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An alcohol & drug rehab clinic

Eating Disorders

What is an eating disorder?

The term ‘eating disorder’ describes a psychological illness, affecting both men and women, covering a wide range of eating habits from compulsive eating to anorexia. Three types of eating disorder are recognised in the American Psychiatric Association’s mental health manual(1). These are:

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge Eating Disorder
  • Eating Disorder Not Otherwise Specified (EDNOS).

The disorders that occur most commonly with substance abuse are bulimia nervosa and EDNOS. Those suffering from bulimia have often experienced anorexia in the past. An eating disorder that is dormant often re-emerges following substance abuse treatment when alcohol or drugs are no longer used.

Anorexia Nervosa

Anorexia Nervosa is characterised by obsessional weight loss and an extreme fear of gaining weight. The weight loss is never enough and the sufferer sees their body as fat and ugly, even though it may be emaciated. Sufferers restrict the amount that they allow themselves to eat and exercise excessively to burn calories, use amphetamines and appetite suppressants and may also vomit, take laxatives, enemas or diuretics. They are constantly preoccupied with food and the amount of calories they consume.

Psychologically sufferers often fear growing up, have perfectionist and obsessive tendencies, suffer depression and low self-esteem.

Bulimia Nervosa

Bulimia revolves around a cycle of binge eating (consuming large quantities of food in a short period of time), followed by a sense of loss of control over their food intake, resulting in inappropriate strategies to offset the calories they have consumed. Methods of losing weight include purging by vomiting, use of laxatives, enemas, diuretics. Excessive exercise, restricting food and use of appetite suppressants are also a means of controlling their weight. Bulimia can continue for many years without the knowledge of family or friends as sufferers often appear to eat normally and don’t necessarily lose much weight.

Psychologically people with bulimia nervosa suffer from impulsivity, compulsivity, loss of control with food which seems to be the loss of emotional control for the person, low self-esteem.

Binge Eating Disorder

Binge Eating Disorder is characterised by eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of feeling embarrassed by how much one is eating, feeling disgusted with oneself, depressed or guilty after overeating.

Eating Disorder Not Otherwise Specified (EDNOS)

This is identified when the characteristics for any other eating disorder are present but not in sufficient severity to diagnose a particular eating disorder. Despite weight loss the individual’s current weight is in the normal range, bingeing and purging are less frequent than for bulimia nervosa, the individual may chew and spit out food while binge eating. In females the individual has regular menstruation.

Causes of eating disorders

All eating disorders are influenced by body image. Dissatisfaction with the body as a whole, or particular parts can lead to an eating disorder. It can also maintain the disorder as the person attempts to reach the desired body shape and size, which is frequently unattainable. Sufferers usually display signs of denial - consciously or unconsciously refusing to admit there is a problem. Denial is a powerful obstacle to treatment and will discourage the sufferer from looking for help.

There is no specific reason for the development of an eating disorder. Different eating disorders are due to a variety of factors:

  • Anorexia and bulimia: evidence of reduced serotonin activity in the brain
  • Anorexia: genetic vulnerability, family history of an eating disorder or obsessive compulsive disorder (OCD)
  • Bulimia can be triggered by food restriction in childhood
  • Binge eating disorder and bulimia can be triggered by ‘normal’ dieting.

Characteristics of both substance abuse and eating disorders:

  • They are chronic diseases
  • They are characterised by denial, secretiveness, rituals and obsessive/compulsive behaviour, pre-occupation with a substance (e.g. drugs, food)
  • They may be life-threatening
  • Sufferers may move from one disorder to another.

Physical risks of eating disorders

  • Anorexia: Low body weight and in extreme cases emaciation, low vitamin and mineral levels leading to electrolyte imbalance which in turn leads to muscle cramps, slow brain function and heart problems; osteoporosis, anaemia, loss of hair, developing a covering of fine body hair, gastric problems, faintness, constipation, oedema (fluid retention), vulnerability to cold and infection, in females menstruation (periods) stops and the sufferer risks fertility loss.
  • Bulimia nervosa: Fertility problems, gastro-intestinal disorders, tooth decay, oesophagitis, fatigue, salivary gland enlargement, brittle nails and dry hair, dizziness/fainting, muscle cramps and weakness, electrolyte imbalance. Some sufferers of bulimia nervosa shop-lift, self-harm and suffer from kleptomania.
  • Binge eating: Reduced sense of feeling full which leads to further eating, obesity and cardiovascular problems.

Eating disorders and addiction

Research indicates that addiction to drugs or alcohol and eating disorders often co-exist. A study in the US found that 30 – 50% of individuals with bulimia and 12 – 18% of those with anorexia are dependent on alcohol or illegal drugs, compared to nine percent of the general population. It also found that 35% of alcohol and drug users have eating disorders, compared to three percent of the general population.(2)

Eating disorders and substance abuse are both long-term illnesses which require intensive therapy to treat. Both involve an obsessive craving and a preoccupation with a substance (food or drugs), both have mood-altering effects, both are compulsive, often secretive and the sufferer will be in denial that there is a problem and continue with the compulsive behaviour despite the negative consequences on their health and in their lives.

