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Anorexia; can it be considered an uncontrolled life-threatening disease
I am told this conditions is notoriously difficult and resistant to treatment. Would it be a stretch to say it is therefore “uncontrolled”?
What does it mean “life threatening”? Does it have to be life threatening NOW, as in client is in mortal danger, or in more general sense, as in “if not treated, you will die”?
Could it be considered for LCWRA purposes? Any case law or tips gratefully received.
The WCA guidebook says that ‘life threatening’ can only be considered for LCW and that somebody with a life threatening condition would still be considered able to do work related activity.
Are you not better looking at ‘substantial risk’ if not found to have LCWRA.
patient.info is a decent resource if you want better understanding of health conditions. Having skimmed their anorexia article I think it answers most of your questions.
BEAT, the national UK charity for eating disorders, has some information about the severity of eating disorders:
“Anorexia has the highest mortality rate of any psychiatric disorder, from medical complications associated with the illness as well as suicide. Bulimia is associated with severe medical complications, and binge eating disorder sufferers often experience the medical complications associated with obesity. In every case, eating disorders severely affect the quality of life of the sufferer and those that care for them.”
https://www.beateatingdisorders.org.uk/about-beat/policy-work/policy-and-best-practice-reports/prevalence-in-the-uk/
NICE has data on the prognosis of anorexia:
“Mortality rates are over 5 times higher for people with anorexia nervosa than the general population.
Anorexia nervosa has the highest rate of mortality of all mental health disorders.
The most common causes of death are cardiac complications, severe infection and suicide (20%).”
https://cks.nice.org.uk/topics/eating-disorders/background-information/prognosis/
NICE also advise:
“The course of anorexia nervosa is very variable — complete recovery is less likely the longer the person has the illness.
Estimates suggest that 46% of people will fully recover, 34% improve partially and 20% develop chronic anorexia nervosa.
Prognosis is best in young people with a short illness duration — up to 60% of adolescents with anorexia nervosa make a full recovery with early specialist treatment.
Relapse is common.
A systematic review (n=16 studies) found that 31% of people relapsed after treatment and that the highest risk of relapse was during the first year after discharge.”
Yeah, substantial risk is a much better fit, thank you.
Thanks also for resources about this eating disorder. The added complication is that this is an “atypical anorexia”. Client is not underweight but there is malnutrition, teeth issues, etc. Will be tough to persuade DWP of “substantial risk” in client of BMI of 25 :(
I can imagine one avenue to substantial risk if the wra interferes with her treatment.
As far as I understand it, anorexia requires very careful and planned intervention and, as is typical with several mental health issues, even small changes to daily schedule etc. can have profound impact.
Can also consider:-
Owing to a severe disorder of mood or behaviour, fails to convey food or drink to the claimant’s own mouth without receiving:
(i)physical assistance from someone else; or
(ii)regular prompting given by someone else in the claimant’s presence
and
Owing to a severe disorder of mood or behaviour, fails to:
(i)chew or swallow food or drink; or
(ii)chew or swallow food or drink without regular prompting given by someone else in the claimant’s presence
for Support Group
...The added complication is that this is an “atypical anorexia”. Client is not underweight but there is malnutrition, teeth issues, etc. Will be tough to persuade DWP of “substantial risk” in client of BMI of 25 :(
Absolute BMI is not the only factor in diagnosis here - abnormal blood tests, bone density loss, cessation of menstruation and heart arrhythmia can all be present, even at higher BMIs. Primary or secondary specialist care providers should be able to provide supporting evidence of these if requested.
ICD-11 advises that “A full and lasting recovery includes maintenance of a healthy weight and the cessation of behaviours aimed at reducing body weight for a sustained period (e.g., at least 1 year) following the termination of treatment.”
https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f263852475
ICD-11 also advises that diagnosis of anorexia can also be made where “Rapid weight loss (e.g., more than 20% of total body weight within 6 months) may replace the low body weight essential feature as long as other diagnostic requirements are met.”
https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/263852475
So, if your client has had rapid and substantial weight loss down to BMI 25 then they would still meet the diagnostic criteria for anorexia and could be experiencing multiple, complex and serious symptoms associated with this.
ICD-11 has been updated with this diagnostic criteria since ICD-10 which only had absolute BMI as the threshold.
(Sorry for multiple posts - consulting with MrsR who is a professional in this field.)
[ Edited: 9 May 2022 at 03:02 pm by MarkR ]Wow, thanks Mark :)
That’s very helpful indeed- pass on my appreciation to MrsR
Helen- this descriptor (eating and drinking), is it relevant to LCWRA under UC? If not, where can I stick it?
Helen- this descriptor (eating and drinking), is it relevant to LCWRA under UC? If not, where can I stick it?
The ESA and UC descriptors are the same. For UC you will find them in Schedule 7 of the UC Regs 2013.
Than you Ian.
I guess I am showing my ignorance after 3 years of delivering Help to Claim :(