Eating disorders, anxiety and depression...lose weight. • Binge eating followed by vomiting,...
Transcript of Eating disorders, anxiety and depression...lose weight. • Binge eating followed by vomiting,...
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Eating disorders, anxiety and depression
Having an eating disorder is neither a lifestyle choice, a ‘diet gone wrong’, nor an attempt to get attention. A person with an eating disorder has a mental health condition. Eating disorders are serious, potentially fatal conditions, and most people with eating disorders need psychological treatment and/or physical health treatment (e.g. nutritional advice) to promote recovery.
Anxietyanddepressionarecommoninpeoplewitheatingdisorders.Thegoodnewsisthatthereareeffectivetreatmentsbothforeatingdisordersandforanxietyanddepression.
Thisfactsheetlooksatthelinksbetweeneatingdisordersandothermentalhealthconditions,suchasanxietyanddepression.Italsolooksatwheretogethelp,treatmentoptionsandwhatfamilyandfriendscandotosupportpeoplewitheatingdisorders.
What are eating disorders?Eatingdisordersinvolveanunhealthypreoccupationwitheating,exerciseandbodyweight/shape.Distortedthoughtsandemotionsaboutbodyimageandself-worthcanleadtomarkedchangesineatingandexercisebehaviours–thesemayincludeexcessivedieting,fasting,overexercising,usingmedications(e.g.slimmingpills,diuretics,laxatives),vomitingorbingeeating.Anunhealthyrelationshipwithfoodisoftenanattempttodealwith
emotionalissuessuchasnegativefeelingsandlowself-esteem.
Eatingdisordersarecommonandincreasinglyprevalent.InAustralia,oneinfourpeopleknowssomeonewhohasexperiencedaneatingdisorder.Abouttwotothreeinevery100Australianfemaleshasanorexiaorbulimianervosa,andaroundfourin100Australianshavesymptomsofbingeeatingdisorder.1Itisnotuncommonforapersontoprogressfromoneeatingdisordertoanother.
Eatingdisorderscanaffectpeoplefromanyagegroup,genderorsocioeconomicandculturalbackground.
Features of eating disorders
Anorexia nervosa
• Distortedbodyimageandobsessivefearofgainingweight.
• Extremelylimitedfoodintakeand/orincreasedlevelsofexercise.
• Canleadtoadangerouslylowbodyweight,malnutritionandstarvation.
Bulimia nervosa
• Oftenstartswithdietingtoloseweight.
• Bingeeatingfollowedbyvomiting,fasting,overexercising,orusinglaxatives/diureticsasameansofpurging.
• Thebinge/purge/exercisecyclecanbecomeincreasinglycompulsiveanduncontrollableovertime.
Binge eating disorder
• Eatingexcessiveamountsoffood,oftenwhennothungry,asadistractionfromotherproblems.
• Nopurging,butfeelingsofintenseguilt,shameandself-hatredafterbinges.
• Mayinvolvesporadicfastsandrepetitivediets.
Other Specified Feeding and Eating Disorders (OSFED)
OSFEDisatermusedwhenapersonshowssignsofdisorderedeatingbutdoesnotmeetallthecriteriaforaspecificeatingdisorder.Forexample,apersonmayshowallofthepsychologicalsignsofanorexiabutnotyetbeconsideredunderweightfortheirheight.Thisdoesnotmeanthatthepersonhasalessseriouseatingdisorder;alldisordersinthiscategoryareseriousmentalhealthconditionsthatcausesignificantdistress.
Whilethegoalofdiagnosisistoaccuratelydescribesymptomsandseektherighttreatmentforthem,alargenumberofpeoplehaveothersignificanteatingconcernsanddistortedbodyimagewhicharenotcoveredbythesecategories.
Warning signs of an eating disorderIfyouareawareofsomeonedisplayingsomeofthefollowingwarningsigns,seekprofessionalhelp.
