Eating Disorders Awareness Week – what should you know?

Eating Disorders Awareness Week, taking place this year from 19th February, aims to tackle common misunderstandings around anorexia, bulimia, Binge Eating Disorders (BED) and other specified feeding or eating disorder (OSFED). There is a degree of overlap between eating disorders and the characteristics of body dysmorphic disorder (BDD) – a mental health condition that affects a person’s body image. Negative body image is a shared characteristic of both eating disorders and body dysmorphic disorder.  This link between eating disorders and BDD highlights the need for aesthetic practitioners to take into account poor self-esteem relating to body image during patient selection, especially when it manifests in rituals and behaviours.

As an aesthetic practitioner it is highly likely that you will encounter patients who are seeking aesthetic interventions as a result of their desire for a solution to fix perceived ‘defects’ in their appearance. Yet for some patients, no matter how many treatments they undergo, they will never be satisfied. It is therefore important to be aware of common eating disorders or the symptoms of BDD with which patients may present in your clinic. Early identification enables you to offer best practice advice to your patients, which in some cases may involve saying ‘no’ to a patient; for certain disorders aesthetic intervention could actually make their condition worse.


Most common eating disorders

Anorexia Nervosa – This is a very serious, potentially life threatening, eating disorder. According to the NHS anorexia is characterised by people trying to keep their weight as low as possible by not eating enough food, exercising too much, or both. In addition, sufferers are also likely to have a distorted image of their bodies.

Bulimia Nervosa – People with this eating disorder will exhibit periods of binge eating within a short period of time, followed by a purge such as making themselves deliberately sick, restricting what they eat or exercising too much to avoid gaining weight. Again, people suffering from bulimia are very likely to be critical of their weight and body shape.

BED – Binge eating disorder is a condition whereby people regularly lose control of their eating, for example eating large portions of food all at once until they feel uncomfortably full, then often feeling upset or guilty about it.

OSFED – Health professionals also have a classification for symptoms that do not match a classic diagnosis for any of the aforementioned disorders but cause significant distress to the person experiencing the symptoms.  Despite broader categorisation, it does not make it any less serious as an illness.

According to the NHS, OSFED  is the most commonly diagnosed type of eating disorder, followed by binge eating disorder and bulimia. Anorexia nervosa is the least common.


Eating disorders and BDD

Charity OCD UK states that, ‘Body Dysmorphic Disorder (BDD) is an anxiety disorder whereby a person is abnormally preoccupied with an imagined defect in their physical appearance that is not observable or appears only slight to others.’ According to the NHS, an eating disorder on the other hand, is when a person has an unhealthy attitude to food, which can take over their life and make them ill. It can involve eating too much or too little, or becoming obsessed with their weight and body shape.

Despite being different illnesses, negative body image is a common factor in both eating disorders and BDD. Obsessive worries, intrusive thoughts, and repetitive behaviours are present in both disorders. Individuals suffering from both conditions strive to improve their appearance by way of potentially detrimental, time-consuming behaviours such as inspecting body parts, excessive grooming and, crucially,  seeking cosmetic surgery.

One study suggests that one third of individuals with BDD have an eating disorder, while another reveals that symptoms of BDD emerge in 25 per cent of anorexia nervosa sufferers for at least six months prior to the onset of their eating disorder. Interestingly, one piece of research by Aesthetic Surgery Journal found that 70 per cent of sufferers of BDD had sought cosmetic treatments, with half ultimately receiving their desired treatments.  The most common areas of patient concern in those with BDD are the face and facial features, skin, breasts, genitals and buttocks, according to OCD UK.


Practitioners’ responsibilities

It is important that practitioners are able to recognise the symptoms of both eating disorders and BDD in patients. Those who have illnesses such as these often hold unrealistic expectations regarding cosmetic procedures and may therefore be dissatisfied regardless of the actual outcome. Therefore, screening assessments and management of expectations is critical for both the patient’s safety and the practitioner’s reputation. The Aesthetics Journal provides a useful assessment tool whereby practitioners can identify if a patient is likely to be suffering from BDD.


When to say no

When discussing patients’ expectations, it is important to be open and honest. If a practitioner is unprepared to treat a patient as they are concerned that they are suffering from an eating disorder or BDD, and cosmetic interventions may aggravate the problem, it’s important to say no. For more guidance on consent and when it might be best to say ‘no’ to a patient, download our free guides on the topics of ‘Consenting and consultation’ and ‘Patient Selection’.

During patient consultation, practitioners should note that early recognition of eating disorders and BDD may help to prevent progression of the disease. Thereby, by saying ‘no’ and instead offering advice to patients, practitioners can contribute positively to the patient’s health and wellbeing. The recommended treatment for BDD is cognitive behavioural therapy (CBT), specific to the disorder. So, if the practitioner suspects an illness, it is advisable to put the patient at ease during the consultation using a sensitive and understanding approach, and suggest they consult their GP for further support and guidance. Practitioners should however if appropriate reassure patients that BDD is a recognised condition and effective treatments are available from mental health professionals.

It is possible that a patient resistant to engaging with mental health professionals may instead simply consult other aesthetic practitioners who may be willing to offer treatments. However, the responsible practitioner would not treat a patient they suspect is suffering with BDD, not only to conserve their own reputation but also for the wellbeing of the patient.

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