MHCC Mental Health Rights Manual

Change font size: SmallerReset textLarger

Chapter 8 Section H: People with Eating Disorders

8H.1: Introduction

Eating disorders, such as Anorexia Nervosa and Bulimia Nervosa are a group of illnesses that have an adverse impact on physical and mental health, and particularly for children, adolescents and young people can have serious consequences for their development. Eating disorders constitute a very significant public health challenge.

In 2012, it was estimated that nearly one million Australians lived with some form of eating disorder. In many cases, these disorders can be life-threatening. Severe eating disorders are not simply ‘lifestyle choices’ being pursued by an individual, they are often a very serious mental health condition that may involve perceptual disturbance (such as false beliefs about one’s own body) and a related severe disturbance of mood.

In this section, we provide an overview of common forms of eating disorder and provide links to sources of additional information, treatment and support services for people with an eating disorder, their families and carers.

8H.2: The most commonly experienced eating disorders

8H.2.1: Anorexia Nervosa

Anorexia Nervosa is a life threatening eating disorder and a serious mental health condition that involves severe intentional weight loss. It has one of the highest death rates of all mental illnesses, with up to 20% of people who develop the disorder dying with 20 years. However, with treatment, most people are able to recover from Anorexia Nervosa, particularly if treatment begins early in the development of the illness. Anorexia Nervosa is a condition that affects both men and women.

People with Anorexia Nervosa engage in severely restricted eating and may compulsively exercise. There are two types of Anorexia Nervosa. One type emphases the restriction of food consumption, while the other type also includes either excessive food consumption (binge eating) followed by purging, or may include purging following the consumption of normal portions, or small amounts of food.

People with the restricting type of Anorexia Nervosa are likely to restrict intake of certain types of food such as carbohydrates or high-fat food, obsessively count their kilojoule (calorie) intake, skip meals and excessively exercise. People with the binge eating and purging type of Anorexia Nervosa have similar symptoms to the restricting type, but they also have behaviours that include binge eating followed by a sense of loss of control, purging following binging or other eating, and compensating for the excess food eaten with techniques such as vomiting, laxatives, enemas and diuretics. Men with Anorexia Nervosa may also use steroids to achieve a muscular and toned body shape.

Untreated and ongoing Anorexia Nervosa can result in serious health problems including weakened bones (osteoporosis), slowed growth in young people, infertility, disorders of the bowel and gut, problems with concentration and thinking, problems with decision-making, and social, emotional and educational problems.

Treatment for Anorexia Nervosa needs to include both physical and psychological health interventions. Multi-disciplinary interventions which may involve contributions from a psychiatrist, psychologist, nutritionist, family therapist, social worker, and occupational therapist are likely to be most effective. Family-based treatment is the most effective treatment recommended for children and adolescents. Cognitive Behaviour Therapy (CBT) is the most researched and recommended treatment for adults with Anorexia Nervosa. CBT aims to change the underlying behaviours and patterns of thinking that have contributed to the development and continuation of the disorder. Other treatment responses may include supplements to achieve better bone strength and psychiatric medications to help stabilise mood.

Most people with Anorexia Nervosa are treated outside hospital, however, if the condition is severe, temporary treatment in hospital may be necessary.

Treatment of Anorexia Nervosa can be challenging if the person refuses to accept treatment and their condition is severe. In these circumstances, if the person has become so cognitively impaired by the condition that they are unable, due to disability, to make decisions regarding their healthcare and treatment, it may be possible to obtain a Guardianship Order which provides or enables substitute consent to treatment to be given. Alternatively, if the person’s condition is associated with acute symptoms of mental illness (for example, delusions about their body, or a severe disturbance of mood), it may be possible for them to be admitted to a Mental Health Facility for mental health treatment as an involuntary patient.

For more information about Guardianship follow this link.

For more information about compulsory mental health treatment follow this link.

For more information about eating disorders, treatments, and support services follow this link.

8H.2.2: Bulimia Nervosa

Bulimia Nervosa is an eating disorder and severe mental health condition. People with Bulimia Nervosa binge eat at least one a week and feel that they have no control over the amount of food they consume or the ability to stop eating. They then try to compensate for their excess food intake using methods such as vomiting, using laxatives and diuretics, fasting, excessively exercising, and using medications inappropriately to control body weight. This cycle of binge eating and exercising is associated with feelings of shame, guilt and self-disgust. The behaviours can become compulsive and obsessive and lead to fixation on food and obsessive thinking about food (eating (or fasting), diet and body image.

