Transcript Binge Eating Disorder

Mental Health
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• It is estimated that approximately 450 million
people worldwide have a mental health
problem.
• 1 in 4 families worldwide is likely to have at
least one member with a behavioural or
mental disorder.
The World Health Report 2001 Mental Health: New Understanding, New Hope Geneva: World Health
Organisation, (2001)
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According to a systematic review of data and
statistics from community studies in European
Union (EU) countries, Iceland, Norway and
Switzerland: 27% of the adult population (here
defined as aged 18–65) had experienced at least
one of a series of mental disorders in the past
year (this included problems arising from
substance use, psychoses, depression, anxiety,
and eating disorders).
http://www.euro.who.int/en/health-topics/noncommunicablediseases/mental-health/data-and-statistics
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http://www.euro.who.int/en/health-topics/noncommunicablediseases/mental-health/data-and-statistics
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These figures represent an enormous human toll
of ill health, with an estimated 83 million people
being affected. Yet even these figures are likely
to underestimate the scale of the problem, as
only a limited number of disorders were
included and it did not collect data on those
aged over 65, a group that is at particular risk.
http://www.euro.who.int/en/health-topics/noncommunicablediseases/mental-health/data-and-statistics
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• About half of people with common mental
health problems are no longer affected after
18 months, but poorer people, long-term sick
and unemployed people are more likely to be
still affected than the general population.
Singleton N, Lewis G. Better Or Worse: A Longitudinal Study Of The Mental
Health Of Adults Living In Private Households In Great Britain London: The
Stationery Office pxviii, (2003)
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Depression
• A depressive episode may be classed as mild,
moderate or severe, depending on the
number and intensity of associated symptoms,
such as sleep disturbance, appetite and
weight change, anxiety, poor concentration,
irritability and suicidal thoughts.
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Depression
KEY SYMPTOMS
ASSOCIATED
SYMPTOMS
persistent
sadness, or low or
irritable mood:
AND/OR
-loss of interests
and/or pleasure
-fatigue or low
energy
-poor or increased
sleep
-poor concentration
or indecisiveness
-low self-confidence
-poor or increased
appetite
-suicidal thoughts or
acts
-agitation or slowing
of movements
-guilt or self-blame
Mild
Up to 4 symptoms
Moderate
5-6 symptoms
Severe
7-10 symptoms
Symptoms cause clinically significant distress or impairment
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in social
or academic functioning
• Between 8% and 12% of the population
experience depression in any year.
• Only 2% of the population are experiencing a
depressive episode without ‘co-morbid’
anxiety, meaning ‘occurring at the same time’.
Singleton N, Lewis G. Better Or Worse: A Longitudinal Study Of The Mental
Health Of Adults Living In Private Households In Great Britain London: The
Stationery Office pxviii, (2003)
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• Depression tends to recur in most people.
More than half of people who have one
episode of depression will have another, while
those who have a second episode have a
further relapse risk of 70%. After a third
episode, the relapse risk is 90%.
• For about 1 in 5 people, the condition is
chronic.
National Institute for Health and Clinical Excellence Depression, NICE Guideline, Second Consultation. London:
NHS, pp19-20, (2003)
The World Health Report 2001 Mental Health: New Understanding, New Hope Geneva: World Health
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Organisation, (2001)
• Worldwide, 5.8% of men and 9.5% of women
will experience a depressive episode in a 12
month period, a total of about 121 million
people.
• The World Health Organisation forecasts that
by 2020 depression will be the second leading
contributor to the global burden of disease.
The World Health Report 2001 Mental Health: New Understanding, New Hope
Geneva: World Health Organisation, (2001)
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• Suicide and self-harm are not themselves
mental illnesses, but they usually result from
mental distress.
• The suicide rate in the EU is 17.5 people in
100,000 and 15.1 in 100,000 worldwide.
The World Health Report 2001 Mental Health: New Understanding, New Hope
Geneva: World Health Organisation, (2001)
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Self-harm
• Deliberate self-harm ranges from destructive
behaviours with no suicidal intent, but which relieve
tension or communicate distress, through to attempted
suicide.
• The UK has one of the highest rates of self-harm in
Europe, at 400 per 100,000 population.
• There is a high correlation between self-harming
behaviour and mental health problems. Most of those
who attend an emergency department after selfharming would meet the criteria for one or more
psychiatric diagnoses. More than two thirds would
meet the criteria for depression.
