Mental health articles

OF mental health care and mentally ill

Mental health promotion – aetiology and demographic features

Health promotion is the focus of Chapter 1 of this book. As in many other psychiatric conditions, it is unlikely that there is one causal factor but rather a host of variables which interact to produce the eating disorder. Then, once the illness has emerged, an array of factors act to maintain the disorder. It is generally agreed that there are two domains of risk factors.

The f irst is the dieting/weight/eating domain and the second includes factors which are general to all forms of psychopathology. Our confidence in the risk factors evidence base for the bulimic disorders is much stronger than that for anorexia nervosa as several of them have been validated in prospective studies or in randomized trials. However, we argue that primary prevention is of most relevance for the bulimic disorders rather than for anorexia nervosa. Bulimia nervosa is a disease with a recent history, which suggests that some novel environmental exposure has been an important causal element. The illness emerged in the later half of the twentieth century. The risk has gradually increased with each birth cohort born since 1950.

Bulimia nervosa was first described clinically by Russell in 1979. There is much less evidence of an increased incidence of anorexia nervosa and so the attributable risk to environmental factors is probably less. Also because anorexia nervosa is less common, a population-based prevention programme is less efficient. However, anorexia nervosa is the ideal candidate for a secondary prevention strategy because it is an overt condition. Thus it should be amendable to early detection and treatment.

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