Admissions for Eating Disorders Increases, what are the reasons?
Hospital admissions for eating disorders have seen a sharp increase in Ireland during the Covid-19 pandemic. But what is in behind these numbers and what are the reasons for this steep rise? Here Dr. Jane Alexander Ph.D., MA (Couns Psych), BA (Hons), PGCE, and Vice President of Academic Affairs at ICHAS discusses the different types of disorders, what causes them, and also what has caused this alarming spike.
Despite the recent steep rise in inpatient admissions for eating disorders “To date, no Irish study has comprehensively researched the epidemiology of eating disorders in Ireland across the age range” (HSE, 2018). Currently, the HSE does not provide a residential treatment programme for individuals but acknowledges that for complex cases an inpatient stay may be necessary (Eating Disorder Hope, 2021).
The types of eating disorders or the ages and gender of patients of these admissions are unclear but international clinical practice guidelines generally recommend that individuals with eating disorders should receive treatment in outpatient facilities However, hospital care may be the only alternative for those at medical or mental health risk (Hay et al. 2019).
Eating disorder is an umbrella term for anorexia nervosa, bulimia, and binge disorders but the core symptoms are similar. Anorexia Nervosa (AN) is relatively common among young women. The overall incidence rates of AN have remained stable over the past decades, but there has been an increase in the high risk-group of 15–19-year-old girls. It is unclear whether this reflects timelier detection of AN cases or an earlier age at onset. The occurrence of Bulimia (BN) might have fallen since the early 1990s. All eating disorders have a higher mortality risk; the risk is highest in AN. Compared with the other eating disorders, Binge Eating Disorder (BED) is more common among males and older individuals (Smink et al, 2012).
Causes of Eating Disorders
There are many theories about their causes indicating multiple pathways to its development. People experiencing eating disorders suffer from an inability to differentiate hunger from other emotional states. Consequently, they may perceive that feelings of tension indicate hunger and the need to eat or restrict intake (Smink et al, 2012).
Theories about High Expressed Emotion (HEE) may also be relevant to an understanding of the recent rise in hospital admissions (Rienecke et al, 2016). It is known that certain family environments may trigger relapse in those experiencing severe mental illness. Quarantining during the pandemic increases contact between household members and may intensify the focus on the person experiencing an eating disorder.
Providing psychoeducation around the treatment implications of parental criticism in treatment can be useful in helping parents moderate critical feelings they may be experiencing. It was found that even low levels of criticism may be harmful to the recovery of a patient with an eating disorder (Rienecke et al, 2016). Family therapy interventions are recommended for the treatment of eating disorders (Bodywhys, 2021).
What is Behind the Rise in Admissions?
The alarming rise in hospital admissions in Ireland during the pandemic may indicate that this group of people are experiencing further psychosocial pressures with a consequent increase in the severity of the illness. The fear of contagion and of the death of family members has created massive insecurities about the present and the future in the general population. Social distancing creates anxiety, sadness, anger, and loneliness. These reactions are likely to be accentuated for many people experiencing eating disorders who are already isolated in emotional and physical terms (Touyz et al, 2020)
It is known that people experiencing eating disorders already have difficulty in coping with their emotions and they struggle with differentiating various emotional reactions from hunger. The recommendations from a study that investigated these phenomena held that the treatment of eating disorders should focus on helping individuals cope with their emotional reactions. The development of awareness of emotional triggers led to an increase in control and insight into reactions that impacted symptoms (Ruscitti et al, 2016). Counsellors and psychotherapists are well placed to offer these interventions. The pandemic seems to have brought the depth of the eating disorder problem to the surface within an Irish context pointing to the need for a greater focus on the biopsychosocial needs of this group within health services.
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Here is a video where Eating Disorder Hope founder Jacquelyn Ekern & Kirsten Müller-Daubermann of Timberline Knolls discuss body image & self-worth.