Personal Record Book
Tier 3: Specialist Eating Disorders Service
The objectives of your personal record book are:
 To act as a collaborative record of your care
All contacts with professional staff can be recorded in this book to enable you
to have a clear understanding of who is who and what your goals are in each
area. It is your responsibility to keep this record book up to date and bring to
all your appointments.
 To provide tools for reflective thinking
There is a list of appendices included in your record book which; allow you to
practise any skills you are learning or have learnt,
document your
achievements or future goals, manage your appointments and monitor your
weight.
 To function as an source of educational information for
yourselves and to share with family/cares
This record book provides information on eating disorders for your personal
use or to share with family/carers. This includes; the effects of an eating
disorder on physical and mental health, useful reading resources, support
groups and misconceptions regarding eating disorders.
 To provide you with a detailed description of the settings, polices
and procedures that are applicable to you in Tier 3
The record book provides detailed information regarding the eating disorders
setting and also the policies and procedures that may influence your care.
 To provide you with information on steps in treatment and
recovery
The record book provides a breakdown of the steps in treatment and
recovery. This also includes what you can expect from the service.
Aneurin Bevan and South Powys Tier 3 Eating Disorder Service
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Contents
Contents :
General Information on Eating Disorders
Eating Disorders explained
Psychological and physical effects of
eating disorders
Advice and support
What happens in Eating Disorder Services?
Introduction to tiers and services
Treatment and Recovery
First steps
Cycle of Change diagram
Role of GP after diagnosis
What is a Care and Treatment Plan?
Who you might meet and their job roles
Dietetic Information
A more in depth look at how your eating
disorders effects bodily functions
Blood tests
Effects on hormones: women/men
Effects of starvation
Facts and misconceptions of eating
disorders
Recovery Testimonial
Miscellaneous
Contact number of you Tier 3 team
Useful reading
Sourced information
Appendix
Page
Numbers:
3-4
4-5
5
5-6
6
6
7
8
9
10
11
11
12
12
13-17
18
19
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General Information on Eating Disorders
Introduction
We all have different eating habits and there are a large number of “eating
styles” which can allow us to stay healthy. However, there are some which
can be driven by an intense fear of becoming fat and actually damage our
health. These are called “eating disorders” and involve eating too much,
eating too little and / or using harmful ways to get rid of calories.
This information will be helpful if you feel your eating or dieting may be a
problem. You may believe that you have anorexia nervosa or bulimia nervosa
or you are experiencing concerns from family and friends who worry that you
have lost too much weight.
What are Eating Disorders?
Worries about weight, shape and eating are common and problems can occur
in a range of ways. Mostly eating disorders present as anorexia nervosa (AN)
or bulimia nervosa (BN). There are also a whole range of other eating
disorders that are slightly different, yet as troubling as AN and BN and are
often referred to as Atypical i.e different or EDNOS meaning, eating disorder
not otherwise stated. These diagnostic descriptions come from the
International Classification Diseases, commonly known by your health
professional as ICD-10.
A lot of people want to be thinner even if they are not overweight in the first
place. They often try to lose weight by dieting or skipping meals. For some,
worries about weight become an obsession which can result in a serious
eating disorder. Eating disorders are very common in women and teenage
girls; however, they do occur in men and teenage boys. Eating disorders can
affect individuals at any age and from all different cultural backgrounds.
Someone with AN worries all the time about being fat even when they are
skinny and eat very little. They lose a lot of weight and their periods may
become irregular or even stop. They may find they spend huge amounts of
time thinking about food, how to restrict it or how to avoid it and constantly
worry about the effects eating food will have on them. Someone with BN also
worries a lot about weight but they alternate between eating next to nothing
and then having to binge or gorge on food. They also may vomit or take
laxatives in order to control their weight.
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There are common signs and symptoms that often occur in both AN, BN and
EDNOS that often make a diagnosis difficult, but it is important to recognise
them so you can identify what the issues are for you as an individual, these
are:
Weight loss or unusual weight changes.
Periods being irregular or stopping.
Missing meals, eating very little and avoiding “fattening foods”.
Avoiding eating in public, secret eating.
Large amount of food disappearing from cupboards.
Believing you are fat when underweight.
Excessively exercising, often in secret.
Becoming preoccupied with food, cooking for other people, calories
counting and setting target weights.
Going to the toilet or bathroom immediately after meals.
