Ellis Meade, Solicitor in our Serious Injury team discusses the effects of acquired brain injury (“ABI”) are truly multi-faceted, ranging from dysexecutive syndrome, neuro-behavioural issues, to more obvious physical disabilities.
It is well documented that the development of mental health issues like anxiety and depression is common after sustaining a brain injury. However, there is undoubtedly a lack of awareness of the link between acquired brain injury and eating disorders.
What is an eating disorder?
The National Health Service (NHS) defines an eating disorder as a mental health condition whereby individuals use the control of food to cope with feelings and other situations.
Unhealthy eating behaviours may include eating too much or too little or worrying about weight or body shape.
The most common eating disorders are:
- Anorexia Nervosa: trying to control your weight by not eating enough food, exercising too much, or doing both
- Bulimia: losing control over how much you eat and then taking drastic action to not put on weight
- Binge Eating Disorder (BED): eating large portions of food until you feel uncomfortably full
Case study: ‘Bobby’
Hugh James acts for Bobby following a Road Traffic Collision (RTC) in 2018 in which he unfortunately sustained a traumatic brain injury, facial fractures and a loss of teeth which required a denture.
These injuries had a profound effect on Bobby and the impacts of his brain injury were multiple. Bobby’s executive functioning was impaired, impacting his ability to initiate activities, plan and organise himself. As a result, he no longer ate regularly and consistently, eating small portions and not finishing meals. When reporting what he had eaten, Bobby would often say that he had a pizza, but in reality, he had only eaten a few slices. Bobby lost his taste and smell, affecting his enjoyment of food. Psychologically, Bobby was conscious of his appearance and avoided taking his denture out to eat in front of people. This however made it difficult for him to eat food whilst also affected his food choices. Furthermore, Bobby’s anxiety arising from his injuries provided an additional limitation to his appetite. These factors created the perfect conditions for the development of an eating disorder.
Bobby unfortunately lost a significant amount of weight in the months following the RTC. During the lifetime of the claim, the Hugh James Serious Injury Team were able to secure a significant funding package for rehabilitation which included Dietetics input not available via the NHS.
How did the rehabilitation work in practice?
Example of goals set by the dietician:
- Consume breakfast 7 days a week
- Consume a supplement drink daily
- Enhance the client’s sensory eating experience
- Developing a consistent sleeping pattern
Bobby’s brain injury had significantly affected his ability to sleep and adhere to a consistent bedtime routine. There was a clear lack of insight from Bobby of the impact of bedtime on his day-to-day function and food intake. Going to bed at 3am became a regular occurrence, an issue which was addressed by his psychologist. With professional input, Bobby was able to develop a more consistent sleeping pattern of going to bed at around midnight and waking at 10:30am. Bobby reported that this had a positive impact on his food intake, as he was no longer sleeping in until 1pm and missing breakfast.
Bobby was provided with a nutritional supplement drink, which he consumed in addition to his breakfast and other meals.
To improve his sensory eating experience, the dietician created a resource which included snacks to help stimulate the trigeminal nerve of the tongue. There was a particular focus on texture and Bobby began to include more ‘crunchy snacks’ as additions to his favourite meals. Foods with contrasting texture, temperature, spice or carbonation were prioritised. These strategies contributed to Bobby’s intake increasing by approximately 600 calories per day. Within 4 months of commencing his rehabilitation, Bobby had gained 5.3kg of weight, progressing from an underweight BMI to the healthy range.
This case study highlights the positive impact of highly focused rehabilitation for a client suffering with the complex impacts of a traumatic brain injury. Further research and publication in this area is undoubtedly required to broaden our understanding of the link between eating disorders and acquired brain injury.
*Name changed to protect anonymity
This blog was written by Ellis Meade, Solicitor in the Hugh James Serious Injury Team who works with clients who have sustained traumatic brain injuries.
