Which came first, the chicken or the egg? This is a common phrase we often use when we do not know which event preceded the other.
In terms of anorexia nervosa (AN) and various psychiatric illnesses, this phrase is highly applicable. A recent study showed that patients with AN and a mental or psychiatric illness (such as depression, substance abuse, etc.) were almost two times more likely to die than those without another condition.
Is this surprising? Well, I suppose it comes as no surprise that having more than one illness increases your risk for death. Nor is it shocking that a psychiatric illness in particular increases this risk. After all, we are all well aware of the effects that mood and emotions can have on our functioning, views of the world and future, and overall health.
But on another note, the fact that the risk increases this much is a bit shocking. But to be honest, the numbers aren't the important thing here. What IS important is what we do with this information. Like the chicken and egg situation, we don't always know whether, for example, the depression came before the eating disorder, or occurred because/alongside the AN. HOWEVER, what we DO know is that depression + AN = bad outcomes. So, what are the implications?
Clearly, early identification and treatment of both the ED and any other co-morbid illnesses is essential. The sooner treatment can begin, the more likely it is to be successful, and the patient will experience less disability or negative consequences. It is also crucial to note that we ought to screen for mental illnesses more often than we should; indeed, screening for mental illnesses is often overlooked in the physician's office, and this can lead to prolonged and unidentified health issues (P.S. stay tuned for an upcoming post about mental health screening!).
One take-away home message? It isn't necessarily important whether, for example, someone with ED (or any health condition) was depressed (or had any other mental health issue) before or after their primary illness. Of course, knowing the time course can help us with many things, including treatment duration and regime, intensity, and so forth. But wasting time trying to future out which came first only delays treatment and prolongs recovery. Instead, we ought to focus on the HERE AND NOW. What problems does this patient have, and how we can we work with them to fix them? What does this patient need from us, and how can we use their resources and strengths to help them? How can we empower the patient and work as a team to meet their needs, promote their health, and prevent further decline? Let's stop running in circles with chickens and eggs, and let's put our efforts into promoting the message that patients deserve - and truly benefit - from early identification, support, empowerment, and patient-centered care that addresses all their concerns and needs.