Study shows lengths patients with eating disorders go to hide illness

Embedding weights in hairstyles and hems of clothing to conceal their true weight are among the lengths patients with an eating disorder will go to to hide their illness, doctors at a special treatment unit in Sligo University Hospital (SUH) have found.

A paper published in the Irish Medical Journal (IMJ) highlights the difficulties doctors and nurses face when trying to treat eating disorders, which have the highest mortality rate of any psychiatric illness.

Entitled The Experience of the Management of Eating Disorders in a Pop-up Eating Disorder Unit, the paper outlines a variety of sabotaging behaviour that patients engaged in, including

• Hiding batteries in sanitary towels on weighing days
• Gripping of scales with toes
• Animated conversation or typing vigorously on a laptop or vigorous tooth-brushing to micro exercise — requests for windows to be opened in order to shiver/micro exercise
• Not going to the toilet on weighing days
• Food concealment

The unit at SUH was set up in 2014 and has treated 20 acutely ill patients, 18 female, mean age 22.

Patients are nursed in a ward with continuous cardiac monitoring, one-to-one continuous supervision, complete bed rest and careful calorie monitoring. However, because the patients are “often inventive in their resistance to treatment”, the paper says a cross-disciplinary approach is needed to manage them safely in a general hospital setting.

The paper describes how a “separation period” is enforced whereby phones, computers and electronic equipment is removed from the patient, as staff have experienced “cases of bullying by peers on electronic devices”.

The paper concludes that multidisciplinary cooperation and communication “is essential for successful outcomes” and that “collaboration, appropriate clinical skills and patience are the keys to success with this cohort of patients”.

Separately, an evaluation of services at the Eating Disorder Clinic Cork (EDCC), which offers support to people aged 12-60, has found a high level of satisfaction among clients.

The report, due for launch at UCC today, notes a 95% satisfaction rating.

Anorexia Nervosa was the most common diagnosis and the average onset age of eating behaviour disorders was 14.5 years. The average age of diagnosis was 20.

Clients said they encountered a number of ongoing challenges in recovering from their eating disorders including uncertainty around diagnosis, comorbidities (such as anxiety and depression), financial burden, hospitalisation, underemployment, and absenteeism from work, college or school.

The report, by Dr Cormac Sheehan, research officer Department of General Practice, UCC and psychologist /researcher Grace Kelly, recommends an integrated care approach to treating eating disorders and that the EDCC invest in other areas of activity outside of the one-to-one counselling offered.