Difference between obesity and other eating disorders

[Guest guest]

Bulimia and anorexia are about far more than food. Psychiatrist,

Reid, sheds light.

By Cedriann J

Sunday, January 1st 2006

Dr Reid

WOMAN: Why are eating disorders classified as psychiatric conditions

and not lumped together with, say, obesity.

SR: Someone who is overweight may be excessive but their attitude to

food and their self image are normal. With eating disorders there is

an abnormality in the attitude to food and perception of self. With

anorexia, a person has a very distorted self image: even though they

may be very thin they see themselves as fat. With both bulimia and

anorexia the issue of food and eating is intermingled with

psychological control.

WOMAN: I've been told that the distorted self image occurs because

of a chemical imbalance caused by starvation?

SR: That's not accurate. Most anorexics start to diet though they

are not overweight to begin with. As the illness progresses weight

loss will come but that skewed perception remains and intensifies We

accept that these conditions are all chemically-based but we are not

sure what the bio-chemical abnormality is exactly. We do know that

the same chemical indicated in depression, serotonin, is indicated

in bulimia.

WOMAN: So is there a link between eating disorders and depression?

SR: They are two independent disorders. You can have overlap. There

is frequently bulimia / depression overlap and there is depression

in some anorexics. But one is not a manifestation of the other.

Eating disorders are not a type of depression.

WOMAN: Are people with an obsessive-compulsive temperament more

likely to develop an eating disorder?

SR: I would say no. I'd prefer to say that people who develop

anorexia tend to have those personality traits. It's all part of

control issues. They are hard-working and very industrious. Bulimia

is much more common in our setting. It often starts off with an over

weight problem and their issue is wanting to control the weight but

not being able to control the eating. Psychological issues lead to

bingeing, then the bingeing leaves you depressed and miserable so

you purge.

WOMAN: Typically, what is the age of onset?

SR: Adolescence.

WOMAN: I've always thought of eating disorders as a white,

middle/upper class, first world thing. With that in mind, has there

been a surge in the incidence of eating disorders in T & T?

SR: Yes, bulimia is quite common And there's an increase in anorexia

as well. That's from just chatting with colleagues, though. No study

has been done. These eating disorders have a large cultural

component. They are influenced by both psychological and cultural

factors and they're most prevalent in societies where thin is in. In

our setting that very thin look is not the cultural norm. With North

American influence, however, the prevalence is increasing.

WOMAN: But what about the class component? Are we more likely to

find eating disorders in West Moorings than in Morvant?

SR: I'd be cautious with that. I cannot say whether there is class

difference because I can only answer based on my practice.

WOMAN: Let's talk diagnosis. To what extent are local GPs and

dentists trained to detect symptoms and refer patients to

psychiatrists?

SR: It's a matter of awareness. Anorexia is so striking that it's

very likely they would pick it up while treating the medical

complications with self starvation. You really do need a multi-

disciplinary team. Psychiatrists do get the multi-disciplinary

input. It may not be formalised but through the system of referral

people get the attention they need.

WOMAN: And recovery. What does it take? Do you need to have someone

checking how much you eat and following you to the bathroom?

SR: Yes, but in a structured treatment environment. Eating disorder

clinics, which we don't have, would be ideal. With anorexia the

approach is behaviour therapy: strict observation and rewards for

eating and adequate weight gain. With bulimia it's a combination of

behaviour therapy and medication.