Therapy for life-threatening eating disorders works, so why can’t people access it?



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Eating disorders are among the leading causes of hospitalisation for mental-health-related issues in Australia.
from shutterstock.com

Richard Newton, University of Melbourne

Eating disorders are complex mental illnesses that have one of the highest death rates of any psychiatric disorder. Among people with anorexia nervosa – who commonly deprive themselves of food due to an obsessive fear of gaining weight – this rate is more than five times greater than in the general population. The Conversation

All eating disorders are associated with significant, wide-ranging physical health complications such as starvation, cardiac arrest (sudden loss of heart function), kidney problems, food intolerance and fits. These are among the leading causes of hospitalisation for mental-health-related issues in Australia.

Because serious medical complications so frequently accompany eating disorders, they defy classification solely as mental illnesses. They should be viewed as complex health-care issues requiring urgent and multidisciplinary care.

Yet many health-care providers have not been provided with enough basic education and training to be able to recognise and respond appropriately to someone presenting with an eating disorder. So despite their severity, eating disorders often go unrecognised.

This leads to substantial economic costs for the Australian health system and devastating effects for sufferers, loved ones and the communities that surround them.

What are eating disorders?

Eating disorders have been around through recorded history. Even an ancient Egyptian tomb painting depicts a noble self-inducing vomiting.

There are several types of eating disorders. These include anorexia nervosa, bulimia nervosa and binge eating disorder. Collectively, these are characterised by abnormal eating behaviours, poor body image, overemphasis on weight and shape, and extreme weight-control behaviours.

In the case of anorexia, such behaviours lead to severe weight loss and often life-threatening complications. Vomiting, laxative abuse and excessive exercise can be features of both anorexia and bulimia, as can binging and purging.

Unlike the severe weight loss associated with anorexia, bulimia is characterised by the presence of binging and usually purging at a relatively normal weight. Binge eating disorder features frequent binging, in the absence of purging or other compensatory behaviours, which often leads to significant weight gain.

Eating disorders are also commonly accompanied by low self-esteem, guilt and disgust, along with depression, severe anxiety and suicide risk.

Who gets eating disorders?

There are psychological, environmental and biological (including genetic) risk factors for developing eating disorders. A genetic predisposition in combination with poor body image is one of the strongest predictors of disordered eating.

Poor body image has been reported in nearly half of Australian women and over one-third of Australian men. Disturbingly, the rate of body-image concerns is even greater in children and adolescents. A study of Australian children found up to 61% of girls and boys between the ages of eight and 11 are trying to control their weight.

Around 10% of the Australian population will experience an eating disorder in their lifetime, and the rate is increasing. For example, one study observed a two-fold increase in disordered eating between 1995 and 2005 in South Australia. And a more recent study in the same state observed a more than two-fold increase in extreme dieting and binge eating between 1998 and 2008.

While the reasons for this increase have not yet been fully explored, they may be related to increasing concerns about weight in the general Australian population.

Contrary to the long-held belief eating disorders are the domain of wealthy young females, the greatest increase has been observed in older people, males and those in lower socio-demographic groups.

This may be due, at least in part, to inadequate access to treatment, differences in people seeking treatment, or detection in under-represented groups, and stigma surrounding the development of a disorder commonly associated with a specific (different) group in the community.

How are they treated?

A number of evidence-based treatments are available for eating disorders. It is important to note that no single approach will be effective for all individuals.

People who are unable to access effective treatment early experience greater duration and severity of illness. They then need more complex, prolonged treatment.

Structured, psychological therapies are considered the cornerstone of treatment for eating disorders. For adolescents with anorexia, this takes the form of family-based therapy. This involves helping the whole family support the person with the disorder.

In adults with eating disorders, evidence shows a minimum of 20 sessions of cognitive behaviour therapy (CBT) – which challenges learnt ways of thinking – is necessary. In severe cases of anorexia, at least 40 CBT sessions that include a strong emphasis on restoring healthy eating attitudes and behaviours are required.

A multidisciplinary team is best equipped to address the complex nutritional, medical and psychological needs of someone with anorexia.

Increasing funding to improve outcomes

The total social and economic costs of eating disorders in Australia exceed A$69 billion per year. These costs can be reduced with early detection.

Most people with eating disorders go a long time before receiving adequate care. One study of over 10,000 adolescents found that, while nearly 90% of those with an eating disorder contacted a service provider for help, in only a minority (3-28%) of cases were the services specifically for their eating disorder.

Factors such as denial, shame, stigma and a lack of recognition of eating disorder symptoms by health-care professionals are likely contributors to this discrepancy.

Medicare provides Australians with funding for ten sessions with an allied mental-health professional (such as a psychologist or social worker). This is below the minimum treatment recommendation of 20 sessions for all eating disorders.

We should not accept a system that prevents people with a severe life-threatening mental illness from accessing a treatment that is available, effective and will save costs in the long term.

Federal Health Minister Greg Hunt recently requested the Medicare Benefits Schedule Review Taskforce investigate increasing Medicare coverage to treat people with an eating disorder. We urgently need early identification of eating disorders and the delivery of quality, targeted treatments at evidence-supported durations.

This article was co-authored by Tina Peckmezian, Principal Research Officer at The Butterfly Foundation.


