Eating disorders: early warning signs identified
More than 1.6m people in the UK alone are estimated to have an eating disorder such as anorexia or bulimia. These disorders predominantly affect vulnerable women, but men can develop them too, and most people are diagnosed during adolescence and early adulthood.
Early diagnosis and treatment are crucial for those with an eating disorder but many people do not always seek help – and even when they look for help, treatment is difficult. Many are not diagnosed or treated in a timely way. There are also only a few specialist centres for eating disorders in the country, and funding is scarce. This is of particular concern as eating disorders have the highest mortality of all mental illnesses, both from physical causes and from suicide.
But our research, recently published in the British Journal of Psychiatry, found several health warning signs that point to a person developing an eating disorder, and these may help GPs diagnose and treat people with one of these conditions much earlier.
Mental and physical health
Using an anonymised database of GP and hospital records, we looked at the health of 15,558 people diagnosed with an eating disorder between 1990 and 2017 in Wales – 4,870 of these people were diagnosed with anorexia nervosa, 4,836 with bulimia nervosa and 5,852 with other eating disorders. These people were between the ages of ten and 65, the majority were female and most were diagnosed between the ages of 15 and 19. We found that as many as 24 in 100,000 people had a new diagnosis in 2017 alone. That is roughly one new patient per year in a medium sized GP practice with 5,000 patients.
We compared a subset of this group with controls from the general public in Wales. These people did not have eating disorders but were of the same age and gender. We specifically looked at the two years before the people with an eating disorder had been diagnosed, and three years afterwards to find out what other health conditions they had had during that time.
In the two years prior to their diagnosis we found that people diagnosed with an eating disorder were more likely than their counterparts in the control group to have had other mental health disorders such as personality or alcohol disorders and depression. They were also more likely to seek help following an accident, injury or self-harm.
Our study showed that the people diagnosed with an eating disorder had been issued a higher amount of drug prescriptions for central nervous system drugs (such as antipsychotics and antidepressants), gastrointestinal drugs (constipation relief, for example) and dietetic supplements (such as multivitamins) in comparison to the general population. These higher rates of conditions and medications were apparent for the three years following diagnosis too.
Support in the community
There are limits to this research, however. For example, we were only able to look at diagnosed cases of eating disorders. As mentioned above, despite people with these disorders having higher rates of seeking medical help for other things like self-harm, many still ultimately try and hide their eating disorder, and they can be very difficult for doctors to diagnose. It is thought that the real number of people affected by an eating disorder is much higher than the amount that are treated for them.
Our study does suggest, however, that the majority of people with eating disorders are already being – and can be – treated by their GPs and not in specialist clinics which have limited space. And by linking together warning signs like self-harm and use of certain medications, we hope GPs will be able to identify further people at risk of eating disorders.
Our work also emphasises the need to provide healthcare professionals with the training and support to give early treatment in the community. By seeking to help those with eating disorders early on, we can prevent great suffering and a loss of lives.
If anything in this article causes distress or concern about eating disorders, visit the BEAT website for more information and support. We have also created a free bilingual app with the NHS – Diet or Disorder – to support and empower anyone who is worried that they or someone the care about might have an eating disorder.
Sinead Brophy receives funding from Welsh Assembly Government, MRC, ESRC.
Joanne Demmler does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.