MICHELLE BARRATT PSYCHOLOGY

35 Wondall Road

WYNNUM WEST

Qld 4178

Tel: 0401 924 331 

Fax:  (07) 3009 0553

MICHELLE BARRATT PSYCHOLOGY

Suite 37, Level 1 Benson House,

No. 2 Benson Street, TOOWONG,

Qld 4066.

Tel: 0411 731 516

Fax: (07) 3009 0075

 

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Accreditations

Michelle Barratt is a Fellow of the Clinical College at the Australian Psychological Society. 

 

 

MAIN TOPICS ON THIS PAGE

EATING DISORDER OVERVIEW

WHAT DOES THAT MEAN FOR MENTAL HEALTH

ANOREXIA - Brief write up 

BULIMIA - Brief write up

BODY IMAGE DISTURBANCE

BULIMIA - Main article

ANOREXIA - Main article

 

EATING DISORDER OVERVIEW

Unfortunately, diagnosed Eating Disorders are on the rise, and not only because we are becoming more aware of how Eating Disorders present themselves, but because there is clear statistical evidence that has shown that more people are struggling with an Eating Disorder.  For the most part in our Australian Society, many people who would be reading this page will have either have known someone with an eating disorder, have a family member with an eating disorder, be a parent with a child suspected on an eating disorder, or be wondering themselves if they have an Eating Disorder.  Before we begin understanding the statistical significance of Eating Disorders, we must make it known that Eating Disorders are treatable.

 

The Butterfly foundation (2012) found that 4% of the population in Australia have been diagnosed with an Eating Disorder.  Within that 4%, 47% have binge eating disorder, 12% bulimia nervosa, 3% anorexia nervosa and 38% other eating disorders.   From a gender perspective, 64% of the 4% diagnosed are female, with the mortality rate twice as high with those people diagnosed with an Eating Disorder, but more critical are those diagnosed with Anorexia (Arcelus et al., 2011).

 

Looking at those above the age of 15 years old, suicide has been identified as a major cause of death for people with an eating disorder (Pompili et al., 2006), and between 1995 and 2005 a South Australian study showed the prevalence of disordered eating behaviours doubled among both males and females aged 15 and older (Hay et al., 2008).

 

Further statistics show that eating disorders are on the rise amongst boys and men (NEDC, 2012a), and that as parents we need to take careful care of what our daughters are doing as 15% of young women will experience an eating disorder at some point during their life (Wade, 2006), and that an estimated 20% of females have an undiagnosed eating disorder (NEDC, 2012b).  To finalise the statistics for Eating Disorders, it has been found that Eating disorders are the 3rd most common chronic illness in young women (Yeo & Hughes, 2011). For further statistics, please click on this site:  https://www.eatingdisorders.org.au/key-research-a-statistics

 

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WHAT DOES THAT MEAN FOR MENTAL HEALTH

  • People with eating disorders experience higher rates of other mental disorders with reports of up to 97% having a comorbid condition. The most common of these are depression and anxiety disorders, followed by substance abuse and personality disorders (NEDC, 2010b, 2012a)

  • Adults with eating disorders experience significantly higher levels of anxiety disorders, cardiovascular disease, chronic fatigue, depressive disorders, neurological symptoms and suicide attempts (NEDC, 2012a).

  • Anxiety disorders are experienced by 64% of individuals with an eating disorder. Typically, the anxiety disorder presents before the eating disorder, often in childhood. The most common type of anxiety disorder is obsessive compulsive disorder (Kaye et al. 2004).

  • Personality disorders are experienced by 58% of people with an eating disorder (NEDC, 2010b)

  • Adolescents with diabetes may have a 2.4- fold higher risk of developing an eating disorder (Pereira and Alvarenga, 2007).

BRIEF WRITE-UP FOR THE CRITERIA FOR ANOREXIA - (Please see the main page for Anorexia BELOW)

This is when there is a pattern in the persistent restriction of dietary intake, or obsession with the amount of calories and or exercise a person might partake of (often people try to hide the amount of exercise they do).  This then leads over a relatively short period of time to significant body weight loss.  It can also include the obsession of the above as well as the preoccupation of wanting to lose weight, with an intense fear of gaining weight or becoming fat.  The person is sincerely reluctant to give up these patterns of behaviour, such that it begins to have a significant negative impact on how they have previously lived their life.  Additionally, they begin to have a low or disturbed body image, which greatly begins to impact their self-esteem, as well as refusing to recognise how their behaviour and  management of their weight is impacting their life negatively, and lack the recognition of the seriousness of their current low body weight.  

