Yorkshire Centre for Eating Disorders
Information for service users
Also see:
x YCED Support Group
x YCED Carers Support Group
x Inpatient Information Booklet
x People's experience of eating disorders
What are eating disorders?
There are two interrelated eating disorders: bulimia nervosa and anorexia nervosa. Of these,
anorexia nervosa has the highest mortality. The diagnosis is made in patients with:
1. Low body weight
2. Intense fear of weight gain
3. Over-evaluation of shape and weight
4. Lack of menstrual cycles in women or reduced libido in men
Subclinical eating disorders
Some people have some, but not all, of the symptoms of anorexia nervosa and bulimia
described above. These can be very disabling, but limited resources mean that many
specialist services are only able to offer treatments to the most extreme cases.
Much more information on eating disorders is available from the following websites:
x www.b-eat.co.uk
x All about anorexia nervosa - Mental Health Foundation
x Anorexia nervosa & Bulimia nervosa - Royal College of Psychiatrists
x Understanding eating disorders - Mind
Who gets them?
Eating disorders affect women more than men. However, men are more likely to be underdiagnosed, misdiagnosed, under-referred and less likely to then be referred to specialist
services for treatment than women. They not restricted to a particular ethnic group.
Present estimates suggest that the average general practitioner with a list of 2,000 patients
is likely to have 1-2 patients with anorexia nervosa and 18 with bulimia nervosa. Five to ten
per cent of the adolescent girls on the list will have some degree of disordered eating.
Eating disorders can run in families, and personality traits of low self-esteem and
perfectionism raise vulnerability.
Getting help
People with eating disorders will have mixed feelings about ‘getting better’. The decision to
seek professional help is therefore a ‘water shed’ moment. Most people with eating disorders
will approach their family doctor. They can offer you the opportunity to receive an accurate
diagnosis of your condition. They may carry out a physical examination, to establish any
medical complications resulting from your eating disorder. Some milder eating disorders are
then managed within the family doctor’s practice. In other instances, the family doctor may
suggest a referral to a community mental health service for further therapy.
Navigating your way through the bureaucracy
Mental health services can seem quite complicated, with lots of different types of
professionals and lots of different types of services. Unfortunately in the UK some parts of
the country lack formal access to eating disorder services. Therefore treatments are carried
out by general psychiatric services, or by referral to another geographical area. One way of
navigating this bureaucracy is through local self-help groups. Attending a self-help group puts
you in touch with other people who have experienced similar difficulties. In the UK, the beat
(formally known as the Eating Disorder Association) is the umbrella organisation for self-help
groups, and their website https://www.b-eat.co.uk/ provides invaluable information, as well as
advising on access to treatment. That website includes a list of statutory organisations
providing treatment for eating disorders.
Qualities of a good therapist
There are many different forms of therapy for eating disorders. You need someone who will
show you empathy and respect. Empathy is different to sympathy. Some good therapists
can be quite challenging, and rightly so. Therapy is not about having a shoulder to cry on.
It is about someone who can engender change. What all effective treatments of eating
disorder have in common is a joint emphasis on thoughts and feelings behind the disorder,
and the need to change behaviours. Therapy that simply addresses behaviours tends not to
produce lasting change. Equally limited is therapy that does not require any change in
behaviour,
such as weight gain or cessation of vomiting.
Different forms of therapy
If you have very severe physical symptoms, such as low weight or abnormal blood results
due to vomiting, it may be necessary for you to receive medical treatment before therapy can
commence. Ultimately however, you are likely to be offered some form of ‘talking therapy’.
The various different types of talking therapy are described in the National Institute for
Clinical Excellence (NICE) guidelines, and these can be accessed free via the NICE website.
Different versions include cognitive behaviour therapy (CBT), a variant form of CBT known
as mindfulness CBT, cognitive analytic therapy, psychodynamic psychotherapy, group
therapy, interpersonal therapy, motivation enhancement therapy and couple therapy. For
some people with eating disorders, creative therapy such as art therapy, music therapy and
drama therapy can be very helpful, particularly when your immediate feelings are ‘beyond
words’.
It is important that you understand the rationale for the type of therapy that you are offered,
and you should feel free to discuss, and even challenge, the approach suggested by health
care professionals. Sometimes, it is appropriate to suggest medication (tablets) in addition to
psychotherapy. For example, many people with eating disorders and body image problems
also suffer from depression, and the level of depression can be a barrier to being able to
work in psychotherapy.
It is a sad fact that accessing specialist services can be difficult for some people with eating
disorders. In the UK, if you experience difficulties you can contact the Patient Advice and
Liaison Service (‘PALS’) in your area and they can act as your advocate, giving you
assistance in resolving disputes with health care professionals.
Different modes of therapy
Therapy for eating disorders is usually provided on an outpatient basis for mild and
moderate cases. Inpatient treatment is advocated for people whose illnesses are particularly
severe, where outpatient treatment has been tried unsuccessfully, where there are issues of
medical or emotional risk, where there are additional emotional problems such as
depression, or where there are bad social problems at home. For some people with severe
medical complications, it is necessary to receive treatment on a medical ward or an eating
disorder unit with sufficient expertise to manage medical complications. The guidelines for
the treatment of eating disorders provided by NICE recommend that every region should
have identified a physician with special expertise in eating disorders.
Summary
1. The role of the family doctor is crucial in co-ordinating care and referring you to an
appropriate agency.
2. Accessing specialist services can be tricky, and the more you are informed about the
process through self-help organisations such as the Beat, the more likely you will
succeed.
3. There are many different therapies for eating disorders, but the best of them combine
a non-dogmatic approach with the requirement of addressing thoughts, feelings, and
behaviours
4. The best forms of therapy are challenging, and may indeed make you feel
uncomfortable at times. That is why it is so important you find someone you trust
Useful resources
Eating Disorders and driving
Self-help books
x
Bulimia Nervosa - A Guide to Recovery. P. Cooper. Robinson 1993
x
Getting Better Bit(E) by Bit(E). U Schmidt and J Treasure. Lawrence Erlbaum
Associates, 1993.
x
Overcoming Binge Eating. C Fairburn. The Guildford Press, 1995.
x
Overcoming Anorexia Nervosa, Christopher Freeman and Peter Cooper 2002.
x
The Anorexia workbook: How to Accept Yourself, Heal Your Suffering, and Reclaim
Your Life (New Harbinger Self-Help Workbook) by Michelle Heffner & Georg Eifert,
2004.
x
Skilled-based Learning for Caring for a Loved One with an Eating Disorder: The new
Maudsley Method by Janet Treasure, Grainne Smith and Anna Crane. Routledge
2007.