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While food is huge aspect of eating disorders, it is important to remember that eating disorders like anorexia nervosa, bulimia nervosa, binge eating disorder (BED) and orthorexia (although not yet categorised clinically as an eating disorder) are serious mental health conditions. Eating disorders do not discriminate, and can affect anyone regardless of age, race, gender, sexuality or background. Approximately 1.25 million people in the UK are thought to have an eating disorder with around 25 per cent of those affected being male, according to Beat, the UK’s Eating Disorder Charity.
Spotting the signs
Though those with eating disorders will require further support, pharmacy teams can play a vital role in signposting customers, supporting them and spotting the signs that something might be wrong in the first place.
“As eating disorders are about feelings rather than food, it’s likely that the first signs will be behavioural or psychological rather than physical,” says Tom Quinn, director of external affairs at Beat. An eating disorder can be a way someone feels they can cope with difficult feelings or situations, as this may – potentially without them being aware of this purpose – afford them a sense of control. There are many different types of eating disorders, and each have distinctive signs. However, Tom notes that some common signs include:
- The person saying they have eaten earlier or will eat later, or that they have eaten more than they have
- Strict dieting and avoiding food they think is fattening
- Hiding food
- Taking a very long time to eat meals
- Anxiety, particularly about eating in front of other people
- Physical signs can include weight loss, tiredness and stomach pains.
“Eating disorders are about feelings rather than food”
Common conditions
Though some conditions have similar signs, they are all identifiable in their own right and it’s important to understand their differences.
Anorexia nervosa
People with anorexia nervosa may tend to have developed ‘rules’ around the specificities of food; where and when they can eat, and what they feel they can or cannot eat. It is also common for people with anorexia to suffer from body dysmorphia disorder (BDD), which is a mental health condition that causes people to worry about their appearance. The flaws concerned are usually not visible to others.
Along with the above-mentioned common warning signs, anorexia can be characterised by symptoms like excessive exercise, a low body weight (although bodyweight should not be treated as a direct indication of how well a person is), the misuse of laxatives, being concerned with the number of calories in foods or making oneself sick. Physical signs include the growth of soft, fine hair all over the body (lanugo), irregular or loss of periods, hair loss, weight loss, feeling dizzy and constipation.
Binge Eating Disorder (BED)
BED is when people will eat large quantities of food over a short period of time, known as binges. People with BED find these periods extremely stressful, with some saying that they do not fully remember what they ate during the binge and note a feeling of disconnection between bingeing periods and non-bingeing periods. Binge eating disorder is not the same as ‘over-indulging’, where people eat large portions of food. According to Beat: “The distinction in binge eating disorder is the frequency, nature of and emotional aspect to the binges.” Warning signs that someone may be struggling with BED include high blood pressure, high cholesterol and buying and hoarding lots of food. Other physical signs that pharmacy teams may notice include bloating, weight gain, tiredness and difficulty sleeping, poor skin condition and stomach pain.
Bulmia nervosa
Bulimia nervosa is a serious mental condition, where people find themselves eating, but then trying to compensate for eating by expelling the food by vomiting, exercising excessively, going for long periods of time without eating (fasting) or taking laxatives or diuretics. This is known as purging. People struggling with bulimia will feel a constant pull towards eating (bingeing) and then purging, which can impact their social interactions. These are known as cycles. It is not uncommon for people to appear a ‘normal’ weight and attempts to hide or disguise the illness is paramount. This can make bulimia harder to spot than other eating disorders. Swollen hands and feet, damaged teeth, calluses on the backs of hands, bloating, vomiting, constipation and stomach pain are a few physical symptoms of bulimia.
Orthorexia
Orthorexia is not recognised as an eating disorder in a clinical setting but is a term that may be used when discussing someone’s illness. Someone with orthorexia exhibits an unhealthy obsession with eating ‘pure’ food, notes Beat (beateatingdisorders.org.uk). Importantly, what is deemed ‘pure’ or ‘impure’ will differ from person to person, but it is the use of clean and ‘healthy’ eating to cope with feelings and negative thoughts that indicate the disorder.
Most notably of people struggling with orthorexia will be the cutting out of certain food groups that are judged as unhealthy or fattening, leading to a deprivation of nutrients. Orthorexia strugglers will feel extremely guilty if they eat something they believe to be unhealthy, and this can lead to more anxiety around their food and eating habits. Other warning signs may be poor concentration, judgement over what others are eating, taking a long time to recover from illness, feeling weaker, weight loss and low energy levels – as they are not getting enough of a varied diet from their restrictive eating patterns.
“The sooner someone gets help, the better their chances of recovery”
How to help
“[Pharmacy teams] can play a crucial role in spotting the signs and helping those affected get the support and treatment they need, sometimes even before they realise they are ill,” says Tom.
“If you notice any warning signs, you can create an environment that feels safe for them by using open, non-judgmental questions, for example ‘I wondered if you’d like to talk about how you’ve been feeling?’ rather than ‘you need to get help’. It’s not uncommon for people to say they’re fine or refuse to accept there’s a problem, but it’s important to not wait too long before asking again if you’re concerned.”
By treating the topic with patience and consideration, pharmacy teams can signpost customers towards support groups, help lines, forums, online support or support them in making an appointment with their GP. “Eating disorders are serious mental illnesses but they are treatable. The sooner someone gets help, the better their chances of recovery, so encouraging them to make an urgent appointment with their GP is the best first step,” Tom implored.