 

BRIEF WRITE-UP FOR THE CRITERIA OF BULIMIA - (Please see the main page for Bulimia BELOW)

Bulimia in many instances is harder to detect in people simply because they tend to hide it easier.  They have the same amount of body-image disturbance and pre-occupation with body weight and shape as Anorexia, but the difference is that those with Bulimia binge-eat.  Episodes of binge-eating occurs often without those they care about in sight and include the intake of obsessively large amounts of food. This food is also eaten with a lack of control to stop eating the food which is then followed by weight controlling behaviours such as periods of time of dietary restriction, vomiting/purging, or laxative misuse.

BODY IMAGE DISTURBANCE

One would ask how all this begins?  Normally, these behaviours have been shown to begin during adolescence, and a large body of image has been shown to indicate the various reasons, albeit it never being linked to one reason; to that of increased pressure from peers/peer-groups, social media, genetics play a large role, roles and behaviours observied by the child, etc.  As a child begins to grow up, and the developmental process of individuating takes hold, they naturally begin to evaluate their identity and what they mean in their world, and to that of others?  This evaluation includes largely how they perceive themselves and how they believe others perceive them.  With so much pressure on how we look (taking into account their genetic and previous environmental disposition) one of the issues young people or people consider greatly is their body image.  If their self-esteem is low in regards to body-image, there is that possibility they will begin to have a disturbed body image, and so the disturbance begins.  They can become over concerned with how they look, and so engaged in behaviours to rectify these; depending on the level of success hey have, these behaviours might be enforced; such as becoming preoccupied with their calorie intake, how much exercise they engage in, and an over concern with how much they weigh.  The dietary restriction is often the most obvious feature of all of the eating disorders, as well as needing to monitor their weight.  To sustain such control over their behaviour, people begin to implement strict dietary rules concerning what, when and how much food they can eat, and these rules result in rigid and restricted eating patterns.  People often prefer to eat alone, may count calories, struggle with deciding what to eat, avoid eating food of uncertain content, and find their concentration affected by intrusive thoughts about food.

 

The effectiveness of attempts at dietary restriction vary of course, with some sufferers becoming extremely underweight and if not managed, can result in having significant and serious medical repercussions, with at times needing to be hospitalised until they reach an acceptable body weight.  Aside from the physical impact these Eating Disorders can have in regards to sometimes the threat of organ failure, there is significant impact on a persons mental health.  Of co-morbid disorders include depression, anxiety, and social withdrawal.  Unfortunately, their thinking patterns are impacted to such an extent where they begin to see things in black and white (rigid thinking), and can feel a sense of failure, guilt and shame.

Excessive exercise as a way to control weight is another behaviour common across all the eating disorders, and may be used in an attempt to compensate for a perceived or actual episode of over-eating. Binge eating is common and often followed by purging behaviours (self-induced vomiting and misuse of laxatives), again in an attempt to compensate for the over-eating. Social and family relationships are likely to be affected, as are people’s ability to function in recreational, academic and occupational spheres. Depression and anxiety often co-occur with eating disorders.

 

If you or someone close to you experiences any of these difficulties with disordered eating please consider making an appointment with professional who will support you.  

 

Research has found that the earlier you commit or enter into therapy the more effective the treatment.  Please don't hesitate to contact Michelle Barratt Psychology.  We are a Brisbane Clinical Psychologist Practice that is empathic and non-judmental and will be more than willing to support you or anyone else you know through treatment.  Please don't feel the need to continue to feel alone, ashamed or confused.  Make contact with us today, which you a can do through the email form below. It is very quick and easy. 

 

AUTHOR: Michelle Barratt - Brisbane Clinical Psychologist, and Clinical Director of Michelle Barratt Psychology, a Brisbane and Redland Bay based Psychology Practice - Promoting the Therapeutic Care and Therapy for Adolescents and Teenagers and those suffering an Eating Disorder.

 
 
 
 

One of the core problems underpinning Bulimia Nervosa is the skewed perception of a person evaluating their weight and shape, and their control of such.  This specific perspective held by the person suffering this disorder, propels them to introduce extreme weight control behaviours.  Much of these behaviours will include features such as:

  • dietary restriction,

  • excessive exercise,

  • vomiting and/or

  • laxative misuse, and

  • is associated with recurrent binge eating (in which an objectively large amount of food is eaten)

  • accompanied by a sense of loss of control, and 

  • shortly after, intense emotions accompany the person suffering the binge eating disorder experience guilt and shame.

