Recently, Dr. Campbell was asked by the Ontario Medical Association to participate in a podcast on the occasion of Eating Disorders Awareness Week. This podcast is available on the OMA website. We are pleased to include it here as well.
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First, learn a little more about Dr. Robbie Campbell
Founder & President Eating Disorders Foundation of Canada, Dr. Robbie Campbell, MD, FRCPC, has worked with the treatment, recovery/relapse and research of anorexia, bulimia and binge eating disorders for over 40 years. He is Professor Emeritus, Department of Psychiatry at Schulich School of Medicine & Dentistry for Western University, Consultant Psychiatrist at Fowler Kennedy Clinic, Fanshawe College, St. Joseph’s Family Medical Centre, and St. Joseph’s Health Care.
Please send your question by email to Ask@edfc.ca
Symptoms of eating disorders can actually begin at any age, but I commonly see people between the ages of 13 and 25 as this period of time hosts many major adjustments in life. We often forget that eating disorders represent maladaptive coping strategies as we try to deal with the stressors that life hands us. I have also seen eating disorder symptoms that present in adults over 60 on the one hand, and have seen those who outline clearly that their eating disorder began at age 4 or 5 on the other. It is safe to say that we are all vulnerable throughout our lives, but fortunately, most of us will only experience mild and brief symptoms and are able to get back on track. However, if these symptoms grow in frequency and for prolonged periods, we need to seek help to address an eating disorder possibility regardless of age.
I came across a very alarming statistic indicating that the lifetime co-morbidity of an eating disorder is as high as 80 to 97%. This seems extremely high, but I rarely see an eating disorder that does not co-exist with another form of mental illness. Most commonly, eating disorders are equated with anxiety, depression, substance abuse like alcohol, cannabis, cocaine, etc., as well as post-traumatic stress disorder, borderline personality disorder, obsessive-compulsive disorder and attention deficit hyperactive disorder. It is important to note that it is very difficult to manage an eating disorder when the co-existing mental illness is not dealt with effectively. This becomes a major cause of patients withdrawing from eating disorder programs. Ideally, it is best to try to ensure that the co-morbid illnesses are stable prior to beginning treatment and that any change in symptoms as you work through the program are addressed appropriately.
There is no question that the mortality rate in eating disorders is dramatically increased the longer a person has the eating disorder and as symptoms become more severe. The mortality rate of severe anorexia nervosa is reported as high as 10 to 20%. Deaths due to bulimia nervosa are often under-reported. For instance, bulimia nervosa may not be listed as a cause of death, but rather the complications of the disorder like cardiac arrhythmias or electrolyte imbalance are cited as the only cause. Binge eating disorder can lead to heart attack, stroke, hypertension, high cholesterol, diabetes, etc. and once again, is frequently overlooked as a major contributing factor. It is also important to note that death by suicide is increased in the eating disorder population. The best way to deal with eating disorders and the mental and physical illnesses that often accompany them is to make sure you get the help you need… now.
Diabulimia is a word that has been adapted to address an eating disorder coupled with diabetes. It is defined as the deliberate administration of insufficient insulin to control blood sugars for the purpose of causing weight loss. Needless to say, this causes a great deal of difficulty in the management of diabetes, especially in the adolescent who is experiencing denial of illness coupled with lifestyle adjustments along with eating disorder symptoms. Estimates as high as 30 – 40% of those adolescents with diabetes experience symptoms along this line. This non-adherence to vital insulin treatment places adolescents at serious risk for both short and long-term health complications. It is important to ensure this eating disorder symptom is quickly addressed and treated as it can be life threatening.
The one thing that comes to mind is early intervention. The ability to detect, intervene and treat eating disorders in time can minimize risk to the life of any patient. It is important to follow the treatment program and participate fully. Support of family and friends when possible is so helpful, especially when you are trying to sustain recovery. Medical complications, as well as other psychiatric conditions that are controlled or stabilized throughout the treatment process and the younger a person begins treatment have a major impact on reducing risk of relapse. Ongoing follow-up care is vitally important. There is actually a 30 – 50% chance of relapse in the first year following a treatment program without appropriate follow-up. And, there is a significant decrease in relapse after four years of being symptom free. Getting to treatment early, following the treatment plan and having long-term follow-up greatly reduces the risk of relapse.
Electrolyte imbalance and dehydration that arise from vomiting or using laxatives in bulimia can most definitely affect your heart. For instance, we know that low potassium can cause irregular heartbeat and has been known to lead to death. It should also be noted that binge eating disorders with high BMIs have an increased risk in hypertension, heart attack, stroke, hypercholesterolemia, diabetes, etc. Anorexia is often accompanied by low heart rate, low blood pressure, and low blood sugar. Laboratory investigations including an ECG are routinely done as part of your eating disorder treatment program. Don’t forget to report any vomiting or laxative use to your physician or nurse practitioner. It can have serious consequences.
One of the most researched psychological therapy is that of CBT: cognitive behavioural therapy. Most programs utilize CBT as it is deemed to be the most evidence-based strategy. IPT: interpersonal therapy, DBT: dialectical behaviour therapy, mindfulness and psychodynamic therapy, family or group therapy are also recognized therapies that have been found to be beneficial. It is important to note that there are different psychological therapies as everyone does not respond to the same approach. For best results, an excellent therapeutic relationship is key. Apart from formalized therapies, there are a host of supportive therapies, such as art therapy, music therapy, recreation therapy, nutritional therapy, equine therapy, etc. Supportive groups can provide much to the healing process and play a vital role in follow-up care.
Families need to become more educated about eating disorders and seek help with regard to understanding coping strategies. Families must be patient and not let the eating disorder interfere with the family’s everyday functioning. Many families will dwell on food when this is something that should be avoided. Although it is hard not to compare one member of the family with the other, it becomes a major eating disorder trigger. Families should refrain from making body comments, laying blame, pointing fingers or comparing one child with another. Becoming involved in non-food activities is healthy. Above all, learn all you can about eating disorders and be as supportive as you can.
To start this process going is perhaps the most difficult of all chores. Most people search the web and utilize social media for countless reasons… Making the decision to take the first big step is the hardest step ever. Because eating disorders are such life threatening illness, it is important to ensure that you see your family physician or nurse practitioner to discuss your concerns about having eating disorder symptoms. These front-line medical professionals can help you determine next steps and if more specialized care is needed. In many communities, there are child and adolescent programs, as well as adult eating disorder services. Unfortunately, many hospitals only admit for medical stabilization and do not have eating disorder treatment facilities. Community programs often provide supportive therapies like art, music, yoga, etc. or are actively involved in supportive housing. There are specialty programs available, however, many of these services are not covered by health care insurance. Start with a medical check-up with an initial referral to counselling services and go from there with guidance. If you run into difficulty, check out National Eating Disorders Information Centre (NEDIC) for available resources.
Contrary to most beliefs, dieting invariably does not lead to weight loss. More often than not, going on strict diets or even under-eating is associated with an increase in hunger, an increase in eating, and subsequent weight gain. If you under-eat during the day, you are more than likely to end up binge eating at night in an uncontrollable fashion. It is definitely not good to have alcohol or cannabis as these substances can most certainly trigger increased cravings for food. Trying to deal with a host of stressors can also trigger binge eating as can unstructured time and being alone. Feelings of being fat or fear of gaining weight can lead to food restriction, which can increase hunger – a vicious cycle. We need to try and understand what triggers us and develop more healthy coping strategies to deal with them.