EATING DISORDERS

NH Explore 7/8/15

Ken Yeow

Overview

•WHAT are they?

•WHY do they happen?

•HOW can people be helped?

WHAT

Main types

• ANOREXIA NERVOSA (AN)

• BULIMIA NERVOSA (BN)

• AN with BN symptoms

• Atypical AN/BN

Core features

• Weight– BMI; trend

• Eating– Under; over

• Behaviours– Vomiting; laxatives; exercise etc.

• Thinking/feeling– Fear; self-evaluation; distortion; preoccupation etc.

• Complications– Acute; chronic (periods, bones etc.)

Estimated frequency

Inc./105 pop./yr

Prev./105 pop.

NINew cases/yr

NIExisting cases

AN 4-10 10-30 68-170 170-510

BN 10-30 50-150 170-510 850-2550

Atypical ‘At least as many’

TOTAL 28-80 120-360 476-1360 2040-6120

WHY

Quote

‘It’s not about food, it’s about feelings’

(and much more...self-esteem, identity, control etc.)

One Model For Understanding

Early experience

Emotional problems

Attempted solution

Solution becomes a problem

It serves a purpose

• What is being AVOIDED?– Negative emotions; frightening change; family

disruption etc.

• What is being GAINED?– Control, safety/security; attention, regard; self-

esteem, value; achievement, specialness; anxiety relief, mood lift etc.

• What is being EXPRESSED?– Anger/frustration, guilt, self-hatred (self-

punishment) etc.

HOW

Principles of helping

1) Engagement/motivation

2)Risk assessment/management

3)Nutritional restoration

4)Psychological therapy

5)Medication sometimes

6)Functional/occupational recovery

7)Support for/from family/friends

1) Engagement/motivation

• Curious

• Compassionate

• Containing

2) Risk assessment/management

• Physical, psychiatric, social

• Point in time and trends

• Multidisciplinary team (including patient and family/friends)

3) Nutritional restoration

• Essential priority

• Individualised approach

• ‘Food as medicine’

4) Psychological therapy

• Symptoms/causes

• Structure, focus, timing

• Supervision, reflection

5) Medication sometimes

• Helpful in BN

• Symptomatic treatment in AN

• For co-occurring psychiatric conditions

6) Functional/occupational recovery

• ‘Getting a life’

• Basic living needs/skills

• Structured, purposeful activity

7) Support for/from family/friends

• Young person vs. adult

• Working together against the illness

• Communication, communication, communication

How you can help

• Mild-moderate BN– ‘Guided self-help’ (‘Overcoming’ books)– Encourage to see GP for physical monitoring and

?medication

• Severe BN and AN– Usually referred, via GP (collaboration,

advocacy)

• General support– Friendship, ‘normality’, distraction, spiritual

help, encourage treatment engagement etc.

From a Christian perspective

• Christians not immune!

• Avoid superficial/overly spiritual answers

• Real answers to deeper questions– Self-esteem, identity, control etc.

We have good news!

• Personal Freedom: How The Gospel Can Be Good For Your Mental Health

(www.amazon.co.uk)

Divine resources

• The Word of God (truth)

• The Spirit of God (power)

• The people of God (community)

Other resources

• See handout