Anorexia Nervosa E-Book

Agnes Ayton

• Herausgeber: Hammersmith Health Books
• Kategorie: Ratgeber
• Sprache: Englisch
• Veröffentlichungsjahr: 2012

Beschreibung

Anorexia nervosa is a potentially fatal disorder that is notoriously difficult to treat and provokes feelings of great frustration in carers, families and friends. Child & Adolescent Psychiatrist, Dr Agnes Ayton FRCPsych, offers a new perspective, bringing together what is currently known and scientifically verified with her own ground-breaking work combining psychotherapy with nutritional support. Providing sufferers and carers with a knowledge of the full range of treatment options empowers them to make informed choices that can be tailored to the individual's needs. To assist them, Anorexia Nervosa - hope for recovery: focuses entirely on anorexia and other eating disorders associated with being significantly underweight; emphasises nutrition, especially what is known about the physical and psychological effects of starvation and the process of recovery from these; offers dietary 'prescriptions', menu plans, and recovery strategies; integrates treatment options, showing how the individual can achieve a balance. This is a practical book helping sufferers and carers to make informed choices that can change the lives of all concerned for the better.

Leseprobe

Anorexia Nervosa

hope for recovery

Dr Agnes Ayton

MD MMedSc FRCPsych Consultant Child & Adolescent Psychiatrist

Copyright

First published as a print book in 2011 by Hammersmith Press Limited

First published as a digital book in 2012 by Hammersmith Health Books, an imprint of Hammersmith Books Limited

www.hammersmithbooks.co.uk

© 2011, 2012 Dr Agnes Ayton

All rights reserved. No part of this publication may be reproduced, stored in any retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publishers and copyright holder.

Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made.

British Library Cataloguing in Publication Data: A CIP record of this book is available from the British Library.

ISBN 978–1–781610–10–7

Commissioning editor: Georgina Bentliff Designed and typeset by Julie Bennett Production: Helen Whitehorn, Pathmedia

To our families:

Eszter, Eva and Andrew

Camilla and my parents

Contents

Title Page

Copyright

Dedication

Acknowledgements

Introduction

1 What is anorexia nervosa?

2 Who suffers from anorexia nervosa?

3 What causes anorexia nervosa?

4 Maintaining factors: what keeps anorexia nervosa going?

5 The pros and cons of anorexia nervosa

6 Achieving change

7 Treatment options

8 Prevention of relapse and life without anorexia nervosa

Appendix

Index

Acknowledgements

This book could not have been written without the help and inspiration of many people. First and foremost it has been inspired by sufferers and carers over the course of more than 20 years of clinical practice in the NHS and the independent sector. I continue to learn from patients and families, and I feel privileged that they share their struggles and put their trust in me. I have been struck by the bewilderment people experience when they first encounter anorexia in their lives. This is perfectly understandable: most of us do not anticipate having to cope with illnesses such as this, but when they happen it is important to understand the complete picture. An informed patient or carer is much better equipped to overcome the illness than someone who leaves decisions to professionals alone. I hope that this book will help readers to understand this complex disorder without wasting years of their lives, thereby saving valuable time and reducing unnecessary suffering.

Professor Basant Puri was instrumental in the conception of this work. He suggested to my publisher, Georgina Bentliff, that she contact me and I should like to express my sincere thanks to them both. Georgina has been a great source of support over the years. As someone who has witnessed the effects of anorexia at first-hand, within her own family, she has been both unwaveringly committed to the book and an active contributor to its contents. She has also been extremely patient, which was a practical necessity for a busy consultant psychiatrist like myself, for whom writing a book could be no more than a spare time activity. Her patience has allowed the text to mature over time.

I have learned a great deal from my colleagues at the Royal College of Psychiatrists Eating Disorders Section, and I have tried to cover their work comprehensively in this book. Indeed, I hope that its main strength as a guide for patients and their families is the critical review of the research evidence concerning anorexia that it contains. This should help them to navigate between the certainties and uncertainties of current knowledge, to make informed choices between the services on offer and to avoid the pursuit of quick fixes.

Needless to say, the support and patience of my husband, Dr Andrew Ayton, has been essential. Without his help and emotional warmth this book would not have been possible.

Introduction

It is unclear how many people suffer from anorexia nervosa and related eating disorders. This is a secretive illness: only a fraction of sufferers acknowledge the problem, let alone seek treatment.1,2 Many endure the condition quietly for years without help, wasting their lives away with a preoccupation with dieting, hoping that the happiness and admiration for which they long will come when their weight has become less than that of everyone else. The tragedy is that often they do not realise until it is too late that anorexia brings devastating isolation with poor physical and mental health.

Even when patients and families decide to seek professional advice, they often find it difficult to get the illness recognised or to access the help they need. In the UK, as in most countries, the first contact is usually with a general practitioner. Studies have repeatedly shown that, for a number of reasons, in primary care the condition is often not recognised or diagnosis is delayed.3,4

This should not perhaps be surprising. First, the training of general practitioners does not usually cover eating disorders, apart from a very basic description during undergraduate psychiatric studies. An average family doctor in the UK looks after about 1600-1800 patients, and among them there is unlikely to be more than one patient with a definite diagnosis of anorexia nervosa. Indeed, some general practitioners work for years without encountering a single patient with this condition. Such a level of experience is hardly sufficient to develop expertise in this area; most general practitioners become more interested in common illnesses, such as heart disease or cancer.

