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CHRISTOPHE KEREBEL
roblems attached to eating disorders reach far Importantly, this is a real-world trial of MBS payments and CHRISTOPHE KEREBEL My Twitter : @chriskere other supports for clinicians required to change primary care beyond affected individuals. They ultimately CHRISTOPHE KEREBEL become family concerns, which is why evidence- responses to people with eating disorders. The research based research into eating disorder interventions results – both emerging and final – will be used to influence must be informed by partnerships between patients, state, territory and Commonwealth government policy. carers, health professionals and researchers if they The Blackbird Initiative contributes to a personalised are to lead to tangible improvements.. medicine approach, using individual profiles to fit indicated Eating disorders mainly emerge over adolescence and treatments and adjuncts. For this to succeed, we must are often dismissed at first as “a phase” – a trajectory ask new and more specific questions. What’s the genetic that usually turns from wanting to lose a bit of weight, profile? What’s the personality profile? What are the to developing strict rules around healthy eating, to particular risk factors? What sensible additions to the goodnot wanting to eat with the family, and by that time the enough treatment would be very effective for this individual? changes should be ringing alarm bells. Having worked as a clinician to address eating disorders for 30 years, I know it’s important at this stage for families to seek help as early as possible for an eating disorder. These situations need to be closely monitored because problems can develop quick ly, especially if the individuals are in a peer group that’s particularly critical of appearance and they’re being bullied or teased about appearance through the sometimes toxic world of social media, particularly platforms like Instagram that feature many images of idealised bodies.
MANY FACTORS AT WORK
While interventions like cognitive behaviour therapy help 50% of people with bulimia nervosa to recover, and around 30% of people with anorexia nervosa, we need to extensively comb through clinical, genetic and environmental factors to improve outcomes. This is the focus of the Blackbird Research Initiative. We seek to gain a better understanding of genetic and epi-genetic pathways that may suggest novel adjunct interventions, and we are evaluating and disseminating forms of online therapy that young people and their carers find accessible and compelling. We are developing models for early intervention with primary health care settings such as headspace, and evaluating the rollout of eating disorder treatments by nonspecialist clinicians.
We seek to empower consumers seeking private therapy for an eating disorder under new expanded Medicare items, to locate the best option for them. This work needs to be underwritten by a commitment to involve more people with lived experience in co-designed research.ˮ Applied focus is evident in our partnership with the Sunshine Coast Eating Disorders Access Trial, administered by Butterfly. This Federally funded translation project is evaluating the rollout of the provision of Eating Disorder treatment by clinicians not already working in this area. The analysis will identify what issues need to be sorted before wider rollout of such therapies, in response to the expanded Medicare funding that commenced last November.
MORE THAN A DISORDER OF YOUNG WOMEN
This is challenging because eating disorders are not just a disorder of young women. It is rising steeply in men, who can often experience a severe course with the illness if they get anorexia nervosa as a teenager, resulting in high co-occurrence of obsessive/compulsive traits and perfectionism. Gender identity challenges lead to increased risk for the development of eating disorders. Women in their forties and fifties are another group vulnerable to disordered eating, with about 15% struggling with this at any one time. Engaging people in interventions can be difficult because of ambivalence about disordered eating. While people might not like aspects of disordered eating, such as binge-eating and vomiting, they don’t want to gain weight, or they want to continue losing weight – a value highly endorsed by society generally. Change is also difficult because eating disorders are highly comorbid with other conditions, such as anxiety disorders (50%), mood disorders (40%), self-harm (40%) and substance use (10%). Devastatingly, people with an eating disorder have a mortality rate 12 times higher than people without an eating disorder. Unless treated successfully, a person’s struggles with an eating disorder can be lifelong if not life-ending. Our research indicates 15% of Australian teenage girls will be diagnosed with an eating disorder before they turn 19. The COVID-19 era has seen an alarming increase in demand for eating disorders services, especially from young people, with wait lists extending across all services. There is an urgency and immediate need for the type of applied research that Blackbird champions. My passionate vision is for a future where all young people can live a life free of mental illness and embrace all the possibilities that life has to offer. Author: Professor Tracey Wade, Mathew Flinders Distinguished Professor in Psychology at Flinders University, and Director of the Blackbird Research Initiative. From January 2021, Professor Wade will commence as Director of Órama Institute for Mental Health and Wellbeing at Flinders University. 2020 | INSPIRE 018 29