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Detection, assessment and management of eating disorders; how involved are GPs?

Published online by Cambridge University Press:  13 June 2014

Claire Flahavan
Claire Flahavan*
Affiliation:
St Brigid's Hospital, Ardee, Co Louth, Ireland
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Abstract

Objectives: To determine the extent to which general practitioners are currently active in the screening, assessment, diagnosis and management of eating disorders. To identify current deficits in service delivery for eating disordered patients, as identified by general practitioners.

Method: A postal questionnaire was circulated to 360 general practitioners within the greater Dublin area and North Eastern Health Service Executive.

Results: Response rate was 25%. Respondents had lower case-loads of eating disordered patients than would be expected given the epidemiology of anorexia and bulimia nervosa. Most do not routinely screen for eating disorders, even in at-risk populations and are unaware of the current evidence-based data for guidance. GPs do not feel confident at managing eating disorders within the primary care setting and see their chief role as that of referral to psychiatric services. Treatment outcomes are typically poor. Concern was expressed at the lack of access to specialist treatment in the public sector. Specific deficits in service provision were highlighted including delays in assessment, lack of services appropriate to the adolescent population, poor service transition, and poor availability of psychotherapy at primary care level.

Conclusions: Eating disorders are currently underdiagnosed in the primary care setting. Use of simple screening tools might aid detection of pathological eating patterns, particularly in at-risk groups. General practitioners feel under-equipped to manage these complex disorders, given that the resources required to provide high quality care are not widely available. Better integration of primary and secondary services, coupled with training for GPs in the area of screening, assessment and diagnosis, may lead to earlier intervention and improved outcomes.

Keywords

General practiceprimary careeating disorders.
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 23 , Issue 3 , September 2006 , pp. 96 - 99
Copyright
Copyright © Cambridge University Press 2006

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References

1.Ryan, C. Food for Thought. BMA News Review 1998; 25: 28.Google Scholar
2.Institute of Psychiatry at the Maudsley: Eating Disorder Information. www.iop.kcl.ac.uk/loP/Departments/PsychMed/EDU/FAQEDs.shtml.Google Scholar
3.Patton, GC. Mortality in eating disorders. Psychol Med 1988; 18: 947–52.CrossRefGoogle ScholarPubMed
4.Herzog, W, Deter, HC, Shellberg, D, Seilkopf, S, Sarembe, E, Kroger, F, Minne, H, Mayer, H, Petzold, E. Somatic findings at 12 year follow-up of 103 anorexia nervosa patients: results of the Heidelberg-Mannheim follow-up. In: Herzog, W, Deter, HC, eds. The course of eating disorders: Long-term follow-up studies of anorexia and bulimia nervosa. Berlin-Heidelberg: Springer-Verlag, 1992.CrossRefGoogle Scholar
5.National Collaborating Centre for Mental Hearth. Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. National Clinical Practice Guideline. No. 9. Leicester & London: British Psychological Socety & Gaskell. 2004 http://www.nice.org.uk/pdf/cg009niceguidance.pdfGoogle Scholar
6.Eisler, I, Dare, C, Russel, GFet al: Family and individual therapy in anorexia nervosa. A 5 year follow up. Archives of General Psychiatry 1997; 54:1025–1030.CrossRefGoogle ScholarPubMed
7.Johnson, JG, Spitzer, RL, Williams, JB. Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynaecology patients. Psychol Med 2001; 31 (8):1455–66.CrossRefGoogle ScholarPubMed
8.Walsh, B, Garner, DM: Diagnostic Issues. In Garner, DM, Garfinkel, P (eds): Handbook of Treatment for Eating Disorders. New York, Guildford Press, 1997, pp 25–33.Google Scholar
9.Hoek, HW, Bartelds, Al, Bosweld, JJet al: Impact of urbanization on detection rates of eating disorders. Am J Psychiatry 1995; 152:1272–8.Google ScholarPubMed
10.Bryant-Waugh, RJ, Lask, BD, Shafran, RLet al: Do doctors recognize eating disorders in children? Arch Dis Child 1992; 67(1):103–5.CrossRefGoogle ScholarPubMed
11.Whitehouse, AM, Cooper, PJ, Vize, CV, et al: Prevalence of eating disorders in three Cambridge general practices: Hidden and conspicuous morbidity. Br J Gen Pract 1992; 42(355):57–60.Google ScholarPubMed
12.Treasure, J, Schmidt, U, Hugo, P: Mind the gap: service transition and interface problems for patients with eating disorders. Br J Psych 2005; 187: 398–400.CrossRefGoogle Scholar
13.Becker, AE, Grinspoon, SK, Klibanski, A, et al: Eating Disorders. N Engl J Med 1999; 340 (14):1092–8.CrossRefGoogle ScholarPubMed
14.American Psychiatric Association: The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC, American Psychiatric Association, 1994.Google Scholar
15.Myers, S, Davies, MP, Treasure, J: A General Practitioner's guide to eating disorders. London: Boots Pharmaceuticals, 1993. (Maudesley Practical Handbook Series No. 2)Google Scholar
16.Fairburn, CG, Hanison PJ. Eating Disorders. Lancet 2003; 361 (9355): 407–416.CrossRefGoogle Scholar
17.Morgan, JF, Reid, F and Lacey, JH. The SCOFF questionnaire; assessment of a new screening tool for eating disorders. BMJ 1999; 319(7223): 1467–8.CrossRefGoogle ScholarPubMed
18.Frank, JB, Weihs, K, Minerva, Eet al.Women's mental health in primary care: depression, anxiety, somatisation, eating disorders and substance abuse. Med Clin North Am 1998; 82(2):359–389.CrossRefGoogle ScholarPubMed
19.American Psychiatric Association, Practice guidelines for eating disorders (revision). Am J Psychiatry 2000; 157 (suppl): 1–39.Google Scholar
20.Expert Group on Mental Health Policy. A Vision for Change. Government Publications, Dublin. 2006;149–154.Google Scholar