It is often difficult to define when a perfectly understandable preoccupation with food develops into an eating disorder. In our body image obsessed society, many of us worry about our weight and feel, at times, out of control of our eating patterns. Equally, most of the 1.6 million people in the UK estimated to have a defined eating disorder would struggle to pin-point the time when their eating patterns became profoundly disordered and harmful to their overall health and well being.
Experts at St George's Hospital in London, which provides the largest child and adult eating disorder service, developed five simple questions to help assess eating disorder risk. The questionnaire – called SCOFF – was designed to help GPs quickly work out whether an individual is likely to have an eating disorder and needs a full assessment by a specialist. The five questions are:
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?
You are given one point for every ‘yes' and a score of two or more indicates you are likely to have anorexia nervosa or bulimia. It is not, however, a diagnosis, which must be made by a specialist working in an eating disorders clinic. The specialist may be a psychiatrist, a psychologist or an experienced nurse.
If the concern is that you may have anorexia, the specialist will consider whether you have key physical and psychological symptoms. These are:
However, specialists will not only consider these three features. Men with anorexia, for example, may have a BMI which is higher than 17.5kg/m, but rather than driving for weight loss, their focus may be on muscle definition and extreme over-exercising to achieve this. The specialist will consider other aspects of your behaviour towards food. These include:
If you suspect that you may have anorexia, it is very important that you see a health professional as soon as possible, ideally your GP. Your GP will be able to make an initial assessment then refer you to an eating disorder clinic for a full diagnosis. For the majority of people, it is possible to treat anorexia within an eating disorder clinic on an outpatient basis. This means you are not admitted to the clinic to stay overnight for a period of time (this is called inpatient treatment), but instead visit the clinic once or twice a week for sessions with a psychologist, psychiatrist or other professionals, such as a dietitian or family therapist. For those with a more severe disorder, inpatient treatment may be required. Anorexia is a serious, complex disorder with the highest mortality rates in psychiatry (15 to 20 per cent). The most poor prognosis is for people with a long period of time between onset of anorexia and treatment, during which patterns become increasingly entrenched and difficult to treat.
In very general terms, bulimia nervosa is easier to define and tends to have a better overall prognosis. The key behaviour is binge eating followed by a purge (vomiting, use of laxatives or over-exercising) to compensate for the intake of calories. Although most people ‘binge' from time to time, such as during Christmas, then compensate with a New Year diet, for example, there are distinctive features for bulimia. In a recent book, ‘Bulimia, Binge-eating disorder and their treatment', Dr Bryony Bamford and Amy Brown, Professor Hubert advise: "It is the frequency and persistence, coupled with distress that stamps binge-eating as an illness."
Some people with mild bulimia, it may be beneficial to follow a self-help guide, such as the one referenced above, before seeking treatment in an eating disorder clinic. Cognitive behavioural therapy (CBT) is a well established an effective means of treating bulimia, by addressing the painful and negative thoughts and feelings which trigger the cycle of bingeing and purging. But many people will benefit from professional support provided by a specialist at an eating disorder centre, using a psychologist providing weekly sessions of one hour's duration to help you through the CBT to address your disorder. Although the mortality rates for bulimia are much lower than those for anorexia, it is also imperative to seek specialist treatment and help as soon as possible, for the disorder has a very harmful impact upon your health and psychological well being.
Experts at St George's Hospital in London, which provides the largest child and adult eating disorder service, developed five simple questions to help assess eating disorder risk. The questionnaire – called SCOFF – was designed to help GPs quickly work out whether an individual is likely to have an eating disorder and needs a full assessment by a specialist. The five questions are:
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?
You are given one point for every ‘yes' and a score of two or more indicates you are likely to have anorexia nervosa or bulimia. It is not, however, a diagnosis, which must be made by a specialist working in an eating disorders clinic. The specialist may be a psychiatrist, a psychologist or an experienced nurse.
If the concern is that you may have anorexia, the specialist will consider whether you have key physical and psychological symptoms. These are:
- Intentional weight loss leading to a body mass index of less than 17.5 kg/m
- Phobia of normal body weight and body image distortion. Anorexia is sometimes inaccurately described as a ‘fear of being fat'. In fact, a person with anorexia has an intense fear of being at a normal weight, which they perceive as ‘being fat'.
- Amenorrhoea (loss of libido/erectile dysfunction in men)
However, specialists will not only consider these three features. Men with anorexia, for example, may have a BMI which is higher than 17.5kg/m, but rather than driving for weight loss, their focus may be on muscle definition and extreme over-exercising to achieve this. The specialist will consider other aspects of your behaviour towards food. These include:
- Abnormal means of weight control, such as over-exercising and vomiting
- Excessive calorie counting
- Very frequent weighing
- Eating slowly and cutting up food very small
- Chewing food and spitting it out
If you suspect that you may have anorexia, it is very important that you see a health professional as soon as possible, ideally your GP. Your GP will be able to make an initial assessment then refer you to an eating disorder clinic for a full diagnosis. For the majority of people, it is possible to treat anorexia within an eating disorder clinic on an outpatient basis. This means you are not admitted to the clinic to stay overnight for a period of time (this is called inpatient treatment), but instead visit the clinic once or twice a week for sessions with a psychologist, psychiatrist or other professionals, such as a dietitian or family therapist. For those with a more severe disorder, inpatient treatment may be required. Anorexia is a serious, complex disorder with the highest mortality rates in psychiatry (15 to 20 per cent). The most poor prognosis is for people with a long period of time between onset of anorexia and treatment, during which patterns become increasingly entrenched and difficult to treat.
In very general terms, bulimia nervosa is easier to define and tends to have a better overall prognosis. The key behaviour is binge eating followed by a purge (vomiting, use of laxatives or over-exercising) to compensate for the intake of calories. Although most people ‘binge' from time to time, such as during Christmas, then compensate with a New Year diet, for example, there are distinctive features for bulimia. In a recent book, ‘Bulimia, Binge-eating disorder and their treatment', Dr Bryony Bamford and Amy Brown, Professor Hubert advise: "It is the frequency and persistence, coupled with distress that stamps binge-eating as an illness."
Some people with mild bulimia, it may be beneficial to follow a self-help guide, such as the one referenced above, before seeking treatment in an eating disorder clinic. Cognitive behavioural therapy (CBT) is a well established an effective means of treating bulimia, by addressing the painful and negative thoughts and feelings which trigger the cycle of bingeing and purging. But many people will benefit from professional support provided by a specialist at an eating disorder centre, using a psychologist providing weekly sessions of one hour's duration to help you through the CBT to address your disorder. Although the mortality rates for bulimia are much lower than those for anorexia, it is also imperative to seek specialist treatment and help as soon as possible, for the disorder has a very harmful impact upon your health and psychological well being.
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