Thank you for inviting us today. The Canadian Psychological Association is the national association for psychology in Canada. There are approximately 18,000 psychologists in Canada, making up the largest group of regulated specialized mental health care providers in the country.
Psychologists are committed to evidence-based care—that is, care that is clinically effective and cost-effective. We accomplish this by developing, delivering, and evaluating treatments and programs across a wide range of mental and behavioural health disorders, including eating disorders.
Eating disorders are characterized by severely disturbed eating behaviour, body image, and self-esteem, which typically begin in adolescence or young adulthood. Although boys, men, girls, and women can all be affected by an eating disorder, eating disorders typically affect 10 times more females than males.
Two of the most commonly known eating disorders are anorexia nervosa and bulimia nervosa. Anorexia nervosa is characterized by a refusal to maintain a normal body weight through severe dietary restriction, while bulimia nervosa is characterized by eating an excessive amount of food and losing control during that episode, which is called a binge, followed by purging, usually by vomiting. Binge-eating disorder, which is less well known but is actually the most commonly occurring eating disorder, involves binge eating without purging.
The lifetime prevalence for anorexia nervosa is about 0.9% of the population, for bulimia nervosa it's about 1.5% to 2% of the population, and for binge-eating disorder it's 3.5%. The prevalence of eating disorders, though, is highest among teenage girls and young women.
As Dr. Spettigue mentioned, although we don't have a registry in Canada, if we extrapolate those percentages to the Canadian population we can guess that about 450,000 to 500,000 Canadian women have experienced or will experience an eating disorder during their lifetime. The prevalence rates may actually increase in the coming years, partly for social reasons but also because the diagnostic criteria we use for eating disorders have changed. We're finally recognizing that less extreme levels of disordered eating significantly affect health and functioning.
As was mentioned, eating disorders have a devastating effect on individuals and their families. These disorders often co-occur with other debilitating mental health disorders, such as depression and anxiety. Quality of life, work, education, family, and social functioning are all negatively and significantly affected by an eating disorder. As was previously mentioned, compared with all other mental health disorders, anorexia nervosa has the highest rate of death.
Psychological interventions have the best evidence base for treating eating disorders. Evidence-based psychological treatments are considered by most international treatment guidelines to be the first line of intervention for most eating disorders. Treatments can be provided on an outpatient basis for less severe cases. However, specialist care is required for more severe individuals in both day treatment and in-patient programs for those who are medically compromised.
Successful treatment of eating disorders depends on a comprehensive plan that includes ongoing monitoring of symptoms and stabilizing nutritional status; psychological interventions that include cognitive behavioural therapy, personal psychotherapy, and family counselling; education and nutrition counselling; and in some cases medications.
Often primary care is the first place those suffering with an eating disorder go to for help, so it's critical that family physicians are educated as to the seriousness of eating disorder symptoms, to be able to recognize when there's an eating disorder present and to recognize when the patient requires specialist care.