Ongoing Bulimia Nervosa can cause physical health problems which may include sore throat, indigestion, heart burn and acid reflux, stomach and intestinal ulcers, chronic problems with the gut such as constipation or diarrhoea from the use of laxatives, which can lead to complications such as prolapsed bowel, weakened bones (osteoporosis), infertility in both men and women, irregular heartbeat or a slow heart rate that can lead to heart failure, and electrolyte imbalance from purging which can cause severe dehydration, damaging nerves, muscles and organs.

People with Bulimia Nervosa tend to have a body weight close to the healthy weight range (as compared with people with Anorexia Nervosa for example). This can make Bulimia Nervosa difficult to detect and diagnose.

Treatment for Anorexia Nervosa needs to include both physical and psychological health interventions. Multi-disciplinary interventions which may involve contributions from a psychiatrist, psychologist, nutritionist, family therapist, social worker, and occupational therapist are likely to be most effective. Family-based treatment is the most effective treatment recommended for children and adolescents. Cognitive Behaviour Therapy (CBT) is the most researched and recommended treatment for adults with Anorexia Nervosa. CBT aims to change the underlying behaviours and patterns of thinking that have contributed to the development and continuation of the disorder. Other treatment responses may include supplements to achieve better bone strength and psychiatric medications to help stabilise mood.

For more information about eating disorders, treatments, and support services see below.

8H. 3: Treatment and support services for people with eating disorders, their families and carers 

The best ways to obtain further information about and access to treatment for an eating disorder is by approaching a General Practitioner, Community Health Centre or Community Mental Health Centre.

If you, or someone you know, is in an emergency situation you should call triple zero 000 to obtain emergency service assistance.

People with eating disorders may experience feelings of hopelessness, anxiety, depression and self-disgust.

If you, or someone you know is experiencing these feelings due to an eating disorder, you can call:
Lifeline for assistance on 13 11 14
Lifeline operates 24 hours a day, seven days a week

*Remember, mobile phone calls to freecall numbers (numbers starting with 1800) and to local call numbers (numbers starting with 13 or 1300) are charged to the caller at the usual mobile rate.

Lifeline also has a variety of online resources, including tool kits and fact sheets which may be of assistance. You can obtain access to these resources by following this link.

The NSW Government has developed a State Service Plan for People with Eating Disorders (2013 - 2018) which is available on the NSW Health Website.The Plan provides an overview of the services available for people with eating disorders, their families and carers in the NSW mainstream health and mental health systems. It also includes Guidelines for the Inpatient Management of Adult Eating Disorders in General Medical and Psychiatric Settings in NSW.

You can find a copy of this Plan by following this link.

The Plan aims to ensure that the NSW Health system is responsive to the needs of people with eating disorders, their families and carers by ensuring that early and effective interventions minimise distress to people with an emerging eating disorder and their families, by preventing the escalation of symptoms in people with eating disorders, and by promoting early recovery and access to specialist care.

The Centre for Eating and Dieting Disorders (CEDD) is a Sydney university based service and support centre that operates on the basis of a collaboration with the Sydney Local Health District and funding from NSW Health’s Mental Health and Drug and Alcohol Office.

CEDD’s website includes a wide range of information and referral points, as well as toolkits and self and other educational resources, relevant to people with eating disorders, their families and carers and to clinicians working with them.

You can find CEDD’s website by following this link.

The Butterfly Foundation is a national non-government organisation which aims to be the leading national voice supporting the needs of people with eating disorders their families and carers. The Butterfly Foundation operates a National ED HOPE Service for people with eating disorders, their families and carers, that includes support over the phone, via email, and on-line. It also provides a wide range of programs for service providers and recovery groups. This includes a range of Positive Body Image workshops for schools and workplaces in recognition of the fact that eating disorders often arise from poor body image.

You can contact the Butterfly Foundations ED HOPE support line on 1800 33 4673 Monday to Friday from 8am to 9pm or Email: support@thebutterflyfoundation.org.au

The National Eating Disorders Collaboration (NEDC) is a national collaboration of government and non-government organisations working in the field of eating disorders. It is funded by the Australian Government Department of Health and Aging and is conducted by the Butterfly Foundation. The NEDC has developed a website which provides an extensive range of information about eating disorders, treatment options, services and supports, and educational resources.

Particular sections of the website focus on information and materials relevant to young people, friends, families and carers, teachers and health professionals.

 DISCLAIMER

  • The legal and other information contained in this Section is up to date to 30 January 2015
  • This Manual only refers to the law and practices applying to the Australian state of New South Wales (NSW) - unless it states otherwise.
  • MHCC does not guarantee the accuracy nor is responsible for the content or the currency of the content of external documents and websites linked to this Manual.