Blog
Eating Disorders in the Student Population – A GP’s Perspective
- February 28, 2024
- Posted by: hkearns@irishpsychiatry.ie
- Category: Blog
When a person becomes concerned about their eating behaviour, the GP is usually the first health professional that they will contact for assistance. Dr Aoife O’Sullivan is a GP in the Student Health Centre at University College Cork and the HSE ICGP National Clinical Lead in Mental Health. She has a special interest in eating disorders and was involved in the development of the HSE Model of Care and the self-care app. Dr O’Sullivan also developed a Quick Reference Guide for GPs managing eating disorders in primary care settings.
Here, Dr O’Sullivan reflects on her experience of supporting students who present with eating disorders.
I am a GP working in Student Health in UCC and have been working with students with eating disorders for a few years now. In Student Health Centres, we are seeing increasing numbers of students with mental health issues, especially since the Covid-19 lockdowns. People are often surprised when I say that at least 20% of a GP’s time is spent on mental health and that 90% of mental health issues are managed in primary care.
A quick headcount in one of the morning clinics this week revealed that 50% of the patients I saw or spoke to had mental health issues as part, or all, of their consultation.
The anxiety out there is huge and understandable. More and more students are coping with anxiety through either restricting their eating or binge eating.
Eating disorders have always been more prevalent than you might realise. While those with severe anorexia are very visible, there are a lot of hidden people with bulimia, binge eating disorder and other types of eating disorders. The number of people presenting with eating disorders (or coming to their GPs with other symptoms that have their real origins in an eating disorder) has also increased. The transition to third level education can be a particularly difficult time for those with disordered eating. The newly gained independence and lack of a daily routine can make restricting intake easier to hide.
Those with binge eating disorder often feel really guilty and a failure because they can’t control what they are eating. The shame and isolation they feel is very distressing. Nobody has ever come into me complaining of binge eating – they blame themselves and are taken aback when we explore the possibility of binge eating disorder.
Often students who come in are worried they won’t be believed because their weight is (more or less) within the normal range and perhaps, they haven’t been taken seriously in the past because of this. It is absolutely possible to have an eating disorder and not show it and they need our help.
Students with anorexia often feel very conflicted about getting help. We are asking them to give up their (unhealthy) coping mechanism and to do the very thing that scares them most – put on weight.
If you are already uncertain about whether you even want to get better, a prolonged waiting period is not helpful.
The secondary care community mental health services can have long wait times and limited resources. The introduction of the National Clinical Programme for Eating Disorders in 2018 lead to the development of specialised eating disorder services in some parts of the country. Access to these services is often by tertiary referral (i.e. your GP cannot refer directly).
As with all medical conditions, early diagnosis and treatment make all the difference and lead to a much higher chance of recovery. Eating disorders are unusual in that they affect both mental health and physical health so intensely. They can cause huge conflict and misunderstanding – “why doesn’t s/he just eat?” Unfortunately, it is just not that simple. The internal voice driving the eating disorder can be so loud and dominant in the patient’s head that it drowns out the logical self. Yet at the end of the day, food is the medicine.
To get past this conflict, help is needed and often unfortunately hard to come by. Patients can report feeling abandoned or lost while awaiting specialist appointments that could be months down the line.
GPs and student health doctors can provide support, monitoring and signposting to services that are available to students both within their institution and in their community.
Bodywhys provide a support service via their website and email – I highly recommend their Pilar programme for parents and carers. The HSE have also developed a really useful app with support and advice from psychologists, dietitians and GPs on issues such as managing mealtimes, body image and tips on how to talk about eating disorders.