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Behavioural signs
• dietingorovereatingexcessively
• eatingveryquicklyorveryslowly
• eatingonlycertaintypesandamountsoffood
• avoidingsocialsituationsthatinvolvefood
• ‘playing’withfoodratherthaneatingit
• goingtothebathroomstraightaftermeals
• wearingloose-fittingclothestohideweightloss
• preparingandcookingmealsforothers,butnotactuallyeating
• engaginginrepetitiveorobsessivebehavioursrelatingtobodyshapeandweight(e.g.weighing)
• exercisingexcessively,feelingcompelledtoperformacertainnumberofrepetitionsofexercisesorexperiencingdistressifunabletoexercise.
Physical signs
• weightlossorweightfluctuations
• sensitivitytothecoldorfeelingcoldmostofthetime,eveninwarmtemperatures
• changesinorlossofmenstrualpatterns
• fainting
• swellingaroundthecheeksorjaw,callusesonknuckles,ordamagetoteethduetovomiting.
Emotional or psychological symptoms
• thinkingandtalkingalotaboutbodyimage,bodyweightandfood
• expressingextremedissatisfactionwithbodyorhavingadistortedbodyimage
• becomingirritableorwithdrawingfromfamilyandfriends
• beingsensitivetocommentsaboutfood,exercise,weightorbodyshape
• feelinganxiousordepressed
• havingdifficultyconcentrating
• havingproblemswithrelationships
• havingsuicidalthoughtsorbehaviour.
Eatingdisorderscanresultinawiderangeofphysicalhealthproblems,includingseveremalnutrition,orbrain,heartorkidneyproblems,whichmayleadtolossofconsciousnessordeath.Peoplewithuntreatedeatingdisorderscandieasaresultoftheseillnesses.
What is anxiety? Anxietyismorethanjustfeelingstressedorworried.Anxiousfeelingsareanormalreactiontoasituationwhereapersonfeelsunderpressureandusuallygoawayoncethestressfulsituationhaspassed,orthe‘stressor’isremoved.
However,forsomepeopletheseanxiousfeelingshappenfornoapparentreasonorcontinueafterthestressfuleventhaspassed.Forapersonexperiencinganxiety,anxiousfeelingscannotbebroughtundercontroleasily.Anxietycanbeaseriousconditionthatmakesithardforapersontocopewithdailylife.Therearemanytypesofanxietyandmanypeoplewithanxietyexperiencesymptomsofmorethanonetype.
Livingwithaneatingdisorderisoneofmanythings–suchasafamilyhistoryofmentalhealthconditions,stressfullifeeventsandpersonalityfactors–thatmaytriggeranxiety.
Anxietyiscommonandthesoonerapersongetshelp,thesoonertheycanrecover.
Signs of anxietyThesymptomsofanxietycanoftendevelopgraduallyovertime.Giventhatweallexperiencesomeanxiousfeelings,itcanbehardtoknowhowmuchistoomuch.Inordertobediagnosedwithananxietycondition,itmusthaveadisablingimpactontheperson’slife.Therearemanytypesofanxiety,andtherearearangeofsymptomsforeach.
Anxietycanbeexpressedindifferentwayssuchasuncontrollableworry,intensefear(phobiasorpanicattacks),upsettingdreamsorflashbacksofatraumaticevent.
Somecommonsymptomsofanxietyinclude:
• hotandcoldflushes
• racingheart
• tighteningofthechest
• snowballingworries
• obsessivethinkingandcompulsivebehaviour.
Thereareeffectivetreatmentsavailableforanxiety.FormoreinformationonanxietyandtreatmentsseethebeyondblueUnderstanding anxietyfactsheetorvisitwww.beyondblue.org.au/anxiety
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What is depression?Whileweallfeelsad,moodyorlowfromtimetotime,somepeopleexperiencethesefeelingsintensely,forlongperiodsoftime(weeks,monthsorevenyears)andsometimeswithoutanyapparentreason.Depressionismorethanjustalowmood–it’saseriousconditionthathasanimpactonbothphysicalandmentalhealth.
Depressionaffectshowapersonfeelsaboutthemselves.Apersonmayloseinterestinwork,hobbiesanddoingthingsheorshenormallyenjoys.Somepeoplemaylackenergy,havedifficultysleepingorsleepmorethanusual,whilesomepeoplefeelanxiousorirritableandfindithardtoconcentrate.
