by Anna Gekoski
PSYCHOLOGICAL FACTORS: People with anorexia may often feel out of control in their lives, or an aspect of their lives, and use the condition as a way to regain control. They may also suffer from a large amount of internalised anger and rage that they are unable to express.
SOCIETAL FACTORS: Societies and cultures that idealise thinness are more likely to have higher rates of anorexia.
What is the treatment for anorexia?
TALKING THERAPIES: Counselling, cognitive behavioural therapy (CBT), group therapy, and family therapy are all commonly employed. Advice on nutrition and how to gain weight safely (such as eating small amounts of food regularly) are also given.
MEDICATION: Medication may also sometimes be used, usually in the form of selective serotonin reuptake inhibitors (SSRIs) or Olanzapine, an atypical antipsychotic.
HOSPITALISATION: If the sufferer is dangerously underweight then they may need to go to a hospital or clinic which will run a series of physical health checks, help the sufferer to start eating normally again, monitor their weight gain, and control their anxiety about this. In rare cases, when the condition is severe and the sufferer refuses help, they may be detained under the Mental Health Act (‘sectioned’).
What is the prognosis for people with anorexia?
Those suffering from anorexia are usually ill for an average of 5–7 years and over half of those recover from the condition. However, people with anorexia have the highest death rate of all mental illnesses, with around one in five of those whose condition is severe enough for hospitalisation dying. The death rate is much lower in people who have ongoing support and medical help.
What are the risks associated with anorexia?
Anorexia is associated with numerous physical problems, from the mild to the life-threatening. Those with anorexia may suffer from constipation, abdominal pain, bloating, dizziness, fainting, feeling cold, poor circulation, dry/rough/mottled skin, sleep disruption, increased body hair, dehydration, electrolyte imbalances, epilepsy, anaemia, infections, low blood pressure, difficulty concentrating, brittle bones (which can lead to osteoporosis), organ damage, and heart problems, which may be fatal. Girls and women may also stop having their periods, leading to infertility.
Who can I contact for help if I think I have bulimia or anorexia?
Your first point of contact should be your GP, who may recommend a range of treatment options depending on the severity of your condition, from self-help measures, a referral for CBT or other therapy, dietary advice, and medication. If you have bulimia it is very unlikely that you will need to be hospitalised; however, if you suffer from anorexia and are dangerously underweight then hospitalisation may be necessary. In addition, the below organisations may be able to offer help, support, and advice:
Beat (Beating Eating Disorders)
Tel: 0845 634 1414 (adult helpline)
Tel: 0845 634 7650 (youthline)
Web: www.b-eat.co.uk
Anorexia and Bulimia Care (ABC)
Tel: 030 00 11 12 13
Web: www.anorexiabulimiacare.org.uk
MGEDT (Men Get Eating Disorders Too)
Web: http://mengetedstoo.co.uk
Please see the ‘Useful contacts and links’ pages for more resources and organisations which may be able to help, including national mental health charities such as Mind, Sane, and Rethink.
Body dysmorphic disorder (BDD)
What is BDD?
People with BDD are excessively concerned about their body image, with sufferers often becoming obsessed over perceived ‘imperfections’ on their body or face. They frequently think that such ‘flaws’ make them ugly or disgusting, which has lead to the disorder sometimes being referred to as ‘Imagined Ugliness Syndrome’.
What are the symptoms of BDD?
People with BDD may spend hours every day preoccupied by their perceived defect(s), most frequently involving the nose, eyes, skin, lips, mouth, chin, jaw, and general build. Sufferers, for example, may think that their body parts are the wrong shape or size; they may be concerned over wrinkles or acne; and may obsess over hair loss or receding. They may constantly look in mirrors (or avoid their reflection), examine the part of themselves they are unhappy with, compare themselves to others, and seek reassurance about how they look. As they often see themselves as ugly or abnormal (and think others must too) they may try to hide their ‘defect(s)’ with make-up, hats, clothing, and the avoidance of bright lights. A diagnosis of BDD is made when these symptoms cause significant distress or disrupt daily life.
How common is BDD?
It is difficult to estimate how common BDD is as sufferers usually believe that they have an actual physical problem so do not seek psychological help. However, it is thought that 1–5 per cent of the population may be affected, with 12–15 per cent of people seen by dermatologists and cosmetic surgeons suffering from BDD.
Are certain types of people more prone to developing BDD?
BDD usually starts early in life, when children or adolescents are very sensitive about how they look, although it can also begin in adulthood. Well-educated people who work in an artistic field may also be particularly prone to BDD.
Why do people get BDD?
There has been little research into why people develop BDD. However, like most mental illnesses, there may be genetic, environmental, and psychological factors involved. It is thought that bullying, teasing, and abuse in childhood, resulting in low self-esteem, may play a particular role in the development of BDD.
What is the treatment for BDD?
Many people with BDD consult cosmetic practitioners, rather than seeking psychological help, as they believe that correcting the ‘defect’ will make them happy. However, cosmetic procedures do not generally work, as the person often doesn’t like the results or just begins to obsess about another body part. In extreme cases, sufferers may undergo repeated cosmetic procedures.
