Dr. Teia Plana: "We try to modify the irrational and unrealistic ideas that patients with EDs have”

EDs are multi-causal. In other words, there is no single factor that causes a person to develop the disease. Within this multi-causality, there are individual and environmental factors. The individual factors include gender, which is linked to the more genetic and hormonal part. It has been proven that oestrogen can increase the risk of having this type of disorder. In the environmental factors, on the other hand, we find that women are under greater social pressure regarding their physical appearance. Moreover, the physical changes they go through during adolescence are often more significant and occur faster than in boys. This means girls might worry more and this may favour the appearance of an eating disorder.

Bearing in mind that in all cases different factors are intertwined and that the individual, with their own personality traits, lives in an environment that influences them, it seems that the influence of the genetic predisposition is greater when the onset of the disease occurs during youth. It remains to be determined whether, in younger girls, environmental factors may be more relevant.

Yes. Young girls are increasingly able to access social media, which means that they end up in contact with people or situations that they would not have come across had it not been for these platforms. 

The first thing we do is to offer an initial consultation with the patient and the parents in order to identify the stage of the disease and its severity. When we see a patient with a very slow heart beat, a very low weight or a high risk of suicide or self-harm, we provide immediate in-patient treatment. On the other hand, there are patients who, despite having a moderate or serious ED, show a certain predisposition to change and a certain awareness of the disease. In these cases, we try intensive outpatient treatment. In between, we have the day hospital patients, who go to school in the morning and are with us from midday onwards to have lunch, a snack and dinner and attend the therapeutic groups. In addition, no matter what level they are at, they are all offered treatment linked to psychological therapy as well as the medical nutritional treatment they need. 

This treatment attempts to modify erroneous, irrational and unrealistic ideas that have developed in the patient's head and that prevent them from progressing towards recovery, because the behaviour encourages the ideas. At this point, the well-known body image distortion also appears, which makes the patient unaware of what is happening to their body. We have to make the patient realize that the problem lies neither with their body nor the food, and transfer it to the more cerebral and psychiatric side, discover what the misconception is and start to give the body everything they gave it before. Above all, we have to ensure that the patient is aware that there are two realities, the one they see and the one that others see.

Yes. The average total recovery rate for EDs in adolescents and young people is 70%. And total recovery does not just mean eating well, but covers all aspects of the disease, such as the good relationship with one’s own body, confronting taboo foods, improving one's mood and relationships with others, etc. If any of these elements still require work, the patient has not fully recovered yet.

The more time that passes between the onset of the illness and the start of treatment, the higher the risk that the patient will take longer to recover. That is precisely why early intervention is very important. The patient’s friends and family must be on the lookout for any emotional changes. If our son or daughter suddenly starts to complain a lot about himself or herself, makes self-depreciating remarks about his or her body, refrains from eating certain foods, is more isolated, shows excessive interest in cooking, etc., we should be concerned. If we find ourselves in one of these situations, the most advisable thing to do is to ask this boy or girl what is wrong and how they feel… In short, we need to try to get them to open up to us. At this point, a psychological resource will no doubt be more effective than a diet.

All this may explain the increase in the number of cases that we came across during the COVID-19 pandemic. During the months of lockdown, some people developed an irrational fear of gaining weight because of being unable to control their meals or physical exercise normally. We can divide the cases that emerged at that time into three groups of patients: those we were already treating but who got worse with lockdown; those who had already started to develop an ED but no one had realized yet and, by spending more time at home, their friends and family were able to detect it more quickly and start the treatment; and those whose ED started during lockdown itself and for whom many of these personality traits such as extreme perfectionism or difficulties coping with stress played a very important role. We could say that during that period the emotional risk factors for these diseases increased (greater anxiety, uncertainty, isolation, etc.), whilst the protective factors, such as social relationships, decreased.

In general, society is too concerned about image, the physical appearance or “the photo” we present to others. Self-care has become very fashionable in recent years, and that’s not a bad thing, as long as it doesn’t turn into a permanent dissatisfaction with ourselves.

We can’t control what people publish on social media. What we have to try to do is to ensure that the recipient does not receive images that could harm them or that could become unhealthy role models in relation to their age. Knowing what is true and what is a false, and what is right and what is wrong, requires a lot of cognitive work, which depends on a maturity that a child has not yet acquired. And that is why it will be easier for this girl or boy, during a period of change and concern, to become a vulnerable individual.

At present, in Catalonia a large amount of resources are being allocated to these diseases. In addition, the CatSalut mental health programme has launched an action plan to offer even more. We are happy with the treatments too. Some of them continue to work well and others still need to be designed. I feel that the social part is the weakest one. This means that cases continue to appear that would not appear otherwise. Therefore, all efforts must be focused in this direction so as to try to improve this situation in the coming years.