Using laxatives and vomiting to control weight or sometimes
medications / herbal remedies to lose weight.
It is important to know that eating disorders can have a detrimental effect on
your physical and psychological health resulting in:
Feeling excessively cold.
Headaches and dizziness.
Changes in hair (sometimes hair loss) and skin.
Tiredness and difficulty with everyday normal activities.
Damage to health including stunting of growth and damage to internal
organs and bones.
Loss of periods and risk of infertility.
Anxiety and depression.
Poor concentration, missing school, college or work.
Lack of confidence, withdrawn from family and friends.
Low self esteem and self loathing.
Dependency or over-involvement with parents, instead of developing
independence.
People always want to know “why” and “how” this eating disorder has
happened. There is no one single reason and generally there are a number of
causes / triggers as follows:
Worry or stress may lead to comfort eating, this may cause worries
about getting fat.
Dieting and missing meals leads to craving for food, loss of control and
over-eating.
Anorexia or bulimia can develop as a complication of more extreme
dieting, perhaps triggered by an upsetting event, such as family
breakdown, death or separation in the family, bullying at school or work
or abuse.
Often, anorexia and bulimia may be a way of trying to feel in control if
life feels stressful.
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More ordinary events, such as the loss of a friend, a teasing remark,
school / college / university / work pressures may also be the trigger in
a vulnerable person.
Some people are often more at risk of developing an eating disorder than
others. They are usually sensitive or anxious individuals who are having
difficulties managing some internal conflicts especially when they have low
self esteem. They are also often very perfectionist.
Seeking Advice and Support for yourself and your family
The type of help and treatment can vary from region to region in Wales, but all
health professionals work from guidance called “NICE guidelines” (National
Institute Clinical Excellence) which recommend best practice and treatment, a
downloadable leaflet tells you what treatment you can expect form your GP
and other NHS services. www.nice.org.uk. Further support can be obtained
from:
www.b-eat.co.uk,
www.eatingdisordersresearch.com
and
www.rcpsych.ac.uk. All have useful advice for sufferers, carers and peers,
including readable and well researched information about eating disorders.
Introduction to the Services in Eating Disorders
In 2010 The Welsh Assembly Government committed to funding the
development of specialist eating disorder teams in different areas of Wales.
These Tier 3 teams sit between Tier 2 Community Mental Health Teams
(CMHT’s) and Tier 4 Specialist Inpatient Services.
Specialist
Eating
Disorders
Inpatient Unit
Specialist ED Team
Referrals from CMHT’s
Specialist Interventions
Gatekeeper for Tier 4
TIER
4
TIER 3
Tier 2 Community
Mental Health Teams
TIER 2
Screening Assessing
Information
Joint Working
Annual health Checks
Counselling
TIER 1
PRIMARY CARE (GPs)
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The Tier 3 Specialist Eating Disorder Service for Gwent and South Powys is a
small team of specialist clinician’s based in Maindiff Court Hospital,
Abergavenny, allowing an accessible proximity to all 5 boroughs in Gwent and
across South Powys. The team offers consultation, support and direct joint
working to Tier 2 and allied clinicians. It provides individual, group and family
interventions and has an explicit ‘Gate Keeping’ role for any patients requiring
Tier 4 (Specialist Inpatient Service) and non emergency access to the acute
medical bed in Neville Hall Hospital, Abergavenny.
The aim of the Tier 3 Specialist Eating Disorders Team is to ensure that
service provision for eating disorders is high quality, innovative and equitable
across Gwent and South Powys. This will be achieved by working in
partnership with Tier 1, Tier 2, mental health and acute medical colleagues,
service users and carers and third sector services.
Treatment and Recovery
Recovery from an eating disorder is never easy, never short, and never
painless. The gaining of weight or letting go of unhealthy eating behaviour is a
slow, sometimes long struggle full of emotional turmoil. The strength and
mental will power an individual needs to break free from an eating disorder is
immense and you will often feel lost, alone and vulnerable.
Recovery is complex. Not only does the person have to rebuild their body
physically they also have to rebuild themselves psychologically. A regular and
balanced eating pattern needs to be established and underlying emotional
problems need to be talked about, addressed and resolved. Setbacks are
common and at times, progress is invisible, but recovery is very achievable.
 First Step: Acknowledging That Eating is a Problem
Perhaps the most difficult step in treatment is for the person to acknowledge
that eating is a problem and that they need to “want” to change their life and
give up their eating disorder.
