Anorexia nervosa has the highest mortality rate of all mental health disorders, but early diagnosis means a better chance of recovery,” says Dr Terence Larkin of the St John of God Eating Disorder Recovery Centre.
“You shouldn’t sit on the problem, hoping the person will grow out of it. If you feel that your child’s attitudes around food have dramatically changed, it’s time to get communication going. Get in touch with organisations like Bodywhys and educate yourself about a way that’s likely to steer your daughter or son towards getting help. It’s about getting them motivated to want recovery.”
The risk factors that make people vulnerable to developing an eating disorder, as stated by Dr Larkin, are listed here (see right). Several of these may be involved when a person develops anorexia nervosa. The age group of 15 to 24 is most often affected.
• Genetic vulnerability: Twin studies have shown this can have an influence. • A history of eating disorders in the family: Family attitudes around eating may have a bearing. • Culture: Western world’s emphasis on the pursuit of perfection leads to a lot of focus on body shape and weight. • Being involved in dance, modelling or gymnastics: Higher incidence of eating disorders because of the focus on body weight. • Serious life event occurring: Around 70% of those who present with anorexia nervosa have had a serious life event occur before or around the time of the onset of the eating disorder. • Transition time: Times of transition can trigger anxiety or insecurity, eg going from secondary school to college. • Early onset of periods: Emotional issue of dealing with puberty ahead of peers. • Family history of obesity: May not want to be overweight like family members or may have been bullied as a younger child about weight. • High achiever/perfectionist personality trait: Key factor. Wants the ideal. Is determined and self-disciplined. Thinks in black and white terms. Despite achievements, the person feels insecure about their own value or worth. • Difficulty tolerating low mood or emotions: Uses food (comfort eating or lack of) to regulate mood – food restricting leads to feeling numbed out emotionally. “The person with anorexia believes that changing their body would make their life happier and more secure,” says Dr Larkin. “In actual fact, the starvation that’s involved in pursuing that, actually makes a person more anxious. Gradually, their life begins to shrink down to being about what they’ve eaten or what their weight is. This eventually pushes out other areas of their life and takes over their mind,” he concludes.
What to do
But how should parents react? Dr Larkin’s advice is don’t get drawn into a battle of wills. He believes this is to be avoided at all costs.
“The natural instinct for a parent when a child doesn’t eat is to become very anxious about it, but being drawn into a battle of wills just backs the young person into a corner where they have to deny what they are doing or they do it in secret.
“While they appear to eat again to please you, they may start using vomiting, over-exercising or taking laxatives to get rid of the food.”
communication
“Feed back to them what you’re noticing – the changes in their behaviour – and your concerns without necessarily trying to get them to eat, because if you enter into that battle it will just polarise the young person.”
Educate yourself
As a parent, educating yourself about the illness is vital.
“No one else, even me who is supposed to be an expert, can make somebody recover from an eating disorder,” says Dr Larkin.
“They have to get to the point where they have come to the conclusion that their life would be better without the eating disorder in their life. Often it’s only 51% of the person that feels like that and 49% wants to hold on to the eating disorder.
“Get onto the Bodywhys website and helpline, talk to people who can understand, then prepare yourself to talk to the teenager or adult child about your concerns.”
Persuade the person
to have a medical check-up
“This reassures the family that the person isn’t at immediate risk of medical complications from the anorexia. It also allows someone from outside the family to begin the process of trying to get the person motivated to seek recovery.”
Start the conversation about the ‘why’
It is important to help the person to look at why they are holding onto the eating disorder.
“They may be reluctant to let the disorder go because they’ve invested a lot of time and effort into it and because the only thing they may have in their life now is the eating disorder.
“That’s because it will have left them isolated socially. They don’t have the energy to go out with friends anymore so they’ve lost their support. They may not be doing as well in school and will have given up recreational activities.
“The isolation is huge because of the way it takes over the person’s life and their mind. It’s not a whole lot different to an addiction. Gradually, the person’s whole life is revolving around what they have used and the whole day focuses on this one area, to the exclusion of everything else,” says Dr Larkin.
What signs can parents look out for?
• Eating smaller portions.• Not finishing meals.• Skipping meals.• Making excuses that they’ve eaten somewhere else.• Over-exercising.• Talking about/being more preoccupied with food.• Increased self-consciousness about weight and image. • Self-induced vomiting.• Taking laxatives.Readiness to change
“Treatment programmes are useful for someone who has gotten to the point that they’re ready to break out of this vicious cycle, but they have to be ready to change.
