What's Normal Anyway? Celebrities' Own Stories of Mental Illness (30 page)

What is the treatment for bulimia?

S
ELF-HELP MEASURES
:
Self-help books or guided self-help have been found to be useful initial treatments for bulimia, and sufferers may also benefit from practising relaxation techniques.

T
ALKING THERAPY
:
A range of talking therapies has been found to be helpful in the treatment of bulimia, including behaviour therapy (BT), counselling, psychotherapy, group therapy, and family therapy. However, cognitive behavioural therapy (CBT) is currently the most popular therapy for bulimia, which typically involves encouraging patients to keep food diaries of what they eat and when, noting episodes of binging and purging; educating them about nutrition and healthy eating patterns; challenging distorted thought patterns and beliefs surrounding body image, weight, food, and self-image; and focusing on strategies to prevent future relapse.

M
EDICATION
:
Antidepressants, usually in the form of selective serotonin reuptake inhibitors (SSRIs), and specifically fluoxetine (Prozac), may also be used in some cases.

What is the prognosis for people with bulimia?

When treated with CBT, around 40–60 per cent of people with bulimia stop their cycles of binge-eating and purging. Among people treated with SSRIs alone, around 30 per cent show an improvement. Up to 70 per cent of people benefit from a combined approach.

What are the risks associated with bulimia?

Health problems that may result from bulimia include a sore throat, tooth decay, constipation, IBS, a stretched colon, bad breath, swollen glands, loss of libido, bad skin, hair loss, lethargy, vitamin and mineral deficiencies, irregular periods, epilepsy, and heart problems. People with bulimia are also more vulnerable to anxiety and depression and more likely to engage in other extreme or impulsive behaviours such as inappropriate sexual encounters, shoplifting, substance misuse, self-harm, and overspending.

What is anorexia?

Anorexia is a type of eating disorder in which sufferers have a distorted view of their body image and are terrified of gaining weight, refusing to keep to a normal body weight and being at least 15 per cent below the average healthy weight for their size. They severely restrict their food intake and/or starve themselves in order to lose weight and often still think that they are fat even when they are life-threateningly thin.

What are the symptoms of anorexia?

People suffering from anorexia may restrict their calorie intake, starve themselves, vomit after eating, and/or use laxatives and diuretics. They may also smoke or chew gum to curb hunger. Even though their weight loss is obvious, and usually occurs over a short time frame, they often try to convince others that they do not have a problem. In order to avoid eating any, or much, food, they may claim to have already eaten, avoid socialising where there is food, deny being hungry, hide food, pick at small amounts on their plate, or pile their plate high with salad or vegetables. They may privately research weight loss methods, obsess about the calories and fat contained in different foods, and constantly weigh themselves and examine their appearance. As they are always hungry they may be preoccupied with the thought of food and often buy and cook it for others. They may also display other obsessive behaviours such as excessive cleaning and washing.

Are there different types of anorexia?

R
ESTRICTING TYPE
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In these cases, sufferers essentially starve themselves by severely restricting what they eat.

B
INGE-EATING/PURGING TYPE
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In these cases, sufferers regularly overeat and then purge.

How common is anorexia?

It is thought that up to 6.4 per cent of adults in England have symptoms of an eating disorder, with 10 per cent of those being anorexic, 40 per cent being bulimic, and the rest suffering from an Eating Disorder Not Otherwise Specified (EDNOS).

Are certain types of people more likely to develop anorexia?

Research has found that anorexia is most common in white middle-class teenage girls in Western countries. People with anorexia have also been found to share certain personality traits, often being perfectionists and high-achievers who have very high expectations of themselves and hate making mistakes. Underneath this they frequently have low self-esteem, lack self-confidence, fear rejection and failure, feel inadequate and are eager to please.

Why do people get anorexia?

It is thought that a number of factors can contribute to the development of anorexia:

G
ENES
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Anorexia is thought to have a strong genetic link. Those with close family members with anorexia are around 30 per cent more likely to develop the condition.

E
NVIRONMENT AND LIFE EXPERIENCES
:
Those with anorexia often come from families with parents who have strict rules, avoid showing emotions or having confrontations, and make negative comments about weight and/or frequently diet. Distressing life events such as leaving home, bereavement, divorce, and illnesses may also be contributing factors.

P
SYCHOLOGICAL FACTORS
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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.

S
OCIETAL FACTORS
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Societies and cultures that idealise thinness are more likely to have higher rates of anorexia.

What is the treatment for anorexia?

T
ALKING THERAPIES
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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.

M
EDICATION
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Medication may also sometimes be used, usually in the form of selective serotonin reuptake inhibitors (SSRIs) or Olanzapine, an atypical antipsychotic.

H
OSPITALISATION
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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.

T
ALKING 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).

M
EDICATION
:
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.ocdaction.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.