People with AN highly value their undernourished state and are reluctant to
make changes. In contrast, family members are desperate for change, this
discrepancy makes treatment of AN extremely challenging and often
problematic. Those with BN do not acknowledge there is a problem because
they are often ashamed about their eating habits and it is often organised
around secrecy.
Over the page is a useful diagram (diagram 1), which describes the cycle of
change for an individual with an eating disorder. This includes each stage of
contemplation, the preparation and actions that individuals carry out when
they want to make changes to their lives and also the relapse stage. The
relapse stage should not be seen as a failure, but as a time to reflect on
negative situations and learn from them to begin the cycle again.
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Diagram 1:
PRE
CONTEMPLATION
RELAPSE
This stage is normal, it is when an
individual stops maintaining their action.
This can be momentary or longer. This is not
failure, although it may seem like it, the cycle
will begin again following this.
This stage is where individuals are in denial
of a problem or know that there is a problem,
but are unwilling to change it.
CONTEMPLATION
At this stage and individual accepts
there is a problem but the thought
of change is too scary.
CYCLE OF CHANGE
MAINTENANCE
At this stage the individual
is maintaining the action they
decided on.
ACTION
PREPARATION
At this stage the individual
is making some changes
Aneurin Bevan and South Powys Tier 3 Eating Disorder Service
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At this stage the individual is
motivated to make changes.
 The Role of GPs after diagnosis of an eating disorder
After a diagnosis of an eating disorder has been made, your local GP should
continue to monitor you, checking your bloods and physical health. They
should also provide your prescriptions and family support of required.
Mental Health Services
Out-patient Treatments – you will see a Therapist who may be a
Community Mental Health Nurse, a Psychiatrist or a Psychologist who
will offer regular appointments to help you with your difficulties. A
Dietician may as well be appointed to support you with your diet and
meal plans. Your weight will also be monitored and any other physical
investigations will be agreed.
Intensive Treatments in the Community - sometimes difficulties
become much more of a problem and in this case you may need to see
more than one person or have more than one treatment. These
appointments may be more intensive and frequent.
In-patient & Day Patient Treatments – if out-patient and intensive
out-patient treatment is proving difficult we may recommend day patient
and in-patient treatments, this will depend on services within your area
and may take the form of an admission onto a medical ward for
refeeding, admission to a mental health unit or a specialist eating
disorders unit depending on managing the “risk” issues.
Therapies – there are a range of therapies that may be available,
again dependent on local services and these will be explained to you.
Typically therapies include: motivational therapy, cognitive behavioural
therapy (CBT), dialectical behaviour therapy (DBT), family therapy,
educational therapy as well as dietetic counselling and occupational
therapies. All these therapies can be delivered individually, within
groups and with carer’s and family members.
Working With Families – it is well recognised across Wales the
importance of working with families to enable sufferers to overcome
their difficulties. The exact way in which this works will depend on you,
your family and what services are available. Some services have family
therapy, parental / carer counselling and more specific family based
group treatments.
Compulsory Treatment – sometimes the strength and power of the
eating disorder is extreme and impairs the ability to make rational
decisions about treatment. It is therefore occasionally necessary when
life or health is a risk, to admit a patient to hospital to be treated and
compulsorily fed under the Mental Health Act.
Aneurin Bevan and South Powys Tier 3 Eating Disorder Service
2013
Mental Health Measure 2010: Care and Treatment Plan (CTP)
What is the Care and Treatment Plan (CTP)?
This has recently replaced the Care Programme Approach (CPA) in Wales.
Anyone suffering with an eating disorder that is referred into mental health
services will have a Care and Treatment Plan (CTP) and an appointed Care
Coordinator.
You and your carers will be fully involved in this process, as it is a way of
assessing all of your needs and developing a care plan that meets those
needs.
What is a Care Coordinator?
When referred into mental health services you will have a named Care
Coordinator within 14 days. They will complete the care plan with you and
oversee the care and treatment process.
What is a CTP Meeting?
The aim of this meeting is to review your care plan to ensure that all of your
needs are being met and design your future care plan. It is your choice who
attends this meeting and the location and time of meeting. If you feel it is
necessary you can request a CTP meeting at any time.
What is in my Care Plan?
You will receive a copy of your care plan following your CTP meeting. If you
are happy with it you will be asked to sign it. It will include details of the care
and treatment you are receiving, the individuals involved and your main goals
and objectives. If you are not happy with your care plan it can be amended at
any time.
