Eating problems are characterised by an excessive concern with the control of body weight and shape, along with an inadequate and unhealthy pattern of eating that significantly impacts physical health or psychosocial functioning.
How Common are eating problems?
Anorexia nervosa and bulimia nervosa are most common among female adolescents. The primary symptom of anorexia is a pattern of restricting food intake and starvation whereas the primary symptom of bulimia is eating large quantities of food and then attempting to get rid of this food via a purge, typically vomiting.
Approximately 1-2% of the adolescent population suffering from eating disorders. Anorexia is less common than bulimia in teenage girls occurring in about 0.5% whereas bulimia occurs in about 1%. The female to male ratio for anorexia and bulimia is about 9:1 in adolescent and 4:1 in pre-adolescents. The peak age of onset for anorexia and bulimia is mid to late adolescence.
Features of eating problems
Perception
- Distorted body image where the young person perceptive their body, or parts of their body to be a larger than they are
Thought
- Pre-occupation with food
- In bulimia a belief in lack of control over binging
- Conflict about becoming more mature and independent vs a which to escape parental control and a lack of privacy
- Perfectionism
- Low self-esteem and low self-efficacy (confidence in performing tasks)
Emotion
- Intense fear of being fat
- Depressed mood
Behaviour
- In anorexia, restricted food intake
- In bulimia, binging
- In bulimia, vomiting, using laxative and excessive exercise to prevent weight gain
- In bulimia, self-harm or substance abuse
Interpersonal adjustment
- Poor school performance
- Withdrawal from peer relationships
- Deterioration in family relationships
Assessment
Assessment should being with a medical investigation by a trained medical professional. It is only after this medical investigation has been conducted that appropriate psychological intervention can occur as the medical professional would have determined that either a psychiatric admission or a medical admission to hospital was not required.
Treatment
In young people under the age of 19 years, the gold standard treatment is the Maudsley Method. This treatment has 3 stages:
- Engagement and re-feeding
- Negotiating a new pattern of family relationships
- Addressing issues and the cessation of therapy
In young adults, that is, those aged 19 years and over, the gold standard treatment is Cognitive Behaviour Therapy for Eating problems (CBT-E). Conducted over ten to twenty sessions this therapy aims to disrupt the unhelpful beliefs that are triggering and maintaining the problematic eating behaviours.