“Dealing with the underlying issues that have made them vulnerable to an eating disorder in the first place is very important. This is so that they can avoid going back to it in the future.
“The stressful life events that might have triggered the disorder in the first place also have to be looked at. It’s about getting to the point where they can actually work on their own personal therapy or personal development. This is so that they will have different coping skills and more resilience in the future,” says Dr Larkin.
Early diagnosis vital
“The earlier the person gets help with the problem, the better the prognosis. It’s always a tug of war, so that’s why parents have to accept that it may take time for the person to be ready to use all the knowledge and advice towards recovery.”
The facts
• Around 80 people die because of it each year in Ireland.• Average onset is 15 to 24 years.• 15% to 18% of those who develop anorexia die, either by suicide or direct medical complications of the disorder (malnutrition).• A study of 3,000 secondary school pupils, with an average age of 14.7 years, by the Lucena clinic in Dublin, showed that 11% of pupils, male and female, had significant eating and weight concerns. 1.2% of females met the criteria for anorexia nervosa and 2.4% of the males had significant eating and weight concerns.• Treatment for anorexia usually involves therapy such as CBT (cognitive behavioural therapy) which aims to change the person’s attitudes and behaviour.NEXT WEEK
• Bodywhys advice about how parents can respond.• How a combination of approaches may be needed.• More from Dr Larkin.• How relapse is part of recovery. • Costs of in-patient treatment and counselling. CL• HSE website: One of the biggest challenges in treating anorexia is that it is a condition characterised by self-denial. Many people with anorexia refuse to admit, or are unable to grasp, that there is anything wrong with them or their behaviour. It usually takes five to six years of treatment before the person makes a complete recovery and relapses are common. See www.hse.ie
• The St John of God Eating Disorder Recovery Centre in Stillorgan, Dublin runs an intensive in-patient programme and a day hospital one.
• Note: For a full list of all Irish hospitals and clinics that have eating disorder programmes and a list of counsellors in your area, look up services directory on www.bodywhys.ie
Useful websites
• Bodywhys
www.bodywhys.ie
1890-200 444
• www.stjohnofgodhospital.ie
• Overeaters Annonymous
www.oa.org/newcomers/is-oa-for-you
See www.overeatersanonymous.ie for a list of meetings.
Anorexia nervosa has the highest mortality rate of all mental health disorders, but early diagnosis means a better chance of recovery,” says Dr Terence Larkin of the St John of God Eating Disorder Recovery Centre.
“You shouldn’t sit on the problem, hoping the person will grow out of it. If you feel that your child’s attitudes around food have dramatically changed, it’s time to get communication going. Get in touch with organisations like Bodywhys and educate yourself about a way that’s likely to steer your daughter or son towards getting help. It’s about getting them motivated to want recovery.”
The risk factors that make people vulnerable to developing an eating disorder, as stated by Dr Larkin, are listed here (see right). Several of these may be involved when a person develops anorexia nervosa. The age group of 15 to 24 is most often affected.
• Genetic vulnerability: Twin studies have shown this can have an influence. • A history of eating disorders in the family: Family attitudes around eating may have a bearing. • Culture: Western world’s emphasis on the pursuit of perfection leads to a lot of focus on body shape and weight. • Being involved in dance, modelling or gymnastics: Higher incidence of eating disorders because of the focus on body weight. • Serious life event occurring: Around 70% of those who present with anorexia nervosa have had a serious life event occur before or around the time of the onset of the eating disorder. • Transition time: Times of transition can trigger anxiety or insecurity, eg going from secondary school to college. • Early onset of periods: Emotional issue of dealing with puberty ahead of peers. • Family history of obesity: May not want to be overweight like family members or may have been bullied as a younger child about weight. • High achiever/perfectionist personality trait: Key factor. Wants the ideal. Is determined and self-disciplined. Thinks in black and white terms. Despite achievements, the person feels insecure about their own value or worth. • Difficulty tolerating low mood or emotions: Uses food (comfort eating or lack of) to regulate mood – food restricting leads to feeling numbed out emotionally. “The person with anorexia believes that changing their body would make their life happier and more secure,” says Dr Larkin. “In actual fact, the starvation that’s involved in pursuing that, actually makes a person more anxious. Gradually, their life begins to shrink down to being about what they’ve eaten or what their weight is. This eventually pushes out other areas of their life and takes over their mind,” he concludes.
What to do
But how should parents react? Dr Larkin’s advice is don’t get drawn into a battle of wills. He believes this is to be avoided at all costs.