If this article has raised concerns for you or anyone you know, call Lifeline 13 11 14, Suicide Call Back Service 1300 659 467 or Kids Helpline 1800 55 1800.

People with eating disorders or their families can get help at the Butterfly Foundation, 1800 33 4673, or The National Eating Disorders Collaboration.

Richard Newton, Associate Professor, University of Melbourne

This article was originally published on The Conversation. Read the original article.

Explainer: what are panic attacks and what’s happening when we have them?


Lynne Harris, University of Sydney

What would you think was happening to you if out of nowhere your heart started to race, you were drenched in sweat, you found yourself trembling uncontrollably, short of breath, with chest pain and feeling nauseated, dizzy and lightheaded as though you might faint?

You might also be feeling very cold or very hot, with tingling sensations in your fingers and toes. You might feel removed from the world around you – as though it wasn’t real – and be worried that you might lose control or that you are going insane. You might try to work out what is happening and conclude you are having a heart attack or dying.

A panic attack is a sudden, intense feeling of fear or discomfort with at least four of the signs described above. For some people, a panic attack can come out of nowhere, like a sudden thunderstorm from a clear blue sky. For other people, panic attack may be more predictable, such as an abrupt escalation of a milder anxiety about giving a speech or speaking to someone in authority.

Just as a panic attack can follow an experience of relative calm or of mild anxiety, panic can resolve to a relatively calm state or to ongoing, less intense symptoms. But the symptoms of panic attack are severe and frightening. Many people experiencing a panic attack believe they are seriously ill and seek medical help.

What is happening to the body?

Often one of the first symptoms of a panic attack is hyperventilating (rapidly breathing in and out), which upsets the natural balance of oxygen and carbon dioxide in our system. One view says a low level of carbon dioxide in the blood directly triggers the symptoms of panic, such as feeling lightheaded and dizzy. When we breathe quickly we also build up oxygen in our blood. Paradoxically, too much oxygen is also associated with feeling short of breath.

Hyperventilation causes many of the other symptoms of a panic attack such as dizziness, blurred vision, tingling, muscle tension, chest pain, heart rate increases, nausea and temperature changes.

People who experience panic misinterpret the bodily signs of hyperventilation as indicating immediate physical danger and believe they have little control over the symptoms. When we then say things to ourselves such as “I might be having a heart attack” and “I can’t cope with this”, the anxiety gets worse.

In a 2013 study, researchers showed when people with no history of panic inhaled air with increased carbon dioxide they reported fear, discomfort and panic symptoms. People with a history of panic attack experience these symptoms at lower concentrations of carbon dioxide, suggesting they are hypersensitive to this internal signal for danger.

Panic attacks can occur with a range of diagnosed mental illnesses, including anxiety disorders, depressive disorders and substance use disorders, as well as physical illnesses, especially illnesses that affect heart function, breathing, balance and digestion. It is very important to understand and deal with panic attacks so they don’t lead to a more serious condition known as panic disorder.

People with panic disorder have a history of panic attacks and worry they will have further panic attacks. They change the way they live to ensure they do not have another panic attack. They avoid activities like exercise that cause feelings similar to panic attack (shortness of breath, sweating) and avoid situations where they fear another panic attack may occur. This avoidance brings many additional problems, as social, family and occupational worlds shrink due to fear of panic.

What should you do if you have a panic attack?

Panic attacks are common, with almost 23% of a people from a large US study of the general population reporting at least one panic attack during their lives. Panic attacks are more common in females than males. They are also more common in family members of people with panic disorder.

Panic attacks are more common among people who believe symptoms of anxiety are dangerous and harmful, rather than annoying and uncomfortable. They are also more likely if you are under emotional pressure, have been ill, are tired, are hungover or smoke.

As many of the symptoms of panic attack are physical and can be caused by a number of physical conditions, the first thing to do if you have symptoms like the ones described here is to see your doctor to check whether there is a medical reason for the symptoms.

If the symptoms are due to panic, then there are effective psychological approaches for controlling panic attacks. These focus on:

  1. monitoring and slowing breathing, as overbreathing causes many panic sensations

  2. correcting the interpretations about what the symptoms mean by looking at the things we say to ourselves before, during and after a panic attack. It is very important to remember the symptoms are “just anxiety” and are not life-threatening.


There is useful information about panic attack and how to cope with it available through Lifeline.

The Conversation

Lynne Harris, Professor of Psychological Sciences, School of Psychological Sciences, Australian College of Applied Psychology and Honorary Assoc Prof with the Faculty of Health Sciences, University of Sydney

This article was originally published on The Conversation. Read the original article.

Depression Could Be More a Physical Than Mental Condition, Say Scientists


TIME

A growing number of scientists are coming to the conclusion that depression is at least as much a physical condition as it has to do with the mind.

One explanation is inflammation, which is caused by a part of the immune system that gets called into action when the body suffers a wound, the Guardian reports.

A set of proteins called cytokines sets off this inflammation in the body. This process is why people tend to feel down when they fall ill.

And so scientists think the brain may be tricked into feeling depressed through a process akin to an allergic reaction.

Read more at the Guardian

Read next: Most Cancer Is Beyond Your Control, Breakthrough Study Finds

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