Abstract
Pierre Beumont, Department of Psychological Medicine, The University of Sydney, Sydney, Australia:
The release by the National Mental Health Strategy of its report on the mental health of young people in Australia is a disappointment to those health professionals and consumers who have a particular interest in eating disorders. Although in the declaration of its intentions [1], the Committee stated that the four disorders on which it would concentrate were depression, attention deficit, conduct disorder and eating disorder, eating disorders are not contained in the published report [2]. When asked to explain this discrepancy, a member of the Committee stated that the data for eating disorders was insufficient to draw any conclusions, probably because of the deficiency of the instrument used [Sawyer MG, pers comm., 2001]. Perhaps that is not surprising for patients who are characteristically so secretive about their behaviours as are those with eating disorders when the assessment consisted, as in this case, of an interview with parents and the use of a symptom check list that was not designed to include these illnesses.
The report does contain information on the wellknown risk behaviours for eating disorders, viz dieting and exercise to control weight and use of vomiting, laxatives and ‘pills’ to lose weight (surely pathological). It is of note that the first two risk behaviours mentioned rank first and third among all the risk factors for girls, and that the second most common risk behaviour, viz smoking, is also a well-recognised means of suppressing appetite [[2], p.38, Table 7.3]. It is also noted that these behaviours are markedly more prevalent among subjects with very high levels of emotional and behavioural problems [[2], p.41, Fig. 7.5]. Unfortunately, the report does not examine the relation of these variables to social deprivation.
Although it is accepted that a survey of this kind cannot answer all needs, it is inaccurate to term it comprehensive when disorders such as anxiety and eating disorders are not included. The report admits the exclusion of anxiety disorders compromises its usefulness. It should do the same in respect to eating disorders. It would be unfortunate if the report were to be interpreted as indicating eating disorders are rare in this age group, rather than difficult to recognise. The burden of disease that eating disorders imposes on Australians is very significant [3]. In fact, many eating disorder patients may be included in the depression category. Depression is known to be commonly associated with eating disorders, and the suicide rate of anorexia nervosa patients is even higher than those with major depression [4].