Thegoodnewsisthatjustlikeaphysicalcondition,depressionistreatableandeffectivetreatmentsareavailable.
Signs of depressionApersonmaybedepressedifheorshehasfeltsad,downormiserablemostofthetimefor more than two weeksand/orhaslostinterestorpleasureinusualactivities,andhasalsoexperiencedsomeofthesignsandsymptomsonthelistbelow.
It’simportanttonotethateveryoneexperiencessomeofthesesymptomsfromtimetotimeanditmaynotnecessarilymeanapersonisdepressed.Equally,noteverypersonwhoisexperiencingdepressionwillhaveallofthesesymptoms.Thesymptomswillnotprovideadiagnosis–forthatyouneedtoseeahealthprofessional–buttheycanbeusedasaguide.
Somecommonsymptomsofdepressioninclude:
• notgoingoutanymore,lossofinterestinenjoyableactivities
• withdrawingfromclosefamilyandfriends
• beingunabletoconcentrateandnotgettingthingsdoneatworkorschool
• feelingoverwhelmed,indecisiveandlackinginconfidence
• increasedalcoholanddruguse
• lossorchangeofappetiteandsignificantweightlossorgain
• troublegettingtosleep,stayingasleepandbeingtiredduringtheday
• feelingworthless,helplessandguilty
• increasedirritability,frustrationandmoodiness
• feelingunhappy,sadormiserablemostofthetime
• thoughtssuchas,“I’mafailure”,“Life’snotworthliving”,“Peoplewouldbebetteroffwithoutme”.
Aswithanxiety,thereareeffectivetreatmentsavailablefordepression.Formoreinformationondepressionandtreatmentsseebeyondblue’s Anxiety and depression: An information bookletorvisitwww.beyondblue.org.au/depression
What are the links between eating disorders, anxiety and depression?Researchindicatesthereisalinkbetweenanxiety,depressionandeatingdisorders.Eatingdisordersarethoughttoaffectabout9percentofthepopulation2,andalmost3millionAustraliansarelivingwithdepressionoranxiety.3Oneinfivewomenandoneineightmenwillexperiencedepressionatsometimeintheirlife.Onaverage,oneinfourpeoplewillexperienceanxiety.3Peoplewitheatingdisordersaretwiceaslikelytoexperienceanxietyanddepressionwhencomparedtopeopleinthewidercommunity.Onestudyfoundthatcloseto50percentofadolescentswitheatingdisordershadhighlevelsofanxietyanddepression,especiallythosewithbulimia.4
However,itisunclearwhetherdepressionisariskfactorforaneatingdisorder,oroccursasaresultofaneatingdisorder.Depressioncanmakepeoplemorelikelytofeelnegativelyabouttheirbodiesandthemselves–thismayputthematriskofdevelopinganeatingdisorder.Eatingdisordersmayalsomakepeoplemoreatriskofdevelopingdepression,particularlyiftheyexperiencerapidweightlossorstarvation.
Researchhasdemonstratedthatpeoplewithanorexianervosatendtohavechildhoodandpersonalitycharacteristicssuchasobsessionsandperfectionism,suggestingthattheyhaveanunderlyinganxioustraitthatprecedestheeatingdisorder.
Theconditionsalsosharemanyriskfactors:
• biologicalfactors
• geneticfactorse.g.afamilyhistoryofmentalhealthproblems
• socialfactorse.g.mediaemphasisona‘thinideal’ofbeauty
• psychologicalfactorse.g.lowself-esteem,ineffectivecopingstrategiesandpoorrelationships.
Managinganxietyanddepressioncangreatlyimprovepeople’swellbeingandqualityoflifeaswellastheireatingdisorderandtheirattitudetowardsit.Peoplewithanxietyand/ordepressioncanfinditdifficulttotakethefirststepinseekinghelp.Theymayneedthesupportoffamily,friendsand/orahealthprofessional.
