Introduction[edit | edit source]
Eating disorders are an important cause of physical and psychosocial morbidity in adolescent girls and young adult women. They are much less frequent in men.
Eating disorders are classified according to the Diagnostic and Statistical Manual of Mental Disorders(fourth edition, text revision) and include: Anorexia Nervosa; Bulimia Nervosa; Eating disorder not otherwise specified; and Pica ( involves an individual eating one (or more) non-nutritive, nonfood substance on a persistent basis for at least one month). However, an individual may have an eating disorder or body image issues and not fulfill strict diagnostic criteria. As a result, diagnosis may be delayed or not achieved at all. Although each eating disorder is defined according to a number of diagnostic criteria, there is considerable overlap and patients may not fit neatly into one category 
The cause of eating disorders is complex and badly understood. There is a genetic predisposition, and certain specific environmental risk factors have been implicated. Research into treatment has focused on bulimia nervosa, and evidence-based management of this disorder is possible. A specific form of cognitive behaviour therapy is the most effective treatment, although few patients seem to receive it in practice.
Eating Disorder Facts[edit | edit source]
Eating disorders are complicated and nuanced disorders and vary from person to person. However, there are some overall eating disorder facts that research has been able to clearly delineate regardless of the individual.
- Eating disorders do not discriminate and are observed in “people of all ages, racial/ethnic backgrounds, body weights, and genders.”
- Eating disorder onset typically occurs in adolescence or young adulthood but is not limited to these life stages.
- There is no one distinct cause of eating disorders. Research has found a number of “genetic, biological, behavioral, psychological, and social factors” that can increase the risk of eating disorder development.
- Eating disorders can be life-threatening and have the highest mortality rate of any mental illness.
- While eating disorders do not have a “miracle cure,” there are numerous evidence-based practices proven to support eating disorder recovery.
Prognosis[edit | edit source]
The prognosis for persons with eating disorders is variable. The long-term prognosis is better with Bulimia nervosa when compared to anorexia nervosa. The binge eating and purging behaviors, duration of more than six years, lower body mass index, low motivation, unstable personality, concurrent depression, higher body image concerns, and dysfunctional relationships are consistently associated with poor treatment outcomes in all eating disorders.
A major challenge in treatment outcomes among individuals with eating disorders is a delay in seeking health care due to low levels of health literacy, stigma, poor affordability, and poor psychotherapy access. Recovery from bulimia nervosa occurs earlier than anorexia nervosa. The majority of individuals with bulimia nervosa recover within 9 to 10 years, but only 50% of individuals with Anorexia nervosa recover within 9-10 years. The mortality rate in Anorexia nervosa is higher than other types of eating disorders and is the highest mortality rate of any psychiatric disorders.
Physiotherapy[edit | edit source]
Eating disorders is a specialist service within mental health where patients with anorexia nervosa and bulimia, including atypical presentations, have complex physiological and psychological problems. Two key features of eating disorders are distorted body image, and compulsive exercising behaviour, with the two often being interrelated, with individuals using exercise as a way of controlling their body weight and shape.
Physiotherapy has a unique role to play in the treatment of eating disorders, as a member of the multidisciplinary team using physical therapeutic interventions and education to help patients overcome their symptoms and to accept their changing body shape as they restore weight. The physiotherapy role within this field encompasses specialist assessment, advice, education, treatment and management of the various physical and psychological components of an eating disorder, and plays a vital role in the management of compulsive exercise, osteoporosis and altered body image.
As well as working individually with patients, many physiotherapists will run educative and practical exercise groups for all stages of illness, recovery and/or weight restoration, appropriate to BMI, taking into account the physical and mental health risks associated with eating disorders.
The key areas that physiotherapy can address when treating an individual with an eating disorder:
- Exercise and Physical Activity
- Body Image and body awareness
- Posture and musculoskeletal conditions
- Osteoporosis and Bone Health
- Anxiety management, relaxation and massage.
Improving Outcomes[edit | edit source]
The coordinated interprofessional team effort involving a clinician, a nutritionist, a psychotherapist, a psychiatrist, nurses, exercise therapist, occupational therapist, pharmacist, and social worker enhances patient care in eating disorders. Early treatment and aggressive multidisciplinary interventions increase the chances of success and lower the likelihood of relapse. Eating disorders cause a substantial economic burden on healthcare resources. Efficient use of available healthcare resources potentially reduces costs to the healthcare system and society. Primary care physicians are vital in recognizing and offering early intervention in eating disorders. Family involvement plays an important role, particularly in the younger patient.
References[edit | edit source]
- RadiographicsRadiology of Eating Disorders: A Pictorial Review Available: https://pubs.rsna.org/doi/10.1148/rg.334125160 (accessed 10.8.2021)
- Fairburn CG, Harrison PJ. Eating disorders. Lancet. 2003 Feb 1;361(9355):407-16. doi: 10.1016/S0140-6736(03)12378-1. PMID: 12573387.Available:https://pubmed.ncbi.nlm.nih.gov/12573387/ (accessed 10.8.2021)
- Eating Disorder Hope what is an eating disorder. Available:https://www.eatingdisorderhope.com/information/eating-disorder (last accessed 10.8.2021)
- Balasundaram P, Santhanam P. Eating Disorders. [Updated 2021 Jun 29]. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan Available:https://www.ncbi.nlm.nih.gov/books/NBK567717/#!po=92.8571 (accessed 10.8.2021)
- Chartered Physiotherapists in Mental Health Physiotherapy in Eating Disorders Available: https://cpmh.csp.org.uk/content/physiotherapy-eating-disorders (accessed 10.8.2021)