1 Eating disorders have the highest mortality rate of any mental illness – higher even than depression. This is both from suicide and from medical complications associated with the illness. One of these can be heart attack after a patient’s body mass becomes very low due to lack of nutrition, and the body’s muscles, including the heart muscles, start to eat themselves. This naturally puts a strain on the heart. In addition, when a person makes themselves sick frequently, they lose much of the body’s potassium, which can trigger a heart arrhythmia (irregular heartbeat), again raising their risk of a heart attack.
2 Both men and women can develop eating disorders, which include anorexia, bulimia and binge eating – although around 90 per cent are women. On the plus side, we do know that women are better at seeking treatment than men.
3 Many people get the difference between anorexia and bulimia wrong. It’s not as simple as anorexics starving themselves and bulimics binging and then purging – anorexics often make themselves sick. The clinical distinction is based on a patient’s body weight; those with a body mass index (BMI) of 17.5 or below (a BMI of 18.5 to 24.9 is considered normal) are deemed anorexic; a patient with a normal BMI is termed bulimic.
4 Eating disorders are never just about the way a patient thinks they look – or about feeling fat. They’re generally about control – often triggered because a person feels they have no power over other areas of life; for example, their job or relationship.
5 It’s well-documented that having parents who were perfectionists is a risk factor for developing an eating disorder. Other research shows having overprotective parents who try to shield their child from everything may also be linked to a raised risk of their children going on to develop an eating disorder. This suggests that a more relaxed approach to parenting can help to reduce your child’s future risk.
6 Although the average age to develop an eating disorder is around 15, it’s not just young people who succumb to them. In, fact, they can develop at any age – even in your 70s. We suspect that these older patients have always had a predisposition to anorexia, but perhaps hadn’t had a stressful enough experience to set it off before. We know that severe stress can often be the trigger for an eating disorder; for example, following on from a major life event such as the breakdown of a marriage, a bereavement or from a job redundancy.
7 We’ve yet to identify a specific gene, but we suspect inherited factors also play a huge part in dictating who develops eating disorders. We know that eating disorders do run in families, and if your mother or grandma had problems with eating then your risk factor is higher.
8 Research suggests nearly half of patients fully recover, and go on to lead a normal life. We know the sooner you get help, the better your prognosis. But it’s also true that it can be a slow process, taking years to fully overcome.
9 The first port of call should always be your GP. Research suggests the most successful treatments are ‘talking therapies’, such as cognitive behavioural therapy (CBT) and family therapy. These help address fears of weight gain and aid psychological recovery. Medication can also help control obsessive thoughts; many patients will also be referred to a dietician.
10 If you’re concerned someone you care about has an eating disorder, gently encourage them to seek help. And reassure them that the condition isn’t rare, so they shouldn’t feel embarrassed.
Dr Mark Silvert is a consultant psychiatrist with a special interest in eating disorders working in the NHS, and also privately at The Blue Tree Clinic in London