Last week I had a chat with a local GP about eating disorder awareness which was quite illuminating. Obviously this is just one GP from just one GPs' practice - a large, established practice in the leafy suburbs of a big northern UK city. Anyhow, this is what she said...
As a medical student at Cambridge, we probably had a couple of lectures on eating disorders, part of our psychiatry studies. As GPs we don't receive any further organised training. However if you have a specific interest in eating disorders you will look them up.
How would you identify a person with an eating disorder, say a parent brought their child in and were concerned about them? Maybe an a-typical presentation? Or they’re not emaciated or they’re in denial?
I'd speak to the parents. I'd also speak to the child, in fact I'd try to talk with the child alone if I could. In a case where the child insists there is nothing wrong and it's simply their parents being overly concerned, I'd talk with the parent. I'd ask why they are concerned. Is it because there are a lot of eating disorders around at the moment, for example at school? What evidence do they have that their child has got an eating disorder. Do they have evidence that they are taking laxatives, for example? Can they see their child not eating? I'd take it from there, really. If I felt it was just a paranoid parent then I'd probably just keep things under review, but if there was good hard evidence for me to go on then I would pursue it as much as I possibly could.
How much awareness do you have of males with eating disorders and children under 7?
I referred a boy for treatment recently. I don't have any experience of eating disorders in the under 7s but I am aware that they happen.
What measures might you take on first presentation for example weight, height, bloods, etc?
I'd definitely measure a young person's height and weight. Depending on age I'd talk to them about blood tests and explain why I felt they needed them. And if I were doing those investigations then I would definitely be referring to a specialist for advice. Knowing how long it can take to get someone seen, I would send off a referral at that point. GPs are just general practitioners; we're happy to help as much as we can but I’d be thinking that they would need to be seen by a specialist as well as seeing me.
I would refer a patient to CAMHS immediately, at that first appointment. If I thought there was some doubt about what was going on or what the family dynamic was then I would maybe see them again for another chat before referring but I’d definitely refer sooner rather than later.
While they were on the waiting list for CAMHS, I’d say "Come back, come back and see me whenever you need to". And if I felt the case was getting more urgent and they were really poorly, I'd see if I could expedite the appointment. I'd phone CAMHS. I have done this with eating disorders and self harming, so I can make sure CAMHS is aware of how serious I feel the situation is.
What, in your opinion, causes eating disorders?
Oh my goodness! Society, the child’s personality, upbringing,... there are so many different causes. So definitely personality traits, anxious personalities, perfectionists, the way society projects the perfect female body in that you "have to be" thin, so peer pressure, bullying and comments from other girls. Also, competitive children, competition with other girls, parents... you know, parents with high expectations who put pressure on children so self harm is a release. Control, too. One thing they can control is food so they're using food as a control thing.
How much awareness do you have of the latest research showing that eating disorders are probably genetically based and heritable conditions?
Yes, I’d go with that. I’m sure it’s part of the spectrum of anxiety and depression and it can be – not all the time, but it can be – a manifestation of that spectrum. I know there is a genetic basis, so yes. Interesting how you try and winkle out nature and nurture, though. I mean, if you have a mother who is hyper-paranoid about her weight… but, anyway, yep, I’d go with that.
How many GPs in the practice have extensive experience of eating disorders?
I’d say there probably isn’t a GP here who has done psychiatry. As a GP you just see what crops up. I mean, we’re a middle class, educated GP practice so we might see more eating disorders in middle class well educated girls (and boys) than, say, somewhere with a different demographic.
But I don’t know how many eating disorder patients we see or if any GP particularly specialises in eating disorders. You might need to talk with one of our more senior partners. We don’t see eating disorders very often; GPs’ time is so pressured so, as a GP, you tend to find out more about what you see more of. But if ever I had anyone with an eating disorder and I felt out my depth then I would definitely find out more about the condition.