It is important that where there is a co-existing eating disorder in a person who is chemically dependent that the sufferer is treated within a personalised programme of individual therapy, group therapy and family therapy for both conditions. If not there is an increased risk of relapse after treatment.

Treatment for eating disorders at Castle Craig

Assessment:

At Castle Craig we treat alcohol and drug addicts who have the additional complication of an eating disorder. Anyone with an eating disorder and chemical dependence will be assessed by the Consultant Psychiatrist and by Glynis Read PhD, Eating Disorders Specialist, as to suitability for admission. Most suffer from Bulimia Nervosa or EDNOS. It is not possible to admit patients of extreme low-weight patients with anorexia.

Patients are assessed according to the following diagnostic tests:

  • The Eating Attitudes Test (E.A.T.). This is used for a measure of the features of Anorexia Nervosa. It has a total score and thee sub-scores: Bulimia, Oral Control & Dieting.(3)
  • The Bulimic Investigatory Test, Edinburgh (BITE). This is an aid to diagnosing Bulimia Nervosa. There are two scales: the Symptom scale which measures attitudes to food and weight, and the Severity scale which is a concrete measure of bulimic behaviours.(4)
  • The Body Shape Questionnaire (BSQ). This is a self-rating scale.(5)
  • Eating Restraint Questionnaire (ERQ). This is used to assess the level of restraint exerted over eating.(6)

Counselling and Therapy

“Cognitive behavioural therapy, in the context of specific eating disorders treatment, offers the best evidence-based treatment so far.” - Glynis Read, PhD. Eating Disorders Specialist, Castle Craig.(7)

Treatment at Castle Craig runs in conjunction with the 12 step treatment programme for addictive behaviour. Eating disorders are viewed as illnesses where a compulsive/obsessive relationship with food has developed leading to a negative body image and low self-esteem which in turn will perpetuate addictive behaviour. At Castle Craig those who have an assosocited eating disorder will be assessed. The environment here is safe and patients are supported by trained and knowledgeable staff enabling the patient to begin the recovery process. Throughout treatment patients’ eating behaviour is closely monitored and weights checked.

CBT

Our eating disorder therapy is based on cognitive behavioural therapy (CBT) and takes place both individually and during group therapy. Patients begin by working through the 12 steps of Obsessive Eaters Anonymous (OEA). They also attend OEA meetings during treatment.

Group therapy provides the basis of treatment. Groups are psycho-educational and as well as providing information, the group assists people to address associated low self-esteem. Individual therapy is tailored to the patient’s needs and supplements the group work. With successful treatment there is a growth in self-acceptance and a gradual lessening of obsessive compulsive behaviours.

Diet and Food Preparation

The chefs provide healthy and nutritious meals and snacks for patients. The consumption of sugars and unrefined flour is discouraged as these may set up craving. The principles of normal eating are adhered to and patients have three meals and three snacks daily. Depending on the stage of recovery meals may be plated and staff members may eat with patients in a caring and friendly environment.

Medical Supervision

Medical supervision includes prescription of food supplements, electrolyte monitoring, weight monitoring, electrocardiogram testing where necessary.

Woman on scales illustration

Do I have an eating disorder?

This short assessment will help you determine if you may have an eating disorder.

The SCOFF questionnaire

  • Do you make yourself Sick because you feel uncomfortably full?
  • Do you worry you have lost Control over how much you eat?
  • Have you recently lost more than One stone in a 3 month period?
  • Do you believe yourself to be Fat when others say you are too thin?
  • Would you say that Food dominates your life?

If you answered “yes” to two of these questions you may have anorexia or bulimia.

Signs to look out for

Family members or friends will notice changes in the appearance and behaviour of someone suffering from an eating disorder. Possible signs to look out for include:

  • Loss of weight
  • A change in eating habits (eating less, binge eating, skipping meals)
  • Frequently mentioning weight and body shape
  • Obsessive calorie counting
  • They may seem depressed/distant
  • Wearing loose clothes to hide a change in figure
  • Experimentation with alcohol or drugs
  • Signs of self-harm
  • Complaining of low energy levels, dizziness, irritable bowel syndrome

Food Addiction Disorder

 

References:
1. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, American Psychiatric Association, 2000

2. Food for Thought. Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse at Columbia University. December 2003. Sourced: http://www.casacolumbia.org/articlefiles/380-Food%20for%20Thought.pdf on 30th March 2011.

3. Garner, D.M., & Garfinkle, P.E. 1979. The Eating Attitudes Test, An Index of Symptoms of Anorexia Nervosa. Psychological Medicine 9: 273-279

4. Henderson, M.& Freeman, C. 1987. A Self-Rating Scale for Bulimia.  The BITE.  B.J Psych.150: 18-24

5. Cooper, P.J. et al. 1987. The Development of the Body Shape Questionnaire.  International Journal of Eating Disorders 2: 15-34.

6. Herman CP & Mack D. 1975. Restrained and Unrestrained Eating. Journal of Personality 43 (4): 647-60.

7. Read, G., and Morris, J. 2008, Body Image Disturbance in Eating Disorders, ABC of Eating Disorders.Ed. Jane Morris, 1843-7. Blackwell.