Although binge eating can occur in all kinds of eating disorders, it is most certainly one of the main characteristic features of bulimia.  Binge eating incidents can occur in two forms:  it can either be done objectively or subjectively.  When occurring objective, it is definitely clear that the amount of food consumed is clearly excessive when compared to what would be expected in those particular circumstances.  Or, subjectively, in which the amount of food consumed feels excessive to the sufferer only, and would not be considered excessive by others in similar or normal circumstances.  In either situation, binging is often, but not always followed by purging (self-induced vomiting and/or laxative abuse). 

One of the results of binges, can be the result of under eating, such as dietary restriction and attempts to delay eating.   Unfortunately in these circumstances automatic survival instincts create strong physiological urges to eat.  One of the strategies within the treatment of bulimia in these circumstances is regular eating; such that, clients are asked to eat three planned meals and two or three planned snacks each day, leaving no more than three or four hours between any meal or snack. Fundamentally, eating in this way minimises hunger and usually produces a significant and gratifying reduction in episodes of binge eating.  Unfortunately however, residual binges might linger despite planned eating strategies, but this is normally due to the following three factors:

  • breaking a dietary rule,

  • being disinhibited by alcohol, marijuana etc, and

  • experiencing a distressing or unwanted mood or event (often referred to as “emotional eating”).

When the person suffering Bulimia includes strict dietary rules, the consequence of breaking such rules can be carried out like this: For example, a young woman has a dietary rule about never eating desert after dinner with her family, and thus attempts to strictly adhere to this rule. After dinner one night, she consumes one spoon of desert.  Following this action, it is common then for the woman to feel what we would refer to as “catastrophic thinking”, in that would now feel like a total failure, and could be lead to believe that she has broken all her rules or attempts to succeed in keeping these rules in order to maintain an attempt at dietary control. This catastrophic response in her thinking often leads to an abandonment of dietary control/dietary intake, and thus opens up to the behaviour of bingeing.  It is likely that in this particular instance, she will eat all the desert her mother made for the family that night, and the cascade of events takes place where purging takes place, and then intense feelings of shame, intense regret and guilt.  The consequence of this behaviour enables the strict rules are then reinforced, along the lines of “if only I had stuck to my rule, this would never have happened”. The rule therefore becomes the “good guy”, and the young woman blames herself for lack of strength and self-control.

In fact the reverse is true - the rule is the driver for this entire cycle of events, and the woman is merely responding to a strong physiological urge to eat when hungry. In treatment, dietary rules are addressed and people encouraged to instead adopt dietary guidelines, which by their very nature cannot be “broken”.

 

“Emotional eating” is also often a focus of treatment. Clients are assisted in identifying events or mood states that trigger binge eating and/or purging and, in conjunction with their psychologist, learn alternate ways to deal with distressing and difficult emotions.

STATISTICAL OCCURANCE

Recent research by the Victorian Government found the incidence of bulimia nervosa in the Australian population to be about 5%, and two recent studies estimate that only about 10% of bulimia cases are identified. Research shows that bulimia sufferers typically hide the disorder for 8 to 10 years before seeking treatment, which of course has significant impacts on physical and psychological health. Depression and anxiety are also common in bulimia sufferers. On the positive side, well-researched effective treatments are available, and studies show that 70% of bulimia sufferers who seek treatment report significant improvement in their symptoms. 

If you are concerned that you or someone close to you has a problem with binge eating please consider making an appointment with our specialised psychologists. 

AUTHOR: Michelle Barratt - Brisbane Clinical Psychologist, and Clinical Director of Michelle Barratt Psychology, a Brisbane and Redland Bay based Psychology Practice - Promoting the Therapeutic Care and Therapy for Adolescents and Teenagers and those suffering an Eating Disorder.

 
 

The Main Criteria For A Diagnosis of Anorexia Nervosa.  

There is a persistent desire for thinness, which involves a consistent restriction of dietary intake leading to significant low body weight (Below the BMI of 17).  The person will generally experience extreme levels of fear of gaining weight or becoming fat, hence they will generally incorporate strict patterns of behaviour (restrictive eating, intake of suppositories) that edge them closer and closer to their goal.  What maintains this type of behaviour, are sustained body-image disturbances that consistently skew self-evaluation.  Unfortunately, because most of their endeavours to lose weight are so successful, their insight to recognise their health risk and thus the seriousness of the current low body weight is low.  In turn, this often means that people do not want to either risk gaining weight by seeking professional help or deny they have an issue at all.   

