Monday, 10 June 2013



Eating Disorders

Eating disorders typically begin in adolescence and are increasing in young men. Body image is an increasing pressure on all young people but young women in particular are bombarded by glossy magazines, adverts, and clothing manufacturers to aspire to a certain image. When this is linked with normal developmental changes after puberty the mixture can be explosive and in certain youngsters, create the conditions for the onset of an eating disorder.

Assessment of your problem should be comprehensive and include physical, psychological and social needs, and a comprehensive assessment of risk to self. The level of risk to your mental and physical health should be monitored as treatment progresses because it may increase, for example, following weight change or at times of transition between services in cases of anorexia nervosa. For people with eating disorders presenting in primary care, GPs should take responsibility for the initial assessment and the initial co-ordination of care.

This includes the determination of the need for emergency medical or mental health assessment. Be very careful about the advice and information available on the internet which encourages weight loss and advises or even promotes anorexia as a life-style choice. It is not - it is an illness and can be managed, treated and sorted out.

Young people and, where appropriate, carers should be provided with education and information on the nature, course and treatment of eating disorders. In addition to the provision of information, family and carers may be informed of self-help groups and support groups, and offered the opportunity to participate in such groups where they exist. Workers should acknowledge that many people with eating disorders are ambivalent about treatment and recognise the consequent demands and challenges this presents.

Young people with eating disorders should be assessed and receive treatment at the earliest opportunity. Early treatment is particularly important for those with or at risk of severe emaciation and they should be prioritised for treatment.

Anorexia nervosa

Most people with anorexia nervosa should be helped in the community with psychological treatment provided by a service that is competent in giving that treatment and assessing the physical risk of people with eating disorders. If you require in-patient treatment you might be admitted to a setting that can provide the skilled implementation of re-feeding with careful physical monitoring (particularly in the first few days of re-feeding) in combination with psychosocial interventions.

Family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa. Feeding against your will should be an intervention of last resort in the care and management of anorexia nervosa. Feeding against your will is a highly specialised procedure requiring expertise in the care and management of those with severe eating disorders and the physical complications associated with it.

This should only be done in the context of the Mental Health Act 1983 or Children Act 1989 (UK). When making the decision to feed against the will of the patient, the legal basis for any such action must be clear.

Bulimia nervosa

As a possible first step, young people with bulimia nervosa should be encouraged to follow an evidence-based self-help programme. The course of treatment should be for 16 to 20 sessions over four to five months. Adolescents with bulimia nervosa may be treated with cognitive behavioural therapy (CBT-BN), adapted as needed to suit their age,
circumstances and level of development, and including the family as appropriate.

For all eating disorders

Family members, including siblings, should normally be included in the treatment of children and adolescents with eating disorders.Family Therapy is the cardinal and optimum form of help and support because it brings together everyone in the family to harness their inner strengths to help change happen. Families and Parents know themselves better than anyone else so the therapy works by helping the Family support the young person in trouble.

Interventions may include sharing of information, advice on behavioural management and facilitating communication. In children and adolescents with eating disorders, growth and development should be closely monitored. Where development is delayed or growth is stunted despite adequate nutrition, paediatric advice should be sought. Professionals assessing children and adolescents with eating disorders should be alert to indicators of abuse (emotional, physical and sexual) and should remain so throughout treatment.

The right to confidentiality of children and adolescents with eating disorders should be respected. When working with children and adolescents with eating disorders social workers should familiarise themselves with national guidelines and their employers’ policies in the area of confidentiality. In the absence of evidence to guide the management of atypical eating disorders (eating disorders not otherwise specified) other than binge eating disorder, it is recommended to follow the guidance on the treatment of the eating problem that most closely resembles the individual person’s eating pattern.

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