November 27, 2013

Anorexia linked to high suicide risk

[Posted: Wed 06/11/2013 by Deborah Condon]

People with anorexia nervosa are 50 times more likely to die by suicide, while at least one in four people with bulimia have a history of attempted suicide or self-harm, a leading consultant has said.

Anorexia nervosa is characterised by an obsessive desire to lose weight and dissatisfaction with body weight and shape. Extreme weight loss is achieved by excessive dieting behaviours, including the use of laxatives and self-induced vomiting.

Bulimia nervosa is a psychological eating disorder, in which people binge eat and then get rid of the food immediately, either by vomiting or by taking laxatives and/or diuretics.

According to Prof Alf Nicholson, a consultant paediatrician at Temple Street Children's Hospital, up to one in every 200 teenage girls has anorexia nervosa, while up to 2% have bulimia. However, these eating disorders can also affect males, younger children and adults.

"Anorexia nervosa is associated with significant morbidity and mortality, with 5% of cases dying from it and 20% progressing to chronic eating disorders. Death from suicide is 50 times more likely in patients with anorexia and 25-35% of bulimia patients report a history of attempted suicide or self-harm," Prof Nicholson explained.

He said that when a doctor is presented with a patient with a suspected eating disorder, they should ask ‘pointed questions about the patient's desired weight, e.g. what would you like to weight?'

They should also ask about the patient's exercise routine, current eating habits and whether there is any history of binge eating or self-induced vomiting.

A family history is also important, particularly if there is a history of obesity, eating disorders or other mental health issues, such as depression.

Diagnostic criteria of eating disorders can include a refusal to maintain weight, a body weight of 85% or less than that expected, an intense fear of gaining weight or being fat even if they are underweight, and amenorrhoea (absent periods) in teenage girls.

Prof Nicholson said that eating disorders can often be managed on an outpatient basis, however admission to hospital may be required in certain circumstances, e.g. where a patient has complications as a result of extreme malnutrition or in the case of younger children.

He said that a multidisciplinary team should be involved in the treatment of anorexia and bulimia and goals should include ‘nutritional rehabilitation and motivation for recovery'.

"The multidisciplinary team should review the treatment plan on a regular basis and clear boundaries should be set," Prof Nicholson said.

He explained that patients who develop their eating disorder at a younger age, who have a shorter duration of symptoms and who have a better relationship with their parents ‘have a better prognosis'.

"Purging behaviour, physical hyperactivity, more significant weight loss and chronic symptoms are all associated with a less favourable prognosis," he noted.

He added that even after recovery, ‘depression and anxiety may persist'.

Prof Nicholson made his comments in Forum, the Journal of the Irish College of General Practitioners.