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Who You Might Meet in an Eating Disorders Service
Physiotherapist:
Clinical Lead:
Care Co-ordinator (CMHT):
Will work with you to
improve/help restore bodily
movement and functioning.
Leads the Tier 3 Specialist
Eating Disorder Service and
will provide you with added
support/therapy if
necessary.
Is responsible for ensuring you are
receiving the care you need. This
person tends to be a CPN or social
worker.
Admin Support:
Support Workers
(CMHT):
Provides clerical and
administrative support.
Work with you to provide
general support and
engagement in practical and
social activities.
Dietician:
Psychologist:
Will work with you to provide
ongoing dietary support and
advice.
Works with you to explore
thoughts, feelings and behaviours
and will try to reduce distress.
Occupational Therapist:
Works with you to explore how eating
disorder affects everyday functioning.
Will use individual goal-directed activities
to maximize your independence.
Community Psychiatric Nurse
(CPN):
Social worker:
Psychiatrist:
Will offer general support to
you and your family and will
be involved in organising
and managing packages of
care/support.
Will work with you to treat
the eating disorder and
provide help and support
with emotional difficulties.
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Will work with you to provide practical
advice, ongoing monitoring and support
and create an individual care plan on the
basis of your needs.
Dietetic Information: A More In-depth Look at how Your Eating Disorder
Affects Bodily Functions
What is a Healthy Weight for an Adult?
There is not just one body weight that is healthy but a range within which your
weight should fall. Healthy body weight depends on your height which should
be accurately measured.
Body mass index (BMI) is a calculation used to describe your weight in
relation to your height. Medical research and expert opinion define a healthy
BMI as being between 20 and 25.
BMI = weight (kg) / (height x height (m))
Remember:
It is easy to be confused when you see images in the media of thin
people; it is as dangerous to be underweight as it is to be overweight.
People have different bone and muscle body composition, so will be
healthy at a different place in the range. Exercise increases muscle
mass.
Menstruation usually restarts when you are within the healthy range.
Often you will menstruate at a similar weight as you did before you lost
weight.
Once your body is used to food and it is safe for you to restore weight,
best recovery is achieved by 0.5 kg/ week at home or 0.5 – 1kg / week
in hospital.
Blood Tests
It is important as part of your assessment and treatment plan that you and the
team have some idea of how well your body of working. When you starve your
body or try to use methods to lose weight these will disrupt your body
functioning. One way in which problems can be picked up is to have blood
tests which give us a snapshot of how your body is functioning.
Electrolytes are chemicals within your body which are kept in careful balance
to allow all body functions e.g. nerve messages and muscle contraction.
Starvation/binging/vomiting/laxative use and purging cause electrolyte
imbalance e.g. too much potassium may be lost which causes muscle
weakness, problems with circulation and heart function and seizures.
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Effect on Hormones - Women
There are several reasons why your regular menstrual cycle (periods) may be
disrupted: malnutrition, hormone imbalance, illness or emotional
distress/stress.
When you lose a lot of weight and become malnourished your body stops
producing the hormone oestrogen. Lack of this important hormone means that
your body will not work properly; you will lose your periods (amenorrhoea).
This will have serious health consequences on fertility and bone strength
(osteoporosis).
If this happens during your teenage years this results in stunted growth and
delayed puberty.
Once a healthy balanced diet and body weight has been achieved most
women will restore oestrogen levels and periods will return. For a few women
normal menstruation does not occur and they may have fertility problems.
Effect on Hormones – Men
Starvation causes the body to save energy by stopping hormone production,
this disrupts normal bodily function. Men will experience lowered libido, a loss
of early morning erections and nocturnal emissions (‘wet dreams’). Once a
healthy balanced diet and weight have been achieved normal body
functioning will return.
The Effects of Starvation
The Minnesota experiment done in 1940 looked at the effects of starvation on
behaviour. The calorie intake of healthy men was halved over a 6 month
period. All the men experienced dramatic physical, psychological and social
changes. These continued during the re-feeding stage.
Starvation Syndrome
Physical changes in muscle strength, athletic performance, feeling light
headed or giddy.
Tired, pale and cold decreased ability to concentrate or comprehend.
Preoccupation with food, thinking, talking, planning and daydreaming.