 

Therefore, if you notice your child or adolescent losing weight or developing and maintaining any strict dietary rules, please engage with a Child Psychologist that can professionally assess whether your child has an eating disorder diagnosis and requires urgent medical and psychological support. 

 

RECENT DATA for ANOREXIA NERVOSA 

  • Recent data released by the Victorian Government documents that approximately 1 in 100 girls in Australia will develop Anorexia Nervosa, and 1 in 10 males suffer anorexia.   

  • The onset of anorexia occurs mostly during adolescent or young adulthood (American Psychiatric Association, 2013) with the average age of onset documented at age 17.   

  • Anorexia has the highest mortality rate of any psychiatric disorder (NEDC, 2012b).   

  • It also has a mortality rate that is 12 times higher the annual death rate of women aged between 15-24 years (NEDC, 2010b).  

https://www.eatingdisorders.org.au/key-research-a-statistics 

 

The seriousness of anorexia is clearly formidable.  Therefore, seeking treatment is essential, and most commonly long-term treatment is required to prevent relapse.   

IMPACT and VARIOUS FEATURES OF ANOREXIA 

Anorexia is treated as one of the most serious diagnoses largely because of the considerable physical and psychological implications of being significantly underweight and/or undereating.  Various features are listed below, however please bear in mind that these represent only some of the features that might be present and not all of them, as some might not be visibly present: such as gradual organ failure. 

Physical:  

  • Shaking of hands, dehydration, fainting, low blood pressure, low body temperature, osteoporosis, dizziness, consistent fatigue, always feeling cold, electrolyte imbalance, brittle nails, bruising, dry brittle hair, dry skin, headaches, slow heartrate. 

Weight: 

  • Underweight, significant/extreme sudden weight loss and thinness. 

Mood:  

  • Anxiety, apprehension, depression, guilt, shame, low mood, agitation. 

Behavioural:  

  • Depression, binge-eating behaviour, dietary restriction, social isolation/withdrawal at home, impulsivity, compulsive behaviour, obsessiveness about type of food-intake, binge-eating and then periods of restriction.  

Developmental: 

Delayed puberty, slow growth 

Menstrual: 

  • Irregular menstruation or absence of menstruation 

Gastrointestinal: 

  • Constipation or vomiting 

Psychological effects are generally less well understood in the general population. Knowledge about these effects have come from studies of starving populations and experiments in which volunteers adhered to dietary restriction over an extended period of time. This has led to a concept known as “starved brain syndrome”, which involves problems with thinking, emotional responding and behaviour. Problems with thinking include poor concentration, inflexible thinking and preoccupation with food and eating, often to the extent that other aspects of life are “not within their focus or set values or priorities”.  

Dietary restriction leads to low mood, increased irritability and a flattening-out of normal emotional experience. Anorexia is also associated with heightened obsessiveness, particularly in relation to food and eating such that sufferers may eat their food in very small bites, be extremely pedantic in food preparation, and eat alone and in a highly ritualised manner. In other areas of life this obsessiveness shows itself in reduced spontaneity, or concerns about tidiness and routines. Being underweight causes internal focus and this coupled with the reduced spontaneity and obsessive thinking usually results in quite significant social withdrawal. Often people with anorexia and their relatives believe these psychological phenomena reflect the sufferer’s personality but these psychological effects will largely resolve with enough weight restoration. 

TREATMENT FOR ANOREXIA: 

  1. Depending on the severity of dietary restriction, we might seek an evaluation by a psychiatrist to ensure the client does not need further medicated support. 

  1. Treatment for anorexia will initially primarily focus on weight restoration in order to reverse the effects of starvation on psychological function.  

  1. Treatment can then address maintaining factors of the eating disorder such as pervasive negative self-image valuations regarding weight and shape, and other rules that insist on perfectionist tendencies which often develops symptoms of depression and anxiety.   

  1. Interventions: Cognitive Behaviour Therapy and Dialectical Behaviour Therapy as well as Interpersonal Therapy will support a client developing insight to what’s maintaining their cognitive and emotional inner-world and its’ processes.    

 

Getting timely and effective treatment for anorexia is extremely important. If you or someone close to you is engaging in dietary restriction, or is underweight or undereating please consider making an appointment with one of our psychologists. Please also review other information on on Eating Disorders Overview, Bulimia Nervosa 

AUTHOR: Michelle Barratt - Brisbane Clinical Psychologist, and Clinical Director of Michelle Barratt Psychology, a Brisbane and Redland Bay based Psychology Practice - Promoting the Therapeutic Care and Therapy for Adolescents and Teenagers and those suffering an Eating Disorder.