In the last post, we saw how:
- There are social and physiologic factors that can give rise to AN
- Using EAT-26 the there were 15% of people who had eating disorders in the study.
- Family therapy and pharmacology is not particularly helpful in AN
Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Eating Disorders. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Schizophrenia.
In this post, we are looking at research work done in Nigeria on Eating Disorders. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.
Clinicians who do psychoanalysis agree that a possible cause of AN is separation from the mother. They explain that the uncaring and distant mother inhabits the child and tries to destroy the child. Starvation is seen as a way to destroy the child who inhabits the uncaring mother.
Most times, the clinician can not these interactions between the patient and the family members.
Many of the patients with AN think that the need for food is centred in greed and is bad for the patient.
A parent typically becomes worried in reality about the patients eating habits and the response of the patient to the parent’s behaviour to see the parent's behaviour as unacceptable.
AN typically starts around 10 to 30 years. The characteristic features are those of voluntary weight loss with maintenance in the state of bad health or failure to gain weight as the person ages, fear to become fat in the light of clear starvation or both, symptoms of starvation such as reduced temperature, reduced heart rate, dizziness and lack of body fat, 3 months of the above feature
Eating Disorders in Nigeria (Discussion)
The mean age in this study was about 21.228 years as noted and it was expected seeing as it is supposed to be a young adult population. 76.2% of the subject were on a ₦10,000 to 20,000 allowance per month. This equated to about 66.7 USD to 133 USD every month.
This is the money that allows the subject to feed, to clothe themselves and accounts for transport and other daily expenditure. This shows that most of them live below the poverty line but this is not seen when you take into account the Body mass index in the population. 75% of the people in this study were within the normal range.
There are different appropriate self-reporting assessments for ED. These are used in assessing patients in the general population and in clinical settings. EAT-26 is one of these and has been noted to have psychometric properties that are appropriate for the study.
This study had 15.3 % of people were who positive for ED according to the EAT-26 used in this assessment. This study found higher levels of ED in the subject than is found in Nigeria when you consider other studies. The studies done by Oyewumi and Kazarian in 1992 are referenced.
According to this ED are rare in the general population and as seen in other studies. In studies done in the west, it was also found to be rare and it is typically thought that this condition is one that affects those in the west more. The prevalence in the west is somewhere between 0.1 to 3.3% as seen in studies done by Preti et al in 2009 and Deans in 2012.
Using self-reported assessments like the one used in this study on undergraduates in America, the studies were able to find a positive prevalence of between 8 to 17% and the in women it was somewhere around 13.5%, this was according to Reinking and alexander their 2005 study.
In 2004 a study done by Szabo and Allwood saw a prevalence of 3% in Zulu south Africa which is very low compared to this study. The reason for the low prevalence in the study done by Szabo could be because of the fact that this study was done in a rural area and the area where this study was done was in an urban area in Lagos.
This shows that urbanisation and western culture adoption has this effect on the population.
In this study, the females were more affected by ED. The ratio was almost 2:1. This shows yet again that ED seems to be more common in females than males. This is the case in western studies as well as studies done in other African countries.
In the 2005 study done by Reinkin and Alexander the female-to-male ratio was as high as 3:1. Other studies keep having the same finding.
AN is treated by a team of specialists from different disciplines. A psychiatrist, physicians, clinical psychologists and dietitians are important parts of this team. The patient needs to be placed on some form of nutrition that they can tolerate while the patient reciepatient'sves therapy.
The patient may be at risk of losing their life and may need emergency admission. While on admission the patient's heart rate, hydration and electrolyte need to be balanced. The patient should be admitted to watch for these parameters. It is also possible that the patient may have other psychiatric problems and they may not want to eat.
There are some specialists that are experts at handling eating disorders. They may be able to offer specific steps to deal with the problem without hospitalisation. These usually take longer to achieve results.
The patient may usually need to be monitored especially if they come in a complicated state. They will need to be hydrated through whatever means (oral or parenteral). Some patients may need to be fed through a Nasogastric tube.
The person who manages the plan for therapy is usually the primary health care provider or the psychiatrist and other specialists.
The most important aspect of the therapy is to have the patient within a healthy weight range. If the patient doesn't learn to take care of themselves to is not in the healthy weight range they can fall back to extremely low eeights.
The physician usually is in charge of coming up with the plan for the caloric intake of the patient while the clinical psychologist teaches methods of coping with the condition.
The dietician is in charge of coming up with the eating plan for the patient and organising the meals and calories that will help the patient get back into good health. It is also good to get the family involved with the therapy.
Among the therapy that should be considered for therapy is family-based therapy. This usually is best for teenagers who have anorexia. This is the best way to teach the parents how to feed the child as the child goes through therapy.
In adults, it is best they go through cognitive behavioural therapy and behavioural therapy because this has the best evidence for them. Eating habits should be guided to normalcy and the patient should be helped through the thought they have about eating
- What did you learn about Eating Diorders?