Horrocks, J, Self-poisoning and self-injury in adults, Clinical Medicine, 2 (6), 509-12, (2002)
The short-term psychological management and secondary prevention of self-harm in primary and secondary
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care, National Collaborating Centre for Mental
Health, London: The British Psychological Society, (2004)
• People who have self-harmed are at
significant risk of suicide. A study found that
the risk of a person dying by suicide within a
year of being treated for self inflicted injury
was 66 times the annual risk of suicide in
England and Wales, and that there is a
significant risk even many years later.
Owens D, Horrocks J, House A, Fatal and non-fatal repetition of self-harm: Systematic review, British Journal of
Psychiatry, 181, 193-9, (2002)
Hawton K. et al (2003) Suicide following deliberate self-harm: long-term follow-up of patients who presented to a
general hospital, The British Journal of Psychiatry 182: 537-542, (2003)
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• Self-harming and suicide may be influenced by
the depiction of similar behaviour in the
media or taking place in peer groups. For
example, one study showed a 17% increase in
presentations to hospital from self poisoning
in the week after an overdose was depicted in
a TV drama.
Hawton K et al (1999) Effects Of A Drug Overdose In A Television Drama On Presentations To Hospital For SelfPoisoning: Time Series And Questionnaire Study British Medical Journal 318 pp972-977, (1999)
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• Similarly, a study of
teenagers who selfharmed found that the
strongest associated
factor was awareness of
friends who had also
self-harmed.
Hawton K et al Deliberate Selfharm In Adolescents: Self-report Survey In
Schools In England British Medical Journal 325 pp1207-11, (2002)
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Anxiety
• Anxiety is a normal response to threat or danger and
part of the usual human experience, but it can become
a mental health problem if the response is
exaggerated, lasts more than three weeks and
interferes with daily life. Anxiety is characterised by
worry and agitation, often accompanied by physical
symptoms such as rapid breathing and a fast heartbeat
or hot and cold sweats.
• ‘Stress’ is not considered a mental health problem in its
own right, but long-term stress may be associated with
anxiety or depression.
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• People who experience
anxiety usually have
symptoms that fit into
more than one category
of anxiety disorder, and
are usually diagnosed
with at least one other
mental disorder, most
commonly depression.
Michael T. and Margraf J.(2004) Epidemiology of Anxiety Disorders, (2004) The
Medicine Publishing Company Ltd available at www.medicinepublishing.co.uk
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Alcohol and other substance misuse
• Definitions of alcohol and substance misuse
vary. However, dependence is usually defined
by preoccupation with use of the substance,
inability to control use, and failure to cut back
despite life-damaging consequences.
– Worldwide, 1.7% of adults are thought to have an
alcohol-use disorder.
The World Health Report 2001 Mental Health: New Understanding, New Hope Geneva: World Health
Organisation, (2001)
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Eating disorders
• Eating disorders are on
the rise (the charity
BEAT estimates that
1.6m people in the UK
have an eating disorder)
and have the highest
mortality of any mental
illness.
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Anorexia
• Anorexia is a disorder (or illness) which stems
from low self esteem and an inability to cope
safely with worries and problems. It involves
lowering your food intake by skipping meals
and cutting down the types and amounts of
food you eat; some people over-exercise as
well. You may believe that if you lose weight
your life would be happier, people will like you
more, you will be more successful or even
perhaps that you may be noticed less.
http://www.b-eat.co.uk/get-help/about-eating-disorders/types-of-eating-disorder1/anorexia/
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Symptoms of Anorexia
Physical signs
Behavioural signs
Psychological signs
Severe weight loss
Wanting to be left alone
Intense fear of gaining
weight
Periods stopping
(Amenorrhoea)
Wearing big baggy clothes
Depressed
Hormonal changes in men
and boys
Excessive exercising
Feeling emotional
Difficulty sleeping
Lying about eating meals
Obsession with dieting
Stomach pains
Denying there is a problem
Mood swings
Constipation
Difficulty concentrating
Distorted perception of
body weight and size
Poor circulation & feeling
cold
Wanting to have control
Thinking about food all the
time
Feeling guilty after eating
http://www.b-eat.co.uk/get-help/about-eating-disorders/do-i-have-an-eating-disorder/
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Bulimia Nervosa
• Bulimia is also a disorder linked with self
esteem, emotional problems and stress. You
may constantly think about calories, dieting
and ways of getting rid of the food you have
eaten. Bulimia is actually more common than
anorexia, but is more of a hidden illness,
because people with bulimia usually remain
an average or just over average body weight.
Bulimia can go unnoticed for a long time,
although you may feel ill and very unhappy.