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What are the treatments for eating disorders, anxiety and depression?Thereisnooneprovenwaythatpeoplerecoverfromaneatingdisorder,anxietyordepressionandit’sdifferentforeverybody.However,thereisarangeofeffectivetreatmentsandhealthprofessionalswhocanhelppeopleontheroadtorecovery.Therearealsomanythingsthatpeoplewithanxiety,depressionandaneatingdisordercandotohelpthemselvestorecoverandstaywell.Theimportantthingisfindingtherighttreatmentandtherighthealthprofessionalthatworksforyou.
Differenttypesofanxietyordepressionrequiredifferenttypesoftreatment.Thismayincludephysicalexerciseforpreventingandtreatingmildanxietyanddepression,throughtopsychologicalandmedicaltreatmentformoresevereepisodes.Thetreatmentforanxietyanddepressioninsomeonewithaneatingdisorderinvolvesacoordinatedapproachthatmonitorsandtreatsthesymptomsofanxiety,depressionandtheeatingdisorder.
Professionaltreatmentforeatingdisordersinvolvesmanagingphysicalhealth(includingnutritionaladvice)andpromotingmentalhealth.Inaddition,medication,supportgroupsandsomealternativetherapiesmaybehelpful.
Physical health managementPhysicalhealthmanagementaimstomonitor,restoreandmaintainaperson’snutritionalbalance(avoidingstarvingorovereating)andalsotreatthelonger-termphysicalproblemsthatresultfromunhealthyeatingpatterns.Thetreatmentusuallyinvolvesseeingadoctorand/oradietitian,developingaplanforhealthyeatingandhavingregularcheck-ups.
Somepeopleneedmoreintenseandstructuredcareinhospital.Beingadmittedtohospitalfortreatmentofweightlossoccursonlyiftheindividualisverymalnourished.
Psychological treatmentsPsychologicaltreatmentforeatingdisordersbeginstoaddresseatingpatternsandrelatedthoughts,feelingsandbehavioursbyhelpingpeoplefindnewwaysofthinkingaboutandhandlingissuessuchasself-esteem,control,perfectionismandfamilyproblems.Thiscanincludeindividualandfamilytherapyandpsycho-education(informationonpsychologicalissues).Psychologicaltherapiesarealsousedtotreatanxietyanddepression.
• Cognitive behaviour therapy (CBT)isaneffectivetreatmentforpeoplewithanxietyanddepression.Itteachespeopletoevaluatetheirthinkingaboutcommondifficulties,helpingthemtochangetheirthoughtpatternsandthewaytheyreacttocertainsituations.
• Interpersonal therapy (IPT)isalsoeffectivefortreatingdepressionandsometypesofanxiety.Ithelpspeoplefindnewwaystogetalongwithothersandtoresolvelosses,changesandconflictinrelationships.
Psychologicaltherapiesmaynotonlyhelpwithrecovery,butcanalsohelppreventarecurrenceofanxietyordepression.Thesetherapieshelpbuildskillsincopingwithstressfullifecircumstancesandcanbeprovidedbyapsychologist,psychiatristorothertrainedhealthprofessional.
MedicationAntidepressantmedication,alongsidepsychologicaltherapies,canalsoplayaroleinthetreatmentofmoderatetoseveredepressionandsomeanxietyconditions.
Makingadecisionaboutwhichantidepressantisbestforapersoncanbecomplex.Thedecisionwillbemadeinconsultationwithadoctor,aftercarefulassessmentandconsideration.Thedoctorshoulddiscussdifferencesineffectsandpossibleside-effectsofmedications.Stoppingmedicationshouldonlybedonegradually,withadoctor’srecommendationandundersupervision.
Adoctorortreatinghealthprofessionalwilltakeintoaccountseveralfactorswhensuggestingthemostsuitabletreatment.Regularcontactwithandongoingassessmentbyadoctortocheckthattreatmentsareworkingeffectivelyisanimportantpartofbecomingandstayingwell.Mostpeopletakingmedicationwillalsobenefitfrompsychologicaltherapies,whichwillreducethelikelihoodofrelapseafterthepersonhasstoppedtakingthemedication.