Conflict over how to eat the food, gulping and/or eating very slowly or in
a ritualistic fashion.
Anxiety, apathy and depression increase.
Socially more withdrawn, isolated and loss of sense of humour and
increase moodiness and irritability.
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The experiences are observed in people who are starved of calories, they will
be common in people with anorexia, bulimia or disordered eating.
These physical and mental changes will be reversed when your body is
regularly supplied with the energy it needs.
Why Eat Regularly?
This is the foundation for the changes in eating habits that you need to make.
Eating regular meals and snacks gives structure to your intake, fitting into your
life and daily routines. Once meals and snacks are in place the composition
and portion sizes may be modified. Eating regularly helps steady your blood
sugars and thereby prevent spells of feeling light headed and dizzy. In turn
this increases metabolism, allowing your body to burn energy (calories) and
not store them – just what you will be trying to prevent.
What is Regular Eating? / What Helps?
Plan in advance what you need to be having – you may have a meal
plan from the dietician that you have worked on together.
This should be an important part of your daily tasks and may have to
take priority over other activities.
Aim to eat every 3-4 hours and not in between, remember to take
snacks with you if you are out and about.
Will I Get Fat?
NO initially your body will restore its fluid balance so you may see some
changes on the scales.
When you are weighed in the first few weeks of recovery, you may notice that
you initially gain a lot of weight despite only increasing your calories a little.
This can be scary, or even traumatic, but it is entirely normal, and your weight
will not continue to increase this way. The initial weight gain is your body’s
cells working hard to begin functioning normally again. Your body doesn’t just
store fat, it also stores glycogen, which is required for energy, and glycogen
requires water to be stored effectively. When you are restricting, purge or take
laxatives, you deplete your energy stores and water; part of the recovery
process is for your body to replenish these stores that have been depleted.
Hence, this initial weight gain is not fat, and does not mean you will continue
to gain weight this way. Once your body’s stores are replenished, weight gain
slows down, and you will gain small consistent amounts of weight every week.
It is very important to not restrict your intake despite how scary this initial
weight gain is and it’s important to keep to your meal plan to help your body to
continue repairing itself, and discuss any concerns about weight gain you
have with your treatment team. Your treatment team can help you deal with
and understand better the processes that take place in recovery.
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What About Drinking?
Water is essential for the body to work properly, to remove waste and help to
regulate temperature in warm weather. Drinking too little and becoming
dehydrated can be dangerous for your health effecting muscle performance
and urinary tract function. Drinking too much can also be dangerous this can
affect electrolyte balance and can make it more difficult to regulate fullness
and appetite.
I’m Afraid That I Might Binge
Fact eating a balanced diet, regularly without too much time between meals
and snacks will help to maintain blood glucose levels and turn off your hunger
making a binge less likely.
In the beginning of recovery, bingeing does sometimes occur as your body
gets used to food, your meal plan, and replenishing its stores as explained in
the weight gain topic. Bingeing does not last forever and it is important to
continue eating as normal, and continue with your meal plan as restricting
after a binge, can cause another binge to happen.
Remember:
If you do binge do not be tempted to restrict, this just leads to low blood
glucose levels, an increased appetite and increases the chances of another
binge happening.
Just get on with your planned meals at the next available place on your menu
do not miss anything!
Distortion of Hunger and Fullness Sensations
Sensations of hunger and fullness are sometimes easy not to notice. Hunger
has a lot to do with when your body expects food, not just when you need it.
Not having a regular eating pattern or missing meals often means that you
sometimes do not get the sensation of being hungry, it does not mean that
your body does not need food.
It is common for people with disordered eating to confuse the sensation of
hunger with thirst; you may subconsciously be drinking to fend off the feelings
of hunger.
Some queries and concerns
‘’I only eat when I am hungry. To eat when I am not hungry doesn’t
feel right’’
‘’I like the sensation of feeling hungry as it means that I am in control
and not greedy’’
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It is common to have fears about eating more; you may worry about gaining
weight too quickly or losing control of your eating/weight. It is very important to
establish a regular pattern of eating; your dietician can work with you to look
at ways to restore a regular meal plan.
Remember:
When overcoming an eating problem the sensations of fullness may not feel
normal, it may help to consider the following
High fibre, low fat foods tend to fill you up.
Drinking a lot of fluid around mealtimes may make you feel bloated.
If you have been restricting your food intake for a long time you may
feel full after small amounts, your stomach is a muscle and needs to be
retrained into performing well.