If you’re worried about your own or someone else’s health, you can contact Beat on: 0808 801 0677 or at: beateatingdisorders.org.uk
Beat helplines nationwide:
- England: 0808 801 0677
- Scotland: 0808 801 0432
- Wales: 0808 801 0433
- Northern Ireland: 0808 801 0434.
Dealing with stress
Stress is a feeling of emotional or physical tension which often results from a difficult or uneasy situation. What constitutes a difficult or uneasy situation can differ from person to person. It is important for pharmacy teams to note the physical and mental impacts prolonged stress can have and how to advise customers to effectively manage their stress.
Kathryn Cousins, wellbeing programme manager at The Stress Management Society, commented on the physical impacts of stress: “When there is a continuous stream of stress in an individual’s life, they are constantly going through the fight or flight reaction, which is directed by the autonomic nervous system. This is the body’s way of preparing itself for danger, which was beneficial when our ancestors needed that adrenaline rush to fight off bears, however, in response to modern day stressors, it can be maladaptive.
“The autonomic nervous system is continuously activated and continues to trigger the physical reactions of stress causing wear and tear on the body. Some physical symptoms of stress include panic attacks, shallow breathing, sleep problems, high blood pressure, muscle aches, headaches, sudden weight gain or loss and existing health conditions worsening.” In the long-term, this can lead to cardiovascular problems, a weakened immune system, digestive issues, sleep disturbances and weight loss or gain.
Looking at the mental impacts of stress, there are cognitive and emotional effects to consider. “People with elevated stress levels are more likely to experience a decline in cognitive functioning,” says Kathryn. “This can show through symptoms like being unable to switch off from your racing thoughts, feeling scattered and overwhelmed, and ultimately being less productive.
“Emotionally, stress can have a big effect in the way you are feeling. Stressors can lead to heightened anxiety as often stress can stem from feeling overwhelmed, with the perception that you cannot cope with the challenges you are facing. This can make you feel irritable, angry and impatient.”
Pharmacy teams can keep these symptoms in mind when dealing with customers and offer advice where appropriate. Customers looking to manage their stress levels may want to discuss medication, which may be appropriate. However, Kathryn implores pharmacy teams to remind customers that in most cases, they can effectively manage their stress by making small but impactful changes. “Highlight the importance of taking care of their general health in times of stress. Suggest that they don’t try to fix everything at once, because this can end up making them feel even more overwhelmed that they already do.” Here are a few tangible, achievable changes people can make:
- Incorporating more fruits and vegetables at each meal
- Making an effort to get to sleep and wake up at the same time each day
- Turning devices off 30 minutes before sleeping
- Staying hydrated by having a glass of water with each meal
- Volunteering in the community
- Exercising regularly for natural mood-boosting endorphins.
If customers are not coping with their stress, they should be encouraged to seek support from a GP. Pharmacy teams can also signpost customers to: stress.org.uk.
Attention on ADHD
Attention deficit hyperactivity disorder (ADHD) is a condition that can affect one’s ability to concentrate, make decisive decisions, and/or cause a person to be restless or act on impulse. It is a behavioural condition and can significantly impact an individual’s ability to perform a task, which could be anything from completing a worksheet at school, to cleaning the kitchen, to reading a page of a book.
In children, there may be difficulty:
- Getting the child to sleep
- Getting ready for school on time
- Listening to and carrying out instructions
- Being organised
- Shopping.
And problem areas for adults include:
- Feeling restless or impatient
- Organisation and time management
- Following instructions
- Completing tasks/focussing
- Some issues with relationships or social interaction.
Alex, 25, notes how her ADHD diagnosis answered questions that she and her parents had when she was diagnosed at 15 (2014).
“My first symptom was struggling to pay attention for longer periods of time, like a full school lesson which was 45 minutes. I was easily distracted by things around me in the classroom, or by things at home when I was trying to study,” Alex says. “I would struggle to sit with a problem and stay focused to consider it fully and work through solutions. I always had the intention to be well prepared for class but would end up leaving things to the last minute and get distracted.”
A combination of ADD (Attention Deficit Disorder) being present in Alex’s family and teachers being concerned with dropping marks at school, Alex first visited her GP to discuss her symptoms and the route forward. After being referred to a specialist, Alex was prescribed medication to help her concentrate in school or when studying at home, which she says helped her focus for longer periods of time. “I’m glad I received the diagnosis in school, as it allowed me to focus and improve my academics. The medication did work as it was meant to. But ADHD is still a large part of my daily life. I am still learning the basics of time management that were a given at school or University, but not during work or my daily life.
“As I was diagnosed in school, the aim was to improve my ability to study and focus in class. But I still struggle in other aspects of life because of ADHD. It is difficult to organise my time, stick to a routine or keep a space tidy,” says Alex.
Pharmacy teams can be aware of some of the symptoms of ADHD and encourage customers to visit their GP if they think they, or someone they know, may be affected. Starting this journey is something for which treatment – whether that be prescribed medication, psychological therapies, school-based interventions, speech and language therapy or parent management training – can significantly impact a person’s life and of those around them. Pharmacy teams can signpost customers to: adhduk.co.uk to find out more.
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