Who can assist?A General Practitioner (GP)isagoodfirststeptodiscussyourconcerns.AgoodGPcan:
• makeadiagnosis
• checkforanyphysicalhealthproblemormedicationthatmaybecontributingtothecondition
• discussavailabletreatments
• ifappropriate,workwiththepersontodrawupaMentalHealthTreatmentPlansoheorshecangetaMedicarerebateforpsychologicaltreatment
• providebriefcounsellingor,insomecases,psychologicaltherapies
• prescribemedication
• referapersontoamentalhealthspecialistsuchasapsychologist,socialworkerorpsychiatrist.
Makesurethatthedoctormanagingyoureatingdisorderknowsifyouhaveanxietyordepression.ItisrecommendedthatpeopleconsulttheirregularGPoranotherGPinthesameclinic,asmedicalinformationissharedwithinapractice.
Psychologistsarehealthprofessionalswhoprovidepsychologicaltherapiessuchascognitivebehaviourtherapy(CBT)andinterpersonaltherapy(IPT).PsychologistsarenotdoctorsandcannotprescribemedicationinAustralia.
Psychiatristsaredoctorswhospecialiseinmentalhealth.Theycanmakemedicalandpsychiatricassessments,conductmedicaltests,providetherapyandprescribemedication.PsychiatristsoftenusepsychologicaltreatmentssuchasCBT,IPTand/ormedication.Iftheconditionrequireshospitaladmission,apsychiatristwillbeinchargeoftheperson’streatment.
Mental health nursesarespeciallytrainedtocareforpeoplewithmentalhealthconditions.TheyworkwithpsychiatristsandGPstoreviewaperson’smentalhealth,monitormedicationandprovideinformationaboutmentalhealthconditionsandtreatment.Somehavetraininginpsychologicaltherapies.
Social workers in mental healtharespeciallytrainedtoworkwithpeoplewhoareexperiencingdifficultiesinlife.Socialworkerscanhelppeoplefindwaystomanagemoreeffectivelysomeofthesituationsthattriggertheseconditionssuchasfamilyissues,financialproblems,workstressandlivingarrangements.Mentalhealthsocialworkerscanalsoprovidefocusedpsychologicalself-helpstrategies.
Occupational therapists in mental healthhelppeoplewho,becauseofamentalhealthcondition,havedifficultyparticipatinginnormal,everydayactivities.Mentalhealthoccupationaltherapistsalsoprovidefocusedpsychologicalself-helpstrategies.
Aboriginal and Torres Strait Islander mental health workersunderstandthementalhealthissuesofIndigenouspeopleandwhatisneededtoprovideculturallysafeandaccessibleservices.Somemayhaveundertakentraininginmentalhealthandpsychologicaltherapies.SupportprovidedbyAboriginalandTorresStraitIslandermentalhealthworkersmightinclude,butisnotlimitedto,casemanagement,screening,assessment,referrals,transporttoandattendanceatspecialistappointments,education,improvingaccesstomainstreamservices,advocacy,counselling,supportforfamilyandacutedistressresponse.
Thecostoftreatmentfromamentalhealthprofessionalvaries.However,inthesamewaythatpeoplecangetaMedicarerebatewhentheyseeadoctor,theycanalsogetpartoralloftheconsultationfeesubsidisedwhentheyseeamentalhealthprofessionalfortreatmentofanxietyordepression.Seebeyondblue’sGetting help – How much does it cost? factsheetat www.beyondblue.org.au/resources
Tofindamentalhealthpractitionerinyourarea,visitwww.beyondblue.org.au/find-a-professionalorcallthebeyondblueSupportServiceon1300 22 4636.
Helpful strategies and tips• Learnaboutanxiety,depression
andeatingdisordersandhowtheseconditionsinteract.
• Developamentalhealthplanwithyourdoctor.
• Visityourdoctorregularlytoreviewyoureatingdisorderandmentalhealthmanagement.
• Talktoyourdoctoraboutpossiblebarrierstotreatment,suchascost,organisationorplanning,aswellaswhattodoifyourconditionworsens.
• Gethelp,supportandencouragementfromfamilyandfriendsandhavethemhelpyoutofollowyourmentalhealthplan.
• Learnrelaxationtechniques.