Your gut movements may be slowed down, your stomach will take
longer to empty which means that you will feel full for longer after a
meal.
Misconceptions about Laxatives
Laxatives help me loose weight…..
Fact – fluid is lost after taking laxatives, there is little effect on calories
absorbed and thus hardly any impact on real weight loss as they work lower
down the bowel when absorption (of calories) has occurred higher up the
digestive tract.
Because I am constipated I need them to help me go….
Fact – people who restrict their eating do not have enough food in the
digestive system and therefore the amount of waste is reduced, the whole
digestive process is slowed down. Laxatives can make things worse because
they can cause a loss of intestinal muscle tone so that the bowels come to not
function properly.
But I am so bloated…..
People with eating disorders do often feel bloated with pain and wind, by not
eating enough the digestive system becomes sluggish the stomach takes
longer to empty. Laxatives actually increase swelling, pain and the formation
of gas.
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Remember:
Laxatives disrupt normal bowel function, they can cause electrolyte
imbalance, the effect of which can be fatal with few signs that there is
anything wrong.
After continuing to eat regularly and stopping laxatives, your digestive system
will start to function normally and you will not be so bloated or constipated.
You will no longer feel that you need them.
Exercise
Can I Do Too Much of a Good Thing?
Yes – exercise is good for you, it strengthens muscles and improves mood.
However, exercising every day for hours, is not healthy it can lead to serious
problems including permanent damage to joints, hormone imbalance, heart
problems and dehydration.
What is a Healthy Approach to Exercise?
Not feeling guilty or anxious if you can’t exercise.
Choosing 30 minutes moderate exercise most days or 30 - 40 minutes
more vigorous exercise 3 - 4 times a week.
Not exercising if you are hurt or injured and keeping exercise in
proportion with other interests.
Remember:
If you are underweight with a BMI below 19 or not menstruating you should
not be exercising. In some cases you may have an individual programme of
strengthening exercises from a physiotherapist. It is crucial for your health that
you restore weight and exercise may interfere with this goal.
If you are not underweight and experience becoming light headed or dizzy you
should seek medical advice before exercising.
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Facts and Misconceptions about Eating Disorders
sourced by:
The Centre for Eating Disorders &
www.eatingdisordersupport.co.uk
Eating Disorders are about
food & weight.
Eating disorders are
symptoms of underlying
issues. It will be important to
focus on food & weight as
part of recovery, but true
recovery will also involve
exploring what purpose the
eating disorder served and
why it developed as well as
resolving the underlying
issues in order to prevent
relapse.
How can she /he have an
eating disorder? They eat
with us every day:
Someone with an eating
disorder may eat or go
through the motions of eating
with the family, and then
purge by vomiting or taking
laxatives later.
The media are to blame for the
prevalence of eating disorders:
A recent survey has confirmed that teenage
girls get the bulk of health information from
the media. These media messages are not a
direct cause of eating disorders. Messages
that promote thinness as an asset can
create unrealistic standards regarding body
size & shape. On the other hand, messages
that present accurate, realistic helpful
information can be a positive influence. The
fact is, the media can positively or negatively
affect the development of a teenager’s selfesteem & self image. It depends on the
message & how it is delivered.
People cannot have more than one
eating disorder:
Many people have more than one
eating disorder. It is very common for
someone to experience anorexia with
bulimic tendencies, or bulimia to
experience anorexia symptoms.
Compulsive overeaters have
sometimes experienced anorexia or
bulimia at some point. This suggests
that the eating behaviour themselves
are merely symptoms, not the
problem which needs to be
addressed.
Only teenage girls suffer
from eating disorders:
Many eating disorders do
begin in the teenage years,
but children, older women,
men and just about anyone
can fall victim to this terrible
disorder.
Are eating disorders just a phase:
Eating disorders are not merely a
phase but serious mental disorders.
Someone with anorexia might say “I
could gain weight if I wanted too!
Someone with bulimia might say” I
could stop bingeing & purging if I
wanted to”. However, people with
eating disorders really don’t have a
choice. In many cases, if they don’t
get help they will have a hard time
stopping on their own and it may
become permanent disease.
Aneurin Bevan and South Powys Tier 3 Eating Disorder Service
Eating disorders are a cry
for attention:
People do not develop
eating disorders as a way to
seek attention. Rather,
eating disorders are coping
mechanisms, though faulty
in nature. For this reason, it
is important to address the
role the eating disorder is
serving for the individual,
rather than writing it off as a
cry for attention.