Furthermore, general practitioners in the UK have only about 10 minutes allocated for each patient. Allowing any more time would result in unmanageable waiting lists, inefficiency and missed government targets. Unfortunately, patients with anorexia require longer than this. They tend to be frightened and embarrassed to talk about their problems openly; and if they do pluck up sufficient courage to seek help, they may not be able to explain the extent of their difficulties in so short a time. Rather than being open about their eating disorder, they will talk about feeling low, or complain about some physical symptom, such as constipation or not having their periods.4,5

To make matters worse, full physical examination has ceased to be a routine procedure in modern medical practice. Apart from the issue of time efficiency, doctors have become increasingly concerned about potential complaints and litigation, particularly against male doctors examining unclothed female patients. Clothes may disguise even severe malnutrition, and anorexia nervosa can easily go undetected during the first consultation if a physical examination is not carried out. Far too often the patient will leave the surgery disappointed, with nothing more than a prescription for an antidepressant, a laxative or the pill (to help with the lack of periods). Many do not return, unless the condition worsens significantly and their families press them to do so.

Parents and patients often report a time lag of several months between first making contact with health services and diagnosis. This is similar to the delay in the recognition of schizophrenia; and in both conditions, delaying treatment can be detrimental.

The situation is similar in other countries. Studies from the US6 and continental Europe suggest that only a fraction of eating disorders are recognised and consequently receive treatment at primary care level. Managed care, which is driven by the financial interest of the large insurance companies, allows only limited services for patients with anorexia nervosa, leaving patient and family to sort out the problem.

In the UK, the specialist services for eating disorders are patchy at best. Although the Royal College of Psychiatrists has laid down clear guidelines for the provision of specialist services in the NHS, these are not necessarily followed by the cash-strapped Trusts. Eating disorders have never been regarded by any government as high on the list of priorities. Sadly, this is mainly because patients with these conditions do not pose a danger to the public, just to themselves, and they are generally law-abiding citizens.

This book has been written with the aim of guiding patients and their families to a better understanding of anorexia. It offers information about services and treatment options with the hope that sufferers will find the inspiration to set out on the road to recovery. It is all too often the case that patients and family members learn about anorexia by trial and error, thereby wasting valuable time and suffering unnecessary anguish.

This book aims to be comprehensive, with information relevant to all age groups and both sexes, and for families and carers as well as patients. This is necessary for a number of reasons. Anorexia is often a chronic disorder, starting in adolescence, but also affecting adulthood. The separation of adolescent and adult issues is somewhat artificial. People make the transition from adolescence to adulthood at different paces, and many anorexia sufferers lag behind their peers in this respect. Child and adolescent mental health services differ from adult services in terms of service organisation and philosophy. This can be confusing and it is important to understand these differences. Furthermore, about one in 10 sufferers is male, and it is particularly difficult to find information for them. I discuss issues specific to males as I go along.

In addition to providing information about the illness and treatment options, this book also offers practical self-help advice for patients, and families. As many sufferers choose not to seek professional help, or cannot access it, self-help may be the only way forward for them. The good news is that some people are able to get better without professional help,7-9 usually by taking advantage of the support and help offered by loved ones. Families and friends can be very effective in helping a person with anorexia. However, first-time experience of the illness can be bewildering and extremely painful for families. Parents and siblings often feel guilty, attributing blame to themselves, and this can have a paralysing effect. I hope that the book will help to dispel these feelings, freeing up positive energies in the family that can assist the sufferer in making changes.

For those who cannot succeed on their own, it is important to know how to ask most effectively for help, and how to assess the quality of services on offer. A well-informed patient is more likely to be able to recognise the dangers of anorexia and to access appropriate services. The same applies to families who are desperate to help their loved ones.

The information in this book may also be helpful for professionals working in educational settings and primary care, including general practitioners.

References

1. Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A et al. Epidemiology and course of anorexia nervosa in the community. American Journal of Psychiatry 2007; 164(8): 1259-1265.

2. Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current Opinion in Psychiatry 2006; 19(4): 389-394.

3. Bryant-Waugh RJ, Lask BD, Shafran RL, Fosson AR. Do Doctors Recognize Eating Disorders in Children? Archives of Disease in Childhood 1992; 67(1):103-105.

4. Ogg EC, Millar HR, Pusztai EE, Thom AS. General practice consultation patterns preceding diagnosis of eating disorders. International Journal of Eating Disorders 1997; 22(1): 89-93.

5. Becker AE, Thomas JJ, Franko DL, Herzog DB. Disclosure patterns of eating and weight concerns to clinicians, educational professionals, family, and peers. International Journal of Eating Disorders 2005; 38(1): 18-23.

6. Walsh JME, Wheat ME, Freund K. Detection, evaluation, and treatment of eating disorders - The role of the primary care physician. Journal of General Internal Medicine 2000; 15(8): 577-590.

7. Ben-Tovim DI, Walker K, Gilchrist P, Freeman R, Kalucy R, Esterman A. Outcome in patients with eating disorders: a 5-year study. The Lancet 2001; 357(9264): 1254-1257.

8. Woods S. Untreated recovery from eating disorders. Adolescence 2004; 39(154): 361-371.

9. Perkins SJ, Murphy R, Schmidt U, Williams C. Self-help and guided self-help for eating disorders. Cochrane Database of Systematic Reviews 2006; (3).