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Bulimia Nervosa
• If you have bulimia you become involved in a
cycle of eating a very large amount of food,
making yourself sick, cutting down or starving for
a few days or trying to find other ways to make
up for the food you have eaten. Starving causes
you to become so hungry that you eat large
amounts of food because your body is craving
nourishment. Some people will not vomit but
will take laxatives: both behaviours may be
described as ‘purging’ by medical professionals
but taking laxatives is particularly dangerous.
http://www.b-eat.co.uk/get-help/about-eating-disorders/types-of-eating-disorder1/bulimia/
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Symptoms of Bulimia
Physical signs
Behavioural signs
Psychological signs
Sore throat / swollen
glands
Eating large quantities of
food
Feeling ashamed,
depressed and guilty
Stomach pains
Being sick after eating
Feeling out of control
Mouth infections
Being secretive
Mood Swings
Irregular periods
Abusing laxatives
Feeling guilty after eating
Dry or poor skin
Difficulty sleeping
Sensitive or damaged
teeth
http://www.b-eat.co.uk/get-help/about-eating-disorders/do-i-have-an-eating-disorder/
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Binge Eating Disorder
• If you binge eat, you may eat large amounts of
food in a short period of time (perhaps not at a
normal mealtime) and feel a lack of control
during these binges, but unlike someone with
bulimia nervosa, you do not try to get rid of the
food. You may feel your eating is out of control,
eat what you think of as an unusually large
amount of food, eat much more quickly in these
binges, eat until you are uncomfortably full, eat
large amounts of food when you are not hungry
or eat alone. You do this for very similar reasons
to someone with bulimia.
http://www.b-eat.co.uk/get-help/about-eating-disorders/types-of-eating-disorder1/binge-eating-disorder/
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Symptoms of Binge Eating Disorder
Physical signs
Behavioural signs
Psychological signs
Weight gain
Eating large quantities of
food
Feeling depressed and out
of control
Eating inappropriate food
Mood swings
Being secretive
Emotional behaviour
Feeling guilty after eating
http://www.b-eat.co.uk/get-help/about-eating-disorders/do-i-have-an-eating-disorder/
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Gender differences
• Women are more likely to have been treated
for a mental health problem than men (29%
compared with 17%).
• Depression is more common in women than
men. 1 in 4 women will require treatment for
depression at some time, compared with 1 in
10 men. The reasons for this are unclear, but
are thought to be due to both social and
biological factors.
Better Or Worse: A Follow-Up Study Of The Mental Health Of Adults In Great Britain London: National Statistics, (2003)
National Institute for Health and Clinical Excellence, Depression, NICE Guideline, Second Consultation. London: NHS p19, (2003)
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• Doctors are more likely to treat depression in
women than in men, even when they present
with identical symptoms.
• Men are more likely than women to have an
alcohol or drug problem. 67% of British people
who consume alcohol at ‘hazardous’ levels, and
80% of those dependent on alcohol are male.
Almost three quarters of people dependent on
cannabis and 69% of those dependent on other
illegal drugs are male.
World Health Organisation, Fact sheet N°248, Women and Mental Health, (2000)
Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H. Psychiatric Morbidity Among Adults Living In Private Households, 2000
London: The Stationery Office, (2001)
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• About 75% of people to die by suicide are
men. This proportion has been about the
same for more than a decade.
Office for National Statistics (2006) Suicides: Rate in UK men continues to fall, Health Statistics Quarterly
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Ethnicity
• Depression in ethnic minority groups has been
found to be up to 60% higher than in the
white population.
• Young Asian women are three times as likely
to kill themselves as young white women.
National Health Service Mental Health: National Service Frameworks London: NHS p77, (1999)
Mind Suicide Factsheet, at www.mind.org.uk, (2004)
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• Mental health staff, including psychiatrists, are
more likely to perceive black patients as being
potentially dangerous, even though there is
no evidence that they are any more aggressive
than other patient populations.
Nazroo J, King M, Psychosis – symptoms and estimated rates in Sproston K, Nazroo J (ed) Ethnic Minority Psychiatric Illness
Rates In The Community (EMPIRIC), Quantitive Report, London: Stationery Office, (2002)
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• Black people are more likely than white
people to be given physical treatments, such
as medication and ECT, and are likely to be
prescribed higher doses of medication. They
are less likely to be offered psychotherapy,
counselling and other non-medical
interventions.
Keating et al, Breaking The Circles Of Fear, London: Sainsbury Centre for Mental Health, (2002)
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Children and young people
• Estimates vary, but research suggests that 20%
of children have a mental health problem in
any given year, and about 10% at any one
time.
Lifetime Impacts: Childhood and Adolescent Mental Health, Understanding The Lifetime Impacts London: Mental Health
Foundation p4, (2005)
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National Statistics Online, Mental Health: Mental Disorder More Common In Boys, at www.statistics.gov.uk, (2004)
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• Among teenagers, rates of depression and
anxiety have increased by 70% in the past 25
years.
