The information below has been written and compiled by the ABC registerd nurse, and the ABC registered dieticitan. Please read the information, use it and share as you see a need in your befriending role.
When does excercise become compulsive excercise?
Exercise, how much? How often?
Glossary of Terms
In some instances, anxiety has preceded the onset of the eating disorder. For instance, a person who is struggling with severe anxiety feels that they are able to control one or more aspects of their life, such as food, weight, and exercise. This behaviour indirectly gives the sufferer a false sense of control, which can temporarily relieve symptoms experienced due to anxiety. The anxiety caused by gaining weight can also cause real concern for many of ABC's service users. This anxiety, along with everyday stresses such as jobs, relationships etc. can sometimes feel overwhelming. To help your Befriendee it is useful to explain how anxiety can affect the physiology in the body, and to outline some strategies to deal with these anxieties as they occur.
Physical effects; Shortness of breath, chest pain, heart palpitations (always seek medical advice for these symptoms), headaches, sweating, muscle weakness.
Emotional effects; Irritability, restlessness, feelings of tension.
Other behavioural effects; Alteration in sleeping patterns, social withdrawal
This is why treatment considerations for an individual suffering from an eating disorder include therapies such as cognitive-behavioural therapy (CBT) and in some services dialectical behavioural therapy (DBT). These therapies focus on managing anxiety.
In the short term the best advice is to encourage the person who is battling the eating disorder to share how they are feeling, ideally by talking;
Tell friends and family how they are feeling and what they can do to help and support.
Talk to a GP or therapist for professional help.
Access support and help from ABC via our phone line on 03000 11 12 13 or via email on email@example.com
When people starve, they deprive themselves of essential nutrients. Nutrients help develop neurotransmitters and noradrenaline. The body uses noradrenaline for all sorts of things but one of the things it does is makes us anxious. So, if we starve ourselves we lose the nutrients that give us noradrenaline, our noradrenaline levels drop and we feel less anxious. Consequently people who have very high levels of anxiety find themselves less anxious when they’re not eating, this in turn reinforces the pattern of not eating. This is one of the reasons that anorexia is so difficult to treat, it’s one of the very few illnesses where people don’t want the treatment because they actually feel better with the illness than without it.
- Brian Lask, Emeritus Professor in Child and Adolescent Psychiatry at the University of London. To read more of Brian Lask's exceprt from a radio 4 Inside Health podcast click here
There are several important things to consider when taking antidepressants, this should be discussed with the GP or mental health professional.
Interactions with other medications; Antidepressants can react unpredictably with other medications, including over-the-counter medications such as ibuprofen. It is important to always read the patient information leaflet that comes with any medication to see if there are any medications that should be avoided. If in doubt, the pharmacist or GP should be able to advise.
Pregnancy: As a precaution, antidepressants are not usually recommended for most pregnant women, especially during the early stages of a pregnancy. However, exceptions can be made if the risks posed by depression (or other mental health conditions) outweigh any potential risks of treatment. Potential complications that have been linked to antidepressant use during pregnancy include: loss of the pregnancy, birth defects affecting the baby’s heart (congenital heart disease), a rare condition in newborns called pulmonary hypertension, where the blood pressure inside the lungs is abnormally high, causing breathing difficulties.
However, there's no hard evidence that antidepressants cause these complications. If your Befriendee is pregnant and depressed, she should be encouraged to discuss the pros and cons of antidepressants with her GP. If antidepressants are recommended, they will usually be a type called a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine.
ABC often receives calls and emails from people who use laxatives to excess. Some people with eating disorders abuse laxatives because they believe they can remove food from their bodies before the calories are absorbed. Laxatives remove lots of water from the colon or large intestine as well as food residue. Laxatives and enemas cannot stimulate the small intestine, the upper part of the digestive tract where food is digested and where nutrients and calories are absorbed. The small intestine does not even have the kinds of nerves that occur in the colon.