TALKING THERAPIES: When psychological help is sought, sufferers are usually offered self-help literature and cognitive behavioural therapy (CBT). During CBT the sufferer may be encouraged to challenge their negative thoughts and beliefs about their body image; learn how to curb obsessive rituals and behaviours (such as constantly looking in the mirror); and be exposed to situations that make them anxious (such as not hiding the perceived flaw).
MEDICATION: Antidepressants, usually selective serotonin reuptake inhibitors (SSRIs) – and specifically fluoxetine (Prozac) – may also be prescribed.
What is the prognosis for people with BDD?
Talking therapy and/or medication can often improve the quality of life for BDD sufferers, although for some the condition may be chronic.
What are the risks associated with BDD?
BDD may affect many aspects of sufferers’ lives – including their education, social life, and work – as they think that other people are judging how they look, which may lead to unemployment and isolation (to the extent that some people become housebound). People with BDD also frequently suffer from other mental health conditions, such as depression, OCD, and/or social anxiety, and may have substance abuse problems. Some people with BDD may self-mutilate – attempting cosmetic or corrective procedures on themselves – and also have suicidal thoughts or attempt suicide.
Who can I contact for help if I think I have BDD?
Your first point of contact should be your GP who may offer you self-help materials, refer you for CBT, and/or prescribe an antidepressant. They may also be able to refer you to a support group (online or in person) where you can share experiences with other people with BDD. If more treatment is needed then the local community mental health team (CMHT) can assess you and may refer you to a specialist BDD clinic, although unfortunately waiting times are frequently long. In addition, the below organisations may be able to offer help, support, and advice:
The BDD Foundation
Web: www.thebddfoundation.com/index.htm
OCD Action
Tel: 0845 390 6232
Web: www.oc
daction.org.uk
OCD-UK
Tel: 0845 120 3778
Web: www.ocduk.org
Anxiety UK
Tel: 08444 775 774
Web: www.anxietyuk.org.uk
Please see the ‘Useful contacts and links’ pages for more resources and organisations which may be able to help, including national mental health charities such as Mind, Sane, and Rethink.
Glossary of terms
Anticonvulsants are medications used primarily to treat epilepsy, which work by suppressing the excessive firing of neurons in the brain that trigger seizures. However, some anticonvulsants may also be used to treat mental health conditions. For example, sodium valporate may be used as a mood stabiliser for people with bipolar disorder, and pregabalin may be prescribed for generalised anxiety disorder.
Antidepressants are psychoactive drugs used for the treatment of depression and other mental health conditions. They include different classes of medication, such as selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs). They work by increasing the levels of certain neurotransmitters in the brain, such as serotonin and norepinephrine, which improve mood.
Antipsychotics or neuroleptics are psychoactive drugs used mainly to treat psychotic conditions such as schizophrenia. However, antipsychotics may also be used in the treatment of other mental health disorders, such as bipolar disorder, severe anxiety, and depression. There are two classes of antipsychotic drug: typical (e.g. chlorpromazine) and atypical (e.g. quetiapine). While both work by blocking the effects of dopamine, atypical antipsychotics also affect serotonin.
Assertive outreach teams work with people who are experiencing the most severe kinds of mental illness who are unable to engage with, or who have lost touch with, mainstream services.
Behavioural therapy (BT) is based on the premise that behaviour is learnt and, therefore, can be unlearnt. As a type of therapy, it may include systematic desensitisation, aversion therapy, and flooding. Flooding, for example, is a technique that may be used to overcome phobias, involving exposing the patient to their feared object or situation until their fear subsides. The therapist may help the patient during this process by using relaxation techniques.
Benzodiazepines (BZDs, ‘benzos’, or ‘tranquillisers’) are psychoactive drugs that work by enhancing the chemical GABA in the brain, producing calming effects. They reduce anxiety, promote sleep, relax muscles, have anticonvulsant properties, and are sedating. Although they are very effective for anxiety states, they are usually only used as a short-term treatment due to their addictive qualities. Diazepam (Valium) is an example of a benzodiazepine.
Beta-blockers are medications that block the release of adrenaline and noradrenaline in various parts of the body. Although they are usually used to treat heart problems and high blood pressure, they may also sometimes be used to treat the physical symptoms of anxiety, such as palpitations and shaking. However, they do not help the mental symptoms of anxiety, such as feelings of worry or dread.
Cognitive behavioural therapy (CBT) is a type of talking therapy that focuses on the here and now rather than the past. It attempts to change the way a person thinks (their cognitions) and how they respond to these thoughts (their behaviour). It may, for example, involve identifying and challenging negative and unhelpful thought patterns and replacing them with positive ones, leading to beneficial behavioural change. It is frequently used to treat depression, anxiety, and eating disorders.
Community mental health teams (CMHT) are made up of different types of professionals – such as psychiatrists, social workers, community psychiatric nurses, and support workers – who work together to give care to people with mental illness.
Cortisol is a steroid hormone released by the adrenal gland. It is sometimes known as a ‘stress’ hormone as it is released into the bloodstream in response to stress.