• Getinvolvedinsocialactivities.
• Stayactiveandexerciseunderthesupervisionofadoctor.
• Eathealthilyandincludeawidevarietyofnutritiousfoods.
• Limityouruseofalcohol,tobaccoandcaffeine.
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Where to find more information
beyondbluewww.beyondblue.org.auLearnmoreaboutanxietyanddepression,ortalkitthroughwithoursupportservice.
1300 22 4636 Email or chat to us online at www.beyondblue.org.au/getsupport
mindhealthconnectwww.mindhealthconnect.org.au Accesstotrusted,relevantmentalhealthcareservices,onlineprogramsandresources.
The Butterfly Foundationwww.thebutterflyfoundation.org.au 1800 33 4673Education,supportandservicesforpeoplewitheatingdisordersandtheirfamilies.
National Eating Disorder Collaborationwww.nedc.com.auEvidence-basedinformationoneatingdisorders;theirprevention,identificationandtreatment.
Eating Disorders Foundation of Victoria www.eatingdisorders.org.au 1300 550 236SupportandinformationforpeoplewitheatingdisordersandtheirfamiliesinVictoria.
Eating Disorders Foundation of ACT (EDFACT)(02) 6166 1679 info@edfact.org.auInformationandreferralforpeoplewitheatingdisordersandtheirfamiliesintheACT.
Eating Disorders Association Inc (QLD)www.eda.org.au (07) 3394 3661SupportandreferralforpeoplewitheatingdisordersandtheirfamiliesinQLD.
Anxiety, Compulsive and Eating Disorders Association (ACEDA) SAwww.aceda.org.au (08) 8237 4011Informationandsupportforpeoplewitheatingdisorders,theirfriendsandfamiliesinSA.
Bridges Association Inc (WA)www.bridges.net.auInformationandsupportforallpeopleaffectedbyeatingdisordersinWA.
The Centre for Eating and Dieting Disorders (NSW)www.cedd.org.auInformationforpeoplewitheatingdisorders,theirfamilyandfriendsinNSW.
facebook.com/beyondblue twitter.com/beyondblue
Donate online www.beyondblue.org.au/donations
beyondbluewouldliketoacknowledgetheassistanceoftheNationalEatingDisorderCollaborationintheproductionofthisfactsheet.
References1 VictorianCentreofExcellenceinEating
Disorders&EatingDisordersFoundationofVictoria(2004).An Eating Disorders Resource for Schools. A Manual to Promote Early Intervention and Prevention of Eating Disorders in Schools.Melbourne:beyondblue.
2 WeltzinTE,WeisenselN,FranczykD,BurnettK,KlitzC,andBeanP.(2005).Eatingdisordersinmen:Update.Journal of Men’s Health & Gender,2(2),186-193.
3 AustralianBureauofStatistics(2008).National Survey of Mental Health and Wellbeing: Summary of Results 2007(4326.0).Canberra:ABS.
4 PattonGC,CoffeyC&SawyerSM(2003).Theoutcomeofadolescenteatingdisorders:findingsfromtheVictorianAdolescentHealthCohortStudy.European Child & Adolescent Psychiatry12:I/25-9.
How family and friends can help • Whenapersonhasaneating
disorderandanxietyordepression,itcanaffectfamilyandfriends.It’simportantforfamilyandfriendstolookaftertheirownhealthaswellaslookingafterthepersonwhohasaneatingdisorder.
• Learnabouteatingdisorders,anxietyanddepressionandtheirsymptomstohelpyourecognisewarningsigns.
• Encouragethepersontogotothedoctoriftheireatingdisorder,anxietyordepressiongetsworse.Makesureyouseekhelpifyouthinkyouneedit,too.
• Supportthepersonbyhelpingthemtofollowtheirmentalhealthplans.Gentlyremindthepersontotaketheiranxietyanddepressionmedicationregularlyandtoattendalltheirmedicalappointments.
• Encouragethepersontodothingsthattheywouldnormallyenjoy.
• Lookafteryourownhealthbyeatingwell,exercisingregularly,gettingenoughsleepanddoingthingsthatyouenjoy,too.