The scales may indicate "weight loss" after a laxative-induced bowel movement, but it is false weight loss. The ounces or pounds return as the body rehydrates. It is very important to rehydrate otherwise you risk dehydration which can lead to fainting spells and imbalances in the electrolytes. Electrolytes are minerals like sodium and potassium that are dissolved in the blood and other body fluids. They must be present in very specific amounts for proper functioning of nerves and muscles, including the heart muscle.
In order to avoid becoming dependent on laxatives ,and to have any kind of bowel movement at all, it is very important to eat enough food. Foods such as fruit and vegetables, pulses and wholegrains are recommended.
It is possible to recover from laxative misuse; however, it is always advisable to seek support from the GP in order that your physical and mental health can be monitored.
At ABC, we always advise our callers who are suffering with eating disorders to have regular medical monitoring. This is important for many reasons but the following information focuses on the heart and highlights why early recognition and treatment of an eating disorder is essential to prevent and minimise health risks.
In people with both short term and longstanding exposure to Anorexia, the heart walls can thin and weaken because the heart muscle loses mass (this is just like the muscles that you can see in your arms and legs). This then can cause the heart chambers to enlarge and alter the pumping mechanism of the heart. Fortunately, with weight restoration and replenishment of essential vitamins and minerals the heart muscle often recovers.
A number of abnormal heart rhythms can occur with Anorexia. One is that the heart beats slowly, a pattern called bradycardia. This is a particular problem in people who have weak heart muscles. Another concern is fast abnormal heart rhythms. People tend to be most sensitive to these types of rhythms if they follow a pattern of binge eating and purging. This can result in dangerous shifts and loss of body electrolytes such as sodium, potassium, and magnesium. The electrical aspects of the heart that create heartbeats are critically dependent on these electrolytes. When they are unbalanced, unstable electrical patterns can develop in the lower heart chambers that can result in cardiac arrest.
People with anorexia can experience severe lightheadedness and fainting spells. This can sometimes be due to the loss of the autonomic regulation of the heart and blood vessels which can cause huge drops in blood pressure when doing normal things like standing or walking. (It is also important to rule out anaemia and hypoglycemia if experiencing these symptoms.)
Blood pressure and heart rate should be checked and a blood sample can be taken at a GP assessment. If appropriate the GP will also organise an ECG to monitor any abnormal heart rhythms. These checks can help ensure that the heart is consistently healthy as it is one of the organs that is most vulnerable to anorexia.
When does Exercise become Compulsive Exercise?
It is well known that some exercise is good for physical and emotional health. However, this information is often interpreted in a different way by those who are struggling with an eating disorder when exercise can be used as a compensation for eating.
It is common for people to take up a sport or activity but for those with eating disorders this can esculate into a punishing daily routine, perhaps for several hours a day; they are driven by the belief that if they don’t complete their routine, then they would not deserve to eat and by the fear that if they do not complete their exercise regime then something awful will happen. They will continue to pursue this schedule through tiredness and fatigue, even when their body is screaming to stop.
It is important to remember that a body needs energy to benefit from exercise.When a ‘well’ body exercises, it uses the food that has been consumed to provide that energy. When done properly, the body adapts to training by strengthening the muscles involved and this allows for achievement and progression within the given sport.
When there is not enough energy this cannot happen. By exercising and restricting food intake the body will have to use existing energy stores; this includes the essential fat that surrounds and protects the vital organs. In addition, the body will break down existing muscle to provide energy.
In this instance exercise is not strengthening the body. It is wrong to think that by constantly running or cycling or swimming without correct energy intake will lead to skills improvement; often there will be a decline in times and speed. There is a risk that the person will see the lack of skill and stamina development as a sign that they are not doing enough and in response will push themselves harder.
Without sufficient fuel, the body will not be able to “spare” energy for the exercise. This is often why as an eating disorder progresses, even if the individual is doing excessive amounts of exercise, weight loss will be slowed. This is frustrating for the person who will try to restrict calories further and/or increase exercise to boost weight loss.
When a body is severely underweight it will preserve energy to keep the body alive. This is why a person with an eating disorder will feel cold all the time, will be unable to sleep, will have a low pulse and heart rate and will find it very difficult to concentrate or follow the thread of a conversation.