Crisis services are services available at short notice to support people through an acute mental health episode. Available on the NHS or through charities, such services can be in the form of telephone helplines, acute inpatient wards in hospitals, and/ or crisis resolution and home treatment (CRHT) teams.
Delusions are irrational and illogical beliefs that may occur in certain mental illnesses, such as schizophrenia. Somebody experiencing delusions may think, for example, that their phone is a mind-control device or that they are being followed or monitored by a law enforcement agency.
Dopamine is a neurotransmitter produced in the brain which is often known as a ‘feel good’ chemical as it controls the brain’s reward and pleasure centres.
Early intervention services (EIS) are local teams – made up of experts such as psychiatrists, psychologists, social workers, support workers, and occupational therapists – who give help and support to people who have recently experienced their first psychotic episode.
Electroconvulsive therapy (ECT) involves having an electrical current passed through the brain while under general anaesthetic. It is usually only used in cases of severe clinical depression that have not responded to other treatment. It is unclear exactly how ECT works but it can be very effective in the short term, although it doesn’t seem to stop depression coming back in the future.
Exposure and response prevention (ERP) is a type of therapy, used particularly in anxiety disorders such as phobias and OCD. Used in the treatment of OCD, it involves a patient, guided by their therapist, being exposed to what they most fear, without then compensating with compulsive behaviours. For example, a person with a fear of germs might be encouraged to gradually build up to touching a toilet seat without washing their hands afterwards. If the patient is able to complete the course of therapy it has been found to be very effective.
Gamma-aminobutyric acid (GABA) is a neurotransmitter that helps to regulate over-excitement of the nervous system. Drugs that enhance GABA – such as benzodiazapines – have a calming effect.
Hallucinations can affect all of the senses and may involve hearing, seeing, smelling, tasting, or feeling things that aren’t actually there. For example, people experiencing hallucinations may hear voices in their head or feel as if there are insects crawling on their skin. Hallucinations may be symptoms of a mental illness such as schizophrenia or may be induced by drugs, alcohol, or a physical illness (such as infection).
Interpersonal therapy (IPT) is a type of therapeutic approach that views psychological symptoms as being a response to current problems and conflicts in the relationships in a person’s life. As a therapy, it is structured and time-limited, usually performed over a course of between eight and sixteen sessions.
Monoamine oxidase inhibitors (MAOIs) are an older form of antidepressant drug that are usually only used today when other medications haven’t worked. They have to be used with care as they can interact dangerously with foods that contain high levels of tyramine, such as aged cheeses, fermented foods, liver, alcohol, yeast, and some meats. Eating such foods while taking MAOIs may result in seriously high blood pressure and, in severe cases, can be fatal.
Neurotransmitters are chemical substances that transmit signals between nerve cells in the brain.
Norepinephrine/noradrenaline is a neurotransmitter and hormone. It is commonly known as a ‘stress hormone’ or ‘fight or flight chemical’ as it underpins the body’s ‘fight or flight’ response, speeding up the heart rate, raising blood pressure, narrowing blood vessels in non-essential organs, and dilating pupils.
Psychiatrists are medical doctors who go on to specialise in the diagnosis and treatment of mental health disorders. Unlike psychologists, they are able to prescribe medication.
Psychoanalysis is a type of psychotherapy, initially developed by Sigmund Freud. Its underlying premise is that early childhood experiences provide unconscious patterns which affect a person’s psychological well-being and functioning into adulthood. In psychoanalysis such patterns are brought back into conscious awareness
so that a patient can understand what is creating their mental distress.
Psychologists are specialists in human behaviour. Clinical or counselling psychologists are trained to work with people with mental health conditions. They may work in various settings, such as hospitals, health centres, or privately.
Psychosis is a general term that describes mental states where people are out of touch with reality. Psychotic symptoms may include hallucinations, delusions, and muddled, disordered, and jumbled thinking. Psychosis is not a mental health disorder in itself but may be a symptom of other disorders, such as schizophrenia or bipolar I disorder. Psychotic symptoms may also be brought on by traumatic events or by some physical illnesses (such as infections).
Psychosomatic symptoms or somatisation is the tendency to experience and express psychological distress in the form of physical symptoms such as chest pain, palpitations, headaches, nausea, insomnia, dizziness, and fatigue.
Psychosurgery/neurosurgery involves using brain surgery to treat mental illness, by destroying or removing a small piece of the brain. Today, psychosurgery is very rarely used in the UK and can only be carried out with the patient’s permission.
Psychotherapy is an umbrella term that generally refers to the process of talking therapy conducted by a trained therapist with a patient experiencing psychological distress. The treatment aims to increase the patient’s sense of well-being and improve their mental health. Psychotherapy may also encompass non-talking therapies such as art, drama, or music therapy.
Schizophrenia is a mental illness that affects the way that a person thinks, feels, and behaves. The symptoms of schizophrenia are often classed as ‘positive’ and ‘negative’. Positive symptoms include hallucinations, delusions, and jumbled thinking (‘not thinking straight’). Negative symptoms may include memory problems, an inability to concentrate, becoming isolated, problems communicating with other people, and loss of interest in usual activities.