Willpower is not the solution to eating disorders

Eating disorders are a serious social problem whose conceptualization and recognition have experienced exponential growth in the last 10 years.

To date, anorexia nervosa (AN) and bulimia nervosa (BM) are not the only eating behavior disorders that permeate the psychiatric field, as there is a growing social awareness of others recently described, such as binge eating disorder (BED) or selective eating disorder (avoidant / restrictive food intake). disorder, ARFID).

Calculating the prevalence of these physical and emotional imbalances is very difficult, especially because of the transitory and inadvertent nature of many of the pictures. For example, the long-term prevalence of anorexia nervosa in adolescents is estimated to be 0.3-2.2% and the point prevalence 0.1-1.5%. When it comes to bulimia, the figures are similar: 0.1 to 2% of the young population.

As shocking as it sounds, as the British Medical Journal (the BMJ) indicates, anorexia nervosa is the psychiatric condition with the highest mortality rate in the world. It is the leading cause of serious weight loss in young women and also takes the podium in terms of admission rate to specialized centers. With these data, today we want to bring you an idea that should be more than clear:

Willpower is not the solution to eating disorders.

• Related article: "Major Eating Disorders: Anorexia and Bulimia"

What are eating disorders?

Before entering subjective areas, it is necessary that we establish a series of bases at the diagnostic level.

An eating disorder is defined as a mental pathology dictated by dietary habits that negatively affect the physical and / or emotional health of the patient.

This includes anorexia, bulimia, binge eating disorder, selective eating disorder, pica, rumination syndrome, and other conditions. It should be noted that obesity is not included in this set of clinical pictures.

We are not going to describe the symptoms of each of the disorders, as it is not our intention to go through the spectrum of all eating disorders. Anyway, as an example, we present you the diagnostic criteria followed by the Diagnostic and Statistical Manual of Mental Disorders (DMS-5) to identify anorexia nervosa:

• The patient restricts energy intake in relation to needs, which leads to a significantly low body weight based on age, sex, developmental course, and health physical.
• Intense fear of gaining weight or gaining weight. The patient presents a persistent behavior that converges directly with a possible weight gain.
• Alteration in the way in which one perceives his own weight or constitution. There is a lack of recognition of the seriousness of the underweight picture.

According to the ICD-10 (international classification of diseases) for a person to be considered anorexic, they must be 15% heavier lower than expected for their condition and age, have a Body Mass Index (BMI) less than 17.5, voluntarily induce their own thinness, displaying behaviors that reveal a distorted body image and suffer a series of characteristic endocrine disorders (in women, modification of the hypothalamic-pituitary-gonadal axis).

Can you carry anorexia alone?

The answer is blunt: no. We recover a data that we have mentioned previously, but that should not be forgotten: Anorexia is the fatal disease with the highest mortality rate in the world, above schizophrenia and bipolar disorder, considered more "serious" by the general population.. Without treatment, up to 20% of people with eating disorders end up dying, while this figure drops to 2-3% with the appropriate medical and psychological approach.

In addition to these data (which already speak for themselves), the study Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders stipulates that anorexia nervosa is a serious disease that must be taken into account. As a product of a meta-analysis that compared 36 different studies and various sources, it was found that only 46% of treated patients recover completely from the pathology, 33% reach a state of "normality" (with behavioral residues of anorexia) and 20% remain chronically ill for a long time. term.

Furthermore, it is estimated that only 1 in 10 people with eating disorders receive treatment and, of all of them, 80% finish the clinical approach sooner than they should (they are sent home when it is not yet time). With these data, we do not intend to discourage anyone, but to show how difficult it is to address this type of disorder. If it is already complex to eliminate all traces of a disorder such as anorexia after internalization and medical and psychological intervention, imagine the difficulty of facing such a serious condition in a autonomous.

• You may be interested in: "Anorexia nervosa: symptoms, causes and treatment"

The real treatment of eating disorders

We have already stipulated that willpower is not the solution to eating disorders, since up to 2 out of 10 people who decide to take them alone end up dying. So, what to do?

You may be surprised to know this information, but according to the scientific article Anorexia nervosa, published in the BMJ in 2007, Anorexia and other disorders are estimated to require a mean recovery time of 5 to 6 years after diagnosis, which requires regular monitoring and, in many cases, consecutive interventions. 30% of patients do not fully recover at any time.

In addition, drastic hospital interventions that deprive the patient have been largely discredited. patient of all freedom and autonomy: this only takes place when the patient's life runs danger. In the long term, family therapy in adolescents and cognitive-behavioral therapy in adults have shown good results, always emphasizing the normalization of ideal eating habits and promote a change in the patient in what his distorted thoughts around the image are refers.

It is necessary to accept, but not to normalize

One of the greatest difficulties in treating eating disorders is that many patients do not see their condition as a pathological condition, but rather as a choice and lifestyle. Vomiting food is an obvious sign of a disease, but selectively and obsessively choose what to eat at all times. eat or "stop eating for a few days because I look fat" enters a gray area that, in many cases, is excused within the normal.

The reality is that no obsessive behavior is normal. If you count each calorie of each food, if you stop eating as soon as you gain a kilo of weight, if you feel ashamed your physical appearance or if you notice that your life revolves around a conflictive relationship with food, you need help. Anorexia, bulimia and other disorders have a solution, but only if the patient is willing to acknowledge her problem and decides to put herself in the hands of a multidisciplinary team of professionals.