Breaking the stigma: nurse sheds light on challenges in treating eating disorders

Peta Marks, a renowned mental health nurse, has dedicated over 20 years to improving the quality of care for people living with eating disorders. 

Peta specialises in psychological therapy for people with Anorexia Nervosa (AN), a mental illness characterised by a distorted body image and a fear of being overweight.

"Recovery is always possible," she said.

She runs a small team as National Programs Manager at Sydney's research institute for eating disorders treatment InsideOut.

Peta shared insights from her daily work routine with Nursing Review, emphasising the importance of early intervention and collaboration with other healthcare professionals in delivering comprehensive care.

NR: What does your day-to-day work life look like?

I work with individuals just like a psychologist or any other clinician would.

In my private practice, I see children, adolescents, and adults with eating disorders, primarily with AN and their families.

My sessions are funded through the local Primary Health Network (PHN) and fall under the mental health nurse funding arrangements by my PHN. 

It's a publicly funded program for people with severe mental illness, and people with AN meet the criteria due to the condition's severity and potentially life-threatening nature.

Based on their age, development stage, illness, and previous treatment experience, we collaborate to create a treatment plan, such as Cognitive-Behavioral Therapy (CBT).

The treatment approach depends on the individual's needs and what the evidence suggests is most effective.

I often collaborate with the person's general practitioner (GP) and coordinate with eating disorder coordinators in the local health districts in NSW.

If additional support is required from the Crisis Assessment and Management Service (CAMS) or the mental health eating disorder team, I work with the coordinator to ensure the person receives appropriate care. 

I also collaborate with local dietitians who specialise in eating disorders. 

Even though I work independently, I operate within a team framework, collaborating with other professionals to provide comprehensive care.

I'm very much like all nurses who come from a team framework where I collaborate with all the other professionals.

How did you become specialised in treating people with AN?

In 1994, I started working at the Royal Prince Alfred Hospital's Eating Disorders Unit, which had an extensive eating disorder program.

I became the coordinator of that program in the late '90s. 

My interest in AN sparked then; during that time, I specialised in the disorder.

AN is a complex mental illness that affects both physical and psychological health. 

It often co-occurs with other conditions such as anxiety disorders, obsessive-compulsive disorder (OCD), depression, and complex trauma.

I like working with people with AN because, even though it can be challenging, it's very, very rewarding.

People who are diagnosed with AN early on and get involved and engaged in treatment have really good outcomes if they stick with good treatment and have the right support. 

What do you find most rewarding working with people with AN?

It's very rewarding as a mental health nurse to have an opportunity to work with someone to help them to recover.

I still receive messages from people years after treatment.

In fact, I had a lovely experience this week where one of the people I worked with 25 years ago, who had severe and complex AN, has now recovered. 

She just gave her maiden speech in the NSW parliament and thanked all the clinicians involved in her care for not giving up on her. 

That's a real demonstration of how rewarding it is to work with people with eating disorders. 

If you can harness your interest, knowledge, and skills as a mental health nurse, it's fantastic work to do.

But it's also lovely when I hear from mothers who have reached out to me after their child has received treatment and recovered.

They share stories like their child getting married, having children, something they never thought would happen or expressing gratitude for the support during a difficult time.

They say, "It was so hard, and you saved our lives."

Or when a mother says, "My daughter is now going to university, doing this great course and living independently."

It's just amazing.

I have had many experiences like that with young people who receive early treatment, have good family support, actively participate, and achieve positive outcomes. 

So I receive lots of fantastic feedback from people.

What makes eating disorders so challenging to treat?

Like all other mental illnesses, we know that if people are identified and receive treatment early, they have a much better chance of recovery. 

The problem is that many people with eating disorders feel intense fear and stigma, preventing them from discussing it or seeking treatment. 

They might visit a general practitioner (GP) with symptoms of an eating disorder without explicitly mentioning it. 

Studies show that people with eating disorders tend to visit GPs more frequently in the five years leading up to their diagnosis than those without eating disorders. 

But they often don't explicitly disclose their condition, leading to missed early intervention opportunities. 

It's usually when the disorder has progressed, and others start noticing, or the individual becomes desperate and scared that they seek help and get identified. 

Sometimes, I see cases where people have been seeing a psychologist for years for anxiety or depression, and it's only later that an eating disorder is discovered as the person's weight loss becomes apparent or their eating behaviours become more pronounced. 

What role does stigma play in eating disorders?

Many people hold stereotyped thoughts about eating disorders, assuming that only extremely thin individuals or those underweight have eating disorders. 

However, we know that most individuals with eating disorders fall within the healthy weight range or overweight category. 

Additionally, people can exhibit severe anorexia symptoms while being within the normal weight range. 

This misconception often invalidates people with atypical anorexia, causing embarrassment and hindering their ability to talk about their struggles. 

This contributes to the stigma surrounding eating disorders and the difficulty in identifying them, even among healthcare professionals.

There's also commonly accepted stereotyping about people with eating disorders, such as that it only affects rich young girls who want to be just beautiful.

Of course, we know that's not the case at all. 

Eating disorders are experienced by people across all age ranges, body shapes and types, and cultural backgrounds. 

Certain groups, like the LGBTQI+ community, are more likely to present with an eating disorder than the general population. 

Adolescents and people in the overweight range or above their most healthy body weight are also more likely to have an eating disorder. 

Therefore, a lot of assumed and stereotyped information, including among health professionals, contributes to the lack of identification of people with eating disorders in healthcare settings.

What role can nurses play in the early identification of eating disorders?

So, early identification is crucial, and this is an area where nurses can play a significant role. 

Nurses can encourage individuals to talk about their eating issues and gently inquire about their feelings regarding their bodies and eating during routine health checks.

They can integrate these questions into mental health assessments when people from high-risk demographics seek treatment for the first time.

Inside Out has an e-screening tool with six user-friendly and acceptable questions that any nurse can use to let people know it's okay to discuss the issues they are experiencing. 

Regarding the role of a nurse compared to a psychologist in treating and helping people with eating disorders, there are some commonalities but also differences. 

In what way do you feel your nursing background helps you in treating people with eating disorders?

Nurses have a background in biological science, allowing them to conduct assessments such as measuring weight and blood pressure, discussing medications, and explaining the biology of the disorder. 

While psychologists can also engage in these discussions if trained in eating disorders, nurses often take on a care coordination role and work as part of a team. 

Nurses have the capacity to work with and involve families in the treatment process, which may be limited by funding arrangements for psychologists. 

The interdisciplinary nature of nursing enables a holistic approach to treatment, including psychoeducation on the impacts of starvation, nutritional requirements and recognising signs of starvation.

It also helps manage risks associated with eating disorders, including the high risk of suicide and biomedical complications in individuals with anorexia.

Recovery is always possible, and seeking help as early as possible is crucial. 

Don't allow the thoughts and beliefs of the eating disorder to minimise your experiences and concerns.

 If you're worried about your eating habits or the impact of weight and shape concerns on your life, it's time to take action.

There are health professionals, including mental health nurses, who have knowledge and expertise in eating disorders and can provide the necessary support. 

Treatment options are available, and more resources are emerging to address these issues. 

Remember, the sooner you seek treatment, the better the outcome can be.

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