24 - Strategies for secondary prevention

Summary

Introduction

If those with anorexia nervosa (AN) or bulimia nervosa (BN) told their parents, teachers and general practitioners that they had an eating disorder and presented as motivated to change their eating behaviour, early detection would not be an issue. However, this is not the case. Most of those with eating disorders experience their slimming behaviour not as a problem but as a ‘solution’ for other problems such as having low self-esteem, a negative body image and feeling they are overweight. Their first success in losing weight generates higher self-esteem and a more positive attitude towards their body (Noordenbos, 1998). They are often very successful in hiding their eating disorder from others, sometimes even for years. This makes early detection by parents, teachers or general practitioners very difficult. The longer the duration of an ED, the more difficult it is to recover (Steinhausen et al., 1991). For this reason early diagnosis and early intervention are seen as important. Because these strategies start when a person already has an ED, we speak about secondary prevention.

Secondary prevention is an early intervention approach to seek out emerging manifestations of EDs, and by early intervention to reduce the likelihood of disease progression. As so many cases are girls between 12 and 18 years old who live with their parents and are in education, parents, teachers, peers and general practitioners may all play pivotal roles in secondary prevention. This chapter will describe the major issues including effectiveness of secondary prevention.