WE KNEW AND expected that there would be a mental health crisis as a result of Covid-19. This has now arrived.
While our minds instinctively think of anxiety, depression and loneliness as being the main causes of distress – another mental health issue that is perhaps not as visible is the rise in eating disorders.
But really it makes sense.
At their heart, a lot of eating disorders are not necessarily all about food or weight – they are also about control and coping.
Patients often use food as a way of taking control over a situation where they no longer feel that they have any control (Covid-19 anyone?). They can become dependent upon this coping mechanism which gives them security and a sense of control while also causing huge damage.
Significant increase
I am a GP working in Student Health in UCC and have been working with students with eating disorders for a few years now.
In student health centres, we are seeing increasing numbers of students with mental health issues as the pandemic winds ever onwards. People are often surprised when I say that at least 20% of a GP’s time is spent on mental health and that figure is going up, not down.
A quick headcount one of the morning clinics this week revealed that 50% of the patients I saw or spoke to (we are blending in-person with remote consults) had mental health issues as part, or all, of their consultation.
The anxiety out there is huge and understandable. More and more students are coping with anxiety through either restricting their eating or binge eating.
Eating disorders have always been more prevalent than you might realise. While those with severe anorexia are very visible, there are a lot of hidden people with bulimia, binge eating disorder and other types of eating disorders.
The number of people presenting with eating disorders (or coming to their GPs with other symptoms that have their real origins in an eating disorder) has increased significantly since the Covid-19 lockdowns started.
Last week it was reported by Noteworthy that people with eating disorders are presenting “more unwell” to the HSE and mental health services with significant increases in referrals in 2020. This is causing huge distress for patients as well as their families and loved ones.
Prolonged waiting period not helpful
Those with binge eating disorder often feel really guilty and a failure because they can’t control what they are eating . The shame and isolation they feel is very distressing. Nobody has ever come into me complaining of binge eating – they blame themselves and are taken aback when we explore the possibility of binge eating disorder.
Often students who come in are worried they won’t be believed because their weight is (more or less) within the normal range and perhaps, they haven’t been taken seriously in the past because of this. It is absolutely possible to have an eating disorder and not show it and they need our help.
Students with anorexia often feel very conflicted about getting help. We are asking them to give up their (unhealthy) coping mechanism and to do the very thing that scares them most – put on weight.
If you are already uncertain about whether you even want to get better, a prolonged waiting period is not helpful.
These are patients who unfortunately in the past have not been served well by the health services, although with the recent introduction of the National Clinical Programme for Eating Disorders this is (slowly) starting to improve. News of funding for eating disorders in 2021 is cause for hope.
As with all medical conditions, early diagnosis and treatment make all the difference and lead to a much higher chance of recovery. With only three out of 16 Eating Disorder Hubs operating, the need for ring fenced funding is clear.
Not a simple solution
Eating disorders are unusual in that they affect both mental health and physical health so intensely. They can cause huge conflict and misunderstanding – “why doesn’t s/he just eat?”
Unfortunately it is just not that simple. The internal voice driving the eating disorder can be so loud and dominant in the patient’s head that it drowns out the logical self. Yet at the end of the day, food is the medicine.
To get past this conflict, help is needed and often unfortunately hard to come by. Patients can report feeling abandoned or lost while awaiting specialist appointments that could be months down the line.
Bodywhys provide a support service via their website and email – I highly recommend their Pilar programme for parents and carers). The HSE have also developed a really useful app with support and advice from psychologists, dietitians and GPs on issues such as managing mealtimes, body image and tips on how to talk about eating disorders.
Dr Aoife O’Sullivan is a GP at UCC Student Health, president of the Irish Student Health Association and GP clinical lead for the National Clinical Programme on Eating Disorders.
If you need to speak to someone, contact:
SILENT TREATMENT Investigation
Do you want to know if people with eating disorders are being failed by the public health system?
The Noteworthy team want to do an in-depth investigation into the progress of the national clinical programme for eating disorders and what is causing delays in its implementation.
Here’s how to help support this proposed project>
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