Eating disorders: the importance of early intervention

This week is #EDAW2017. Every year Eating Disorders Awareness Week takes place at the end of February with the laudable aim to inform as many people as possible about these challenging disorders. The theme for this year’s EDAW is early intervention. Here, Secondo Fassino, Section editor of BMC Psychiatry’s dedicated Eating disorders section tells us why getting people into treatment as quickly as possible is so important


Eating disorders (EDs) are severe mental illnesses with a complex and largely unknown etiology. EDs encompass a variety of disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder. Anorexia nervosa is characterized by self-starving, intense fear of gaining weight and disturbance in self perceived weight or shape. Patients with bulimia nervosa suffer from recurrent binge-eating episodes (the consumption of abnormally large amounts of food in a relatively short period of time) with a sense of loss of control, followed by feelings of guilt and shame, which leads the person to compensatory behaviors (self-induced vomiting, over-exercising, use of laxatives or diuretics). These patients usually maintain normal weight, unlike anorexic ones. Binge eating disorder is characterized by eating excessive amounts of food, often when not hungry, without the compensatory behaviors of bulimia nervosa. As a result, patients are often overweight.



The aetiology of these disorders appears to be multifactorial: genetic, biological, socio-cultural, and psychological factors can contribute to their development and maintenance. The course of EDs is often relapsing and in a substantial proportion of cases protracted with a treatment-resistant disorder sometimes occurring. EDs are severe illnesses for a number of reasons: mortality is high, risk of suicidality is high, quality of life is poor, short- and long-term organic consequences strongly impact patients’ lives, and psychiatric comorbidity (mostly depression, anxiety, and personality disorders) is endemic to sufferers. As a result, EDs tend to appear as a treatment conundrum; although research is proposing interesting novel treatment approaches with encouraging results. Treatments are challenging mostly for anorexia nervosa: no current medications are able to reverse the core symptoms which exist, and long and costly hospitalizations are frequently needed. Duration of illness is a relevant factor in treatment response; adolescents with anorexia nervosa seem to benefit more from outpatient treatments than adults do.


This said, it is key to recognize ED symptoms as soon as possible because an early intervention could be crucial with respect to treatment response and outcome. If EDs are caught in time, treatments can be decisive to change their course and to reduce the risk of stigma, complications, and death. Primary prevention is fundamental, potentially involving families, teachers and personal trainers, to name just a few. Know what to look for – Weight loss, refusal to eat certain foods, anxiety about gaining weight or being “fat”, excessive and rigid exercise regimens are fundamental first signs of an eating disorder that can be recognized early.



Read more …. catch up on BMC Psychiatry’s latest Eating disorders articles.


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