• Children of single-parent families are twice as
likely to have a mental health problem as children
of two parent families (16%, compared with 8%).
Also at higher risk are children in large families,
children of poor and poorly-educated parents
and those living in social sector housing.
Lifetime Impacts: Childhood and Adolescent Mental Health, Understanding The Lifetime Impacts London: Mental Health Foundation
(2005)
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• 41% of British 11-15 year-olds who smoke
regularly have a mental disorder, as well as
24% of those who drink alcohol at least once a
week, and 49% of those who use cannabis at
least once a month.
National Statistics Online, Mental Health: Mental Disorder More Common In Boys, at www.statistics.gov.uk, (2004)
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• Two thirds of refugees have experienced
anxiety and depression, which may often be
linked to war, imprisonment, torture or
oppression in their home countries, and/or
social isolation, language difficulties and
discrimination in their new country.
Burnett A, Peel M, Health Needs Of Asylum Seekers And Refugees, British Medical Journal, 322 pp544-547, (2001)
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• 25-40% of people with learning disabilities are
estimated to have a mental health problem.
Health Needs of People With Learning Disabilities, Foundation for People with Learning Difficulties,
www.learningdisabilities.org.uk (accessed August 2006)
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Mental health and material
deprivation
• Having a low income, being unemployed,
living in poor housing, low levels of education
and membership of social classes IV (partly
skilled people) and V (individuals with no
skills) are all associated with a greater risk of
experiencing a mental health problem.
Based on Meltzer H, Singleton N, Lee A, Bebbington P, Brugha T, Jenkins R , The social and economic circumstances of
adults with mental disorders Her Majesty’s Stationery Office (HMSO): London, (2002)
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• The poorest fifth of adults are at double the
risk of experiencing a mental health problem
as those on average incomes.
Based on Meltzer H, Singleton N, Lee A, Bebbington P, Brugha T, Jenkins R , The social and economic circumstances of
adults with mental disorders Her Majesty’s Stationery Office (HMSO): London, (2002)
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• In a study of British adults taking the GHQ
questionnaire (which measures psychological
well-being), the prevalence of high scores
(indicative of a psychiatric problem) increased
as household income decreased.
Department of Health, Health Survey for England 2003: Summary of Key Findings London: Department Of Health p10, (2004)
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• Financial problems can be both a cause and a
consequence of mental health problems.
People with mental health problems are three
times as likely to be in debt as the general
population and more than twice as likely to
have problems managing money.
Mental Health and Social Exclusion, Social Exclusion Unit, London: Office of the Deputy Prime Minister, p88, quoting Meltzer 2002,
(2004)
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• Children in poor households are three times
as likely to have mental health problems as
children in well-off households.
National Health Service: National Service Frameworks London: NHS, (1999)
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• People without a degree are almost twice as
likely to experience depression as those with a
degree.
Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H, Psychiatric Morbidity Among Adults Living In Private Households, 2000
London: The Stationery Office p79, (2001)
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• A person with a severe mental health problem
is four times more likely than average to have
no close friends.
• 1 in 4 people using mental health services has
no contact with their family, and 1 in 3 has no
contact with friends.
Huxley P, Thornicroft G, Social Inclusion, Social Quality And Mental Illness, British Journal Of Psychiatry 182 pp289-90, (2003)
National Health Service: National Service Frameworks London: NHS p46, (1999)
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• People with a common mental health problem
are twice as likely to be separated or divorced
as their mentally healthy counterparts (14%,
compared with 7%), and are more than twice
as likely to be single parents as those without
a mental health problem (9%, compared with
4%).
Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H, Psychiatric Morbidity Among Adults Living In Private Households, 2000
London: The Stationery Office p78, 79, (2001)
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• Between a third and two thirds of children
whose parents have mental health problems
will develop problems either in childhood or
adult life. Children of depressed parents have
a 50% risk of developing depression
themselves before the age of 20.
Mental Health and Social Exclusion, Social Exclusion Unit, London: Office of the Deputy Prime Minister, p75, quoting Falkov A,
Crossing Bridge: Training Resources for Working With Mentally Ill Parents And Their Children London:Department of Health/Pavilion,
(2004)
Prevention Of Mental Disorders Geneva: World Health Organisation p29, (2004)
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This project (project n° 2013-1-NO1-LEO05-06154)
has been funded with support from the European
Commission. This publication reflects the views only
of the author, and the Commission cannot be held
responsible for any use which may be made of the
information contained therein.
LEONARDO DA VINCI
TRANSFER OF INNOVATION PROJECT
November 2013 -October 2015
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