Exercise, How much? and How often?
Stopping exercise is hard, especially as we are constantly bombarded with messages about how we need to keep active. For individuals with a BMI of 17.5 or under, or for children with a weight for height ratio below 85%, all exercise and PE lessons should be stopped.
For those who are wishing to re-introduce exercise the following points must be applied.
1. People wishing to exercise must be within the normal weight range as a minimum.
2. A moderate amount of exercise is something like 30-40 minutes 5 x week and includes activities such as walking, gardening, yoga and pilates.
3. For more vigorous activities such as running or swimming, and classes such as spinning, body combat etc. aim for no more than 3 x 1 hour classes a week.
Fainting (syncope) is caused by a temporary reduction in blood flow to the brain. This can happen for many reasons. If anyone suffering with an eating disorder gets dehydrated and or is deficient in iron (anaemic), and has low blood sugar due to food restriction or purging, the possibility of fainting is raised.
If a person who is battling an eating disorder starts to feel faint or dizzy:
•They should lay on their back with their head down and legs raised, which will encourage blood flow to the brain.
•If it isn't possible to lie down, then they should sit down with their head between their knees.
•Once recovered they need to rest and drink some fluids. Eating something will restore blood glucose and blood pressure. They should not drive or operate machinery if the feeling of faintness or dizziness continues.
•It is important to keep a record of when this happens and for how long.
•They should seek medical advice and assessment to establish whether they are anaemic and to get a medical assessment.
•If a person does faint and doesn't regain consciousness within two minutes, (this is very rare) they should be put into the recovery position. The emergency services should be called and informed that the person has an eating disorder.
Self-induced vomiting is the most frequently used purging method. Some of the medical complications of self-induced vomiting can include acid reflux, bleeding and damage to the pharynx and larnyx. Acid reflux can arise as a result of frequent self-induced vomiting; it can damage the oesophagal sphincters .
When a person uses self-induced vomiting, the body forces the food up through the oesophagus and through the sphincter the controls the entrance of food into the stomach. The intended job of the sphincter is to prevent acid from backing up into the oesophagus which has no intrinsic protection from the acid. The more that the sphincter is abused in this way, then the less likely it is able to remain closed as intended.
Regurgitated acidic stomach contents may also come into contact with the vocal chords and surrounding areas. This can sometimes result in hoarseness, difficulty swallowing, chronic cough, a burning sensation in the throat or repeated sore throats. With repetitive vomiting, the lining of the throat suffers repeated abnormal exposure to acidic gastric (stomach) contents. The unfortunate potential consequences of this can include inflammation, oesophageal erosions and ulcers.
Barrett’s oesophagus refers to a condition in which there is a change in the mucosal lining type due to chronic and repetitive abnormal acid exposure to the oesophagus. Very occasionally, oesophageal cancer can develop from these cells, so you may need to be closely monitored. The most severe, albeit very rare, acute consequence of self-induced vomiting,is oesophageal rupture. This causes bleeding which doesn't stop and is a medical and surgical emergency.
The most common cause of blood in vomit in bulimia sufferers is from Mallory Weiss tears. These are tears in the lining of the oesophagus caused by forced retching and vomiting. There may be streaks of bright red blood or if the bleeding is from lower down in the digestive system the blood can appear dark, almost brown in colour. It is important not to ignore these symptoms and to describe what you see to a health professional. Mallory Weiss tears usually heal in a couple of days without treatment. During those days, the body needs to be treated gently so purging must be avoided or reduced as much as possible. In more severe cases, Mallory Weiss tears are serious as they can lead to full thickness tears which can be life threatening. Sometimes there are no other obvious signs that you have a Mallory Weiss tear or how bad it is. Because of this, any bleeding following self-induced vomiting should be taken seriously and medical advice should be sought.
Glossary of Terms
There are many descriptors and terminologies used in the treatment of eating disorders, so ABC has compiled a glossary. Click here to access the ABC Glossary of Eating Disorder Terms.