Eating disorders are solely a
problem with food:
All eating disorders involve
controlling food & weight as a
focus of life. This focus allows a
person to block or numb painful
feelings & emotions or use food as
a way of self comfort. Eating
disorders are not a problem with
food itself but what restricting food
or over eating food can do in terms
of blocking out emotions or
providing a way of coping with life.
Eating disorders are in fact only a
symptom of underlying problems.
2013
Recovery testimonial
‘If doctors had told me a year ago that, I’d be where I am today with my
recovery from an eating disorder, I wouldn’t have believed them. I didn’t think
recovery was achievable and I thought that I didn’t deserve to recover. I read
about people who suffered with eating disorders for years, and figured I’d be
one of them. I found initial recovery painful, traumatic, and it’s probably one of
the most anxiety filled experiences I’ve ever been through. However, now I
look back, and realise what I have gained from my recovery, and am truly glad
that I chose to recover. I can eat whatever I want, whenever I want, without
feeling guilty, and I can take part in social activities that involve food, like
Christmas. I hardly ever think about food, and never judge myself by what the
weighing scales tell me, in fact, I don’t even weigh myself or want to anymore.
Sometimes, life can still be difficult, but life is nowhere near as difficult as it
was when I was fully engaged in my eating disorder and that makes my
recovery, to me, totally worth it’.
Aneurin Bevan and South Powys Tier 3 Eating Disorder Service
2013
Miscellaneous Information
Contact number for Tier 3 Eating Disorders Service:
01873 735546
Useful Reading on Eating Disorders
 Overcoming Binge Eating by Dr. Christopher G Fairburn
 Hunger for Understanding: helping young people to understand and
overcome anorexia nervosa
by Alison Eivors and Sophie Nesbitt.
 Help your Teenager Beat an Eating Disorder by James Locke and
Daniel Le Grange.
 Treatment Manual for Anorexia Nervosa, a Family-Based Approach
by James Locke.
 Cognitive Behaviour Therapy and Eating Disorders by Chris
Fairburn.
Information sourced from:
www.rcpsych.ac.uk
www.iop.klc.au.uk
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2013
Appendix
Appendices:
1.Tools to manage me 
Goals and Motivators
Weekly Appointments
Groups Attended
Relapse Statements and Plan
2.Tools to manage my thoughts 
Pros and Cons
Challenging Negative Thoughts
3.Tools to remember whose who 
Dietician – weight monitoring chart
Occupational Therapist
Specialist Clinician
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2013
Tools to manage me 
Appendix 1
GOALS AND MOTIVATORS
GOALS
e.g. I want to go with my friends to the
cinema
MOTIVATORS
e.g. I can wear my new shoes that I
bought and show them off!!!
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2013
Tools to manage me 
Appendix 1
WEEKLY APPOINTMENTS
Week Beginning………………..
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
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2013
Tools to manage me 
Appendix 1
GROUPS ATTENDED
GROUP
REFLECTION
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2013
Tools to manage me 
Appendix 1
RELAPSE STATEMENTS AND PLAN
E.g. Relapse does not mean failure___________________________
__
I can try and try again____________________________________
__
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
RELAPSE PLAN
What to do if I notice things slipping back
E.g. I will ask for help
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2013
Tools to manage me 
Appendix 1
PROS AND CONS
PROS
CONS
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2013
Tools to manage me 
Appendix 1
CHALLENGING NEGATIVE THOUGHTS
NEGATIVE THOUGHTS
POSITIVE THOUGHTS
SSS
E.g. What’s the point I have tried E.g. Change is hard work but I can do
everything!!
it!!
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2013
Tools to manage me 
Appendix 1
DIETICIAN
Date, Time and
Place of
appointment
Homework/activities
Service user reflections
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2013
Tools to manage me 
Appendix 1
OCCUPATIONAL THERAPIST
Date, Time and
Place of
appointment
Homework/activities
Service user reflections
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2013
Tools to manage me 
Appendix 1
SPECIALIST CLINICIAN
Date, Time and
Place of
appointment
Homework/activities
Service user reflections
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2013
Tools to manage me 
Appendix 1
…………………………………….
Date, Time and
Place of
appointment
Homework/activities
Service user reflections
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2013