapies are extremely effective when treating an eating disorder. This can include cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT). This work involves helping with self-esteem and focuses on body image.
Family therapy is usually a large part of treatment to assist family and friends in understanding the disorder. Family and friends can also play an active role in helping them change any behaviours that may be maintaining the eating disorder.
Such therapy can be delivered on an outpatient basis however sometimes intensive day care or inpatient treatment is required. This would involve treatment from a trained dietitian to devise a nutritionally complete and acceptable menu plan for the individual.
Group therapy within hospital inpatient services can provide support with body image disturbance, social skills and emotion regulation. In addition groups provide a useful source of support for people; it shows them that they are not alone in how they are feeling.
Groups can include psycho-education groups, cooking sessions, meal prep with family and friends, and therapy to address cognitive distortions.
Medication is sometimes required to treat an eating disorder. Antidepressants can prove useful alongside other therapy, if co-existing conditions such as depression are evident.