Anorexia and bulimia nervosa (and John Prescott)

 

John Prescott has come out in the papers today as saying that he was suffering from bulimia nervosa whilst he was Deputy Prime Minister.

With two jags, an affair, some punches and a poorly timed croquet game and now a psychiatric illness, I’m impressed with how much mileage John Prescott has provided the red tops with other the past few years.  Bulimia is quite something for someone who was right at the top of the political pile to admit to.  Food’s a difficult thing – if you have a problem with it, eating too much or too little, you can’t just stay away from it.  And everywhere there are pictures of perfect bodies reproving you for not being just like them.   

Here’s a bit about eating disorders for the curious: 

The International Classification of diseases recognises a number of eating disorders, of which are two major flavours identified – anorexia nervosa (F50.0) and bulimina nervosa (F50.2).  If someone presents with a difficulty with their eating which doesn’t fit into either of these patterns then they are classified as having an eating disorder, unspecified (F50.9) 

Anorexia Nervosa is characterised by deliberate weight loss resulting from under-nutrition with associated with endocrine and metabolic disturbance. It occurs most commonly in adolescent girls and young women with males of the same age affected rarely.  For a definitive diagnosis:

  • Body weight must be maintained at 15% below that expected
  • weight loss is maintained by the avoidance of ‘fattening’ foods
  • There need be body-image distortion, where dread of fatness persists as an intrusive overvalued idea. 
  • Amenorrhoea (lack of periods) in women and loss of libido in men. 
  • Delay or arrest of puberty.

In contrast bulimia nervosa is characterised by repeated bouts of overeating and an excessive preoccupation with the control of body weight.  The age and sex distribution is similar to AN, with the age of onset being slightly later.  Bulimic patients often have a history of anorexia nervosa.  For a definitive diagnosis:

  • There is a persistent preoccupation with eating and a craving for food; the patient binges
  • The patient attempts to counteract the ‘fattening’ effects of the food by vomiting, but could also attempt control by purgative abuse or use of appetite suppressants. 
  • There is a morbid dread of fatness

There are two subtypes of BN – purging (with regular use of vomiting/laxatives etc.) and non purging (where compensating behaviours are exercise or fasting). 

Both these diseases are serious.  The death rate for suffers of AN is twelve times that of the general population, the worst of any psychiatric disorder.  Suicide rates for those with AN are two hundred times that of the general population.  The two conditions are also often associated with other psychiatric difficulties such as depression, personality disturbance and alcohol abuse. 

Given his age and presentation Mr Prescott’s case is atypical and and it will be interesting to read about it in his forthcoming biography (this can’t have done his sales any harm) 

Addenda

Here‘s a Guardian article by Decca Aitkenhead about Prescott

NHSblogdoc is rather less charitable than I am

One Response to “Anorexia and bulimia nervosa (and John Prescott)”

  1. give me the beans and I'll count them says:

    Thank you for that – although I’ve come across it rather belatedly.

    It sums up the diagnoses so well. I may well be using your words in doing battle with the DWP and trying to get my GP to understand what I want out of her (she’s being very kind but doesn’t seem to get what I’m talking about when trying to describe EDNOS). Hope you don’t sue me for plagiarism – I’m no Raj Persaud. I’ll acknowledge the words and won’t broadcast them any further than the Citizens Advice Bureau

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