The eating disorders (ED), which mainly include anorexia, bulimia, and binge eating, are not just a matter of girls and adolescents. There are also adults (mostly young women) who suffer from them, and whose prevalence increased significantly in the last two years, on the occasion of the pandemic. The eating disorders unit of the Hospital de la Santa Creu i Sant Pau, in Barcelona, which attends only to of legal age who are seriously ill (the mild ones go to adult mental health centers, those CSMA), has increased by 35% your patients in the last five years. This reality is confronted by another, that of the few resources: in this Sant Pau unit, a reference for the whole of the Barcelonès, only work one full-time psychiatrist, another part-time and a full-time psychologist.
Entities such as the Associació de Famílies Contra l’Anorèxia i la Bulímia (Ahab) denounce that “most of the units in TCA have now the same resources as they were years ago.” There has been no increase in day hospital slots or professionals. “Work is being done with the same resources as 20 years ago, but the number of people in need of care has multiplied. 10-fold.” denounces Ahab. The Conselleria de Salut claims that its ‘Pla director de salut mental i addiccions’ will prioritize the training of professionals in primary care (CSMA and CSMIJ), will increase the number of partial hospitalization places, will strengthen eating disorder units and create a subacute unit specializing in adult ED. But, for the time being, the families of those affected are feeling abandoned.
Sant Pau’s ACT unit receives about 225 referrals per year, twice as many as before the pandemic.
And the covid-19 aggravated the situation. “Within a year we received about 225 referrals, the double than before the pandemic,” he describes Mar Carceller, psychiatrist at Sant Pau’s ACT unit. “We have tripled the first visits since 2017. But it’s true that in the pandemic there was a huge spike in people who would not have made their debut if they had not been cooped up at home watching people on Instagram saying they had to do sports,” notes Carceller. The Sant Pau ACT unit, unlike the one at Sant Joan de Déu (which has two areas, one for total admission and another one for partial admission), has only one partial income area, which is a day hospital.
With the pandemic, warns Carceller, the patients previously cared for by the unit (most of whom are women from between 18 and 32 years old, but there are also a lot of people between 35 and 45, and even people over 60). “they relapsed tremendously”. “We have rebound among our patients, debuts in 25-year-olds and new cases that made their pandemic debut as minors and are now adults.” In addition, there are many “atypical anorexia.” people who previously had a higher than normal body mass index (BMI), who have lost weight very quickly and are now “malnourished.”
There is a lot of “atypical anorexia”: people who had a higher than normal BMI, who have lost weight very quickly and are now “malnourished.”
This unit at Sant Pau, for which there is an three-month waiting list (although it prioritizes the most serious patients, who pass earlier), is. referral for all Barcelonès. It has 20 places. The Patients are “high risk”. “Right now there are nine people waiting to come in. It may not seem like much, but they are people at organic risk: have underweight and malnourished.” notes the psychiatrist, who assures that both her classmates and herself are “on the verge of collapse.”
Catching it “in time.”
“We need more psychologists y psychiatrists to give an answer to all those people who are waiting and also to all those who, although they have an milder disorder, if we catch it in time, it will not relapse and the disease will not go further. It is important that these people are attended in specialty units y we can’t keep up: right now I have to filter and take the most serious patients first”. The Sant Pau ACT unit has one and a half psychiatrists (one who works 40 hours and one who works 20 hours) and one psychologist (40 hours) for all Barcelonès.
A person with TCA has about a 10% mortality rate. These disorders “kill more than covid”. Adults who suffer from them usually have made their debut in their juvenile stage, but later have relapses. In pandemic, this psychiatrist relates, women made their debut university students around 24 years of age. Also women during the postpartum. In short, people who wanted to “lose weight” and then end up developing an ATT.
According to Carceller, the unit has mostly seen. “anorexia and bulimia.” since the “binge eating”, although they are more prevalent, they are less consulted.