Higher levels of accidents and self-harm or higher rate of prescription for drugs such as antidepressants could be early warning signs that someone has an eating disorder. The results of a large-scale study show that people diagnosed with an eating disorder had higher rates of other conditions and prescriptions in the years before their diagnosis. The findings could give general practitioners (GPs) a better chance of detecting eating disorders earlier.
Eating disorders have high morbidity and the highest mortality of all mental disorders — both from physical causes and from suicide — yet they can be challenging to diagnose. Healthcare costs for eating disorders in the National Health Service (NHS) across the UK have been recently estimated as £3.9–4.6 billion, with an overall economic cost likely to be over £6.8–8 billion per year.
“People with eating disorders are often young and highly vulnerable, yet ambivalent about recovery and may be difficult to engage with treatment. Without specific knowledge of the condition, people with this mental health condition can evade detection, thus delaying time to diagnosis and treatment and influencing long-term outcome. Carers for people with eating disorders experience high levels of strain,” says the study, conducted by Swansea University researchers. They anonymized electronic health records from general practitioners (GPs) and hospital admissions in Wales. A total of 15,558 people in Wales were diagnosed with eating disorders between 1990 and 2017.
Results show that two years before their diagnosis, these 15,558 people had higher levels of other mental disorders such as personality or alcohol disorders and depression; and higher levels of accidents, injuries, and self-harm. They had a higher rate of prescription for central nervous system drugs such as antipsychotics and antidepressants before diagnosis. Another factor identified for this study group was that prior to diagnosis, they had a higher rate of prescriptions for gastrointestinal drugs (for example, for constipation and upset stomach) and dietetic supplements (for example, multivitamins, iron). “These excess diagnoses and prescriptions remained three years after diagnosis. Mortality was raised compared with controls for some eating disorders, particularly in females with anorexia nervosa,” says the paper. The researchers recommend that looking out for one or a combination of these factors can help in their early identification.
“The significance of the findings is that the sheer numbers of patients are well in excess of what is known to specialist eating disorder or even general psychiatric services. This means that the specialist services are catering for only a minority of the total patients in the population, which is something that has been known but not evidenced in the past within the UK. The excess prescriptions by GPs, both before and after diagnosis, indicate that there is nevertheless significant morbidity to be prompting the prescription of medication,” Dr. Jacinta Tan, who led the research, told MEA Worldwide (MEAWW). “The findings have already been fed directly into the Welsh Government’s Eating Disorder Service Review, which I led in 2018. I certainly do plan to research more on this issue,” adds Dr. Tan, who is an associate professor of psychiatry at Swansea University and the Welsh representative of the Eating Disorder Faculty in the Royal College of Psychiatrists.
Eating disorders — such as anorexia nervosa, bulimia nervosa, and binge eating disorder — affect an estimated 1.6 million people in the UK, though the actual figure may be higher as many people do not seek help. Most people are diagnosed during adolescence and early adulthood. Further, according to the American Psychiatric Association (APA), eating disorders affect several million people at any given time, most often women between the ages of 12 and 35.
The findings say that despite the scale of the problem, resources to treat eating disorders are scarce. The research team says that the earlier a disorder can be diagnosed, the better the likely outcome for the patient, and this is where the new research can make a big difference. They recommend better identification and early interventions to considerably reduce the multiple burdens of eating disorders in the future.
“We believe that these findings make a strong case for the implementation of better training for general practitioners in detecting and treating eating disorders, as well as better provision of services for eating disorders. Currently, in the UK, most services only cater to patients who meet stringent criteria, for example, having significant loss of weight. We know that the mortality of eating disorders is the highest of any mental disorders and it is important that we need to ensure that people who have eating disorders and their families can get prompt and appropriate treatment, which can prevent morbidity and mortality, regardless of age, severity, and chronicity,” Dr. Tan told MEAWW.
The study was published on July 1 in the British Journal of Psychiatry by the Royal College of Psychiatrists.