“The natural instinct for a parent when a child doesn’t eat is to become very anxious about it, but being drawn into a battle of wills just backs the young person into a corner where they have to deny what they are doing or they do it in secret.
“While they appear to eat again to please you, they may start using vomiting, over-exercising or taking laxatives to get rid of the food.”
communication
“Feed back to them what you’re noticing – the changes in their behaviour – and your concerns without necessarily trying to get them to eat, because if you enter into that battle it will just polarise the young person.”
Educate yourself
As a parent, educating yourself about the illness is vital.
“No one else, even me who is supposed to be an expert, can make somebody recover from an eating disorder,” says Dr Larkin.
“They have to get to the point where they have come to the conclusion that their life would be better without the eating disorder in their life. Often it’s only 51% of the person that feels like that and 49% wants to hold on to the eating disorder.
“Get onto the Bodywhys website and helpline, talk to people who can understand, then prepare yourself to talk to the teenager or adult child about your concerns.”
Persuade the person
to have a medical check-up
“This reassures the family that the person isn’t at immediate risk of medical complications from the anorexia. It also allows someone from outside the family to begin the process of trying to get the person motivated to seek recovery.”
Start the conversation about the ‘why’
It is important to help the person to look at why they are holding onto the eating disorder.
“They may be reluctant to let the disorder go because they’ve invested a lot of time and effort into it and because the only thing they may have in their life now is the eating disorder.
“That’s because it will have left them isolated socially. They don’t have the energy to go out with friends anymore so they’ve lost their support. They may not be doing as well in school and will have given up recreational activities.
“The isolation is huge because of the way it takes over the person’s life and their mind. It’s not a whole lot different to an addiction. Gradually, the person’s whole life is revolving around what they have used and the whole day focuses on this one area, to the exclusion of everything else,” says Dr Larkin.
What signs can parents look out for?
• Eating smaller portions.• Not finishing meals.• Skipping meals.• Making excuses that they’ve eaten somewhere else.• Over-exercising.• Talking about/being more preoccupied with food.• Increased self-consciousness about weight and image. • Self-induced vomiting.• Taking laxatives.Readiness to change
“Treatment programmes are useful for someone who has gotten to the point that they’re ready to break out of this vicious cycle, but they have to be ready to change.
“Dealing with the underlying issues that have made them vulnerable to an eating disorder in the first place is very important. This is so that they can avoid going back to it in the future.
“The stressful life events that might have triggered the disorder in the first place also have to be looked at. It’s about getting to the point where they can actually work on their own personal therapy or personal development. This is so that they will have different coping skills and more resilience in the future,” says Dr Larkin.
Early diagnosis vital
“The earlier the person gets help with the problem, the better the prognosis. It’s always a tug of war, so that’s why parents have to accept that it may take time for the person to be ready to use all the knowledge and advice towards recovery.”
The facts
• Around 80 people die because of it each year in Ireland.• Average onset is 15 to 24 years.• 15% to 18% of those who develop anorexia die, either by suicide or direct medical complications of the disorder (malnutrition).• A study of 3,000 secondary school pupils, with an average age of 14.7 years, by the Lucena clinic in Dublin, showed that 11% of pupils, male and female, had significant eating and weight concerns. 1.2% of females met the criteria for anorexia nervosa and 2.4% of the males had significant eating and weight concerns.• Treatment for anorexia usually involves therapy such as CBT (cognitive behavioural therapy) which aims to change the person’s attitudes and behaviour.NEXT WEEK
• Bodywhys advice about how parents can respond.• How a combination of approaches may be needed.• More from Dr Larkin.• How relapse is part of recovery. • Costs of in-patient treatment and counselling. CL• HSE website: One of the biggest challenges in treating anorexia is that it is a condition characterised by self-denial. Many people with anorexia refuse to admit, or are unable to grasp, that there is anything wrong with them or their behaviour. It usually takes five to six years of treatment before the person makes a complete recovery and relapses are common. See www.hse.ie
• The St John of God Eating Disorder Recovery Centre in Stillorgan, Dublin runs an intensive in-patient programme and a day hospital one.
• Note: For a full list of all Irish hospitals and clinics that have eating disorder programmes and a list of counsellors in your area, look up services directory on www.bodywhys.ie
Useful websites
• Bodywhys
www.bodywhys.ie
1890-200 444
• www.stjohnofgodhospital.ie
• Overeaters Annonymous
www.oa.org/newcomers/is-oa-for-you
See www.overeatersanonymous.ie for a list of meetings.
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