Eating Disorders and Young People (LGGS Presentation)

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1 Eating Disorders and Young People (LGGS Presentation) Dr. Lynne Green. CAMHS Clinical Lead/ Clinical Psychologist Inpatient CAMHS Kairen Creighton Community CAMHS Manager Lancashire Care NHS Foundation Trust

2 Presentation Outline What do we mean by eating disorder (ED?) Cause and effect Early signs What treatment is recommended/available? What can non specialists do to help? Local pathways Questions/discussion

3 What do we mean by ED? Anorexia Nervosa (AN) Bulimia Nervosa (BN) Eating Disorder Not Otherwise Specified (EDNOS) (Binge Eating Disorder) (Childhood Onset Eating Disorders). often exist with other psychological illness (e.g. Obsessional Compulsive Disorder, depression, autism, self harm) Intentional weight loss/attempts to lose weight Fear of fatness Disturbance of body image Endocrine disturbance (AN) Compensatory Behaviours

4 Cause (and effect) Not clear cut and not the holy grail! Personality (e.g. anxious, sensitive, perfectionistic, low self esteem) Adverse events (e.g. loss, trauma, bullying) Exposure to ongoing stressful situation(s) Coping Styles (individual and family) Genetics? Social pressure/media? Specific belief systems (e.g. religious, health related)

5 Cause (and effect) PARENTS DO NOT CAUSE ANOREXIA!..but may unknowingly contribute to the maintenance of it Important to understand and disentangle the factors

6 (Cause and) effect Short term: Sense of being able to control something Sense of achievement Feel more attractive/popular Reduction of anxiety Longer term: Out of control Sense of failure Increased withdrawal/social isolation Strained relationships Heightened anxiety/preoccupation / obsessional symptoms Low mood Physical symptoms

control Sense of failure Increased withdrawal/social isolation Strained

7 Common fears/assumptions (child) If I eat more I may lose control and not be able to stop I will get fat If I could just lose a bit more weight I will feel happier If I don t control my eating my life will feel more out of control I won t look as good if I gain weight (other fears specific to individuals e.g. if I am not ill, I will become less important, my parents won t focus so much attention on me)

will feel more out of control I won t look as good if I gain weight (other fears specific to

8 Stages of awareness 1. I don t have a problem everyone is worrying for nothing 2. I may have a problem now but I am not going to admit it because I won t let it get out of hand 3. I know I have a problem but I don t need/want help 4. I know I have a problem and I need/want help

9 Early signs Reducing amount eaten or skipping meals completely Becoming fussier re food content (may cause arguments at home) Reluctance to eat with others / excuses given for social events that involve eating Eating in an unusual way Increased interest/participation in exercise / unusual exercise (e.g. secretive, standing for long periods) Ideas about healthy eating seem increasingly extreme Becoming generally more withdrawn (spending lots of time in room) though not always present in early stages

interest/participation in exercise / unusual exercise (e.g.

10 Early signs (cont) Increased moodiness, indecisive, lacking in concentration Apparent weight loss (either confirmed or suspected) Concern raised by others (friends/school) Disappearing to bathroom during meals and after Smell of air fresheners / loud music or shower to disguise noise Glassy or blood shot eyes Appearance of downy hair growth on arms Increased sensitivity to cold

bathroom during meals and after Smell of air fresheners / loud music or shower to disguise

11 Distinguishing eating disorders from normal dieting Denial dieters talk about it all the time Denial of hunger or craving Covering up the weight loss Increased interest in food scrutinising recipe books, cooking for others, calorie counting Needing to eat less than others or only very small portions

loss Increased interest in food scrutinising recipe books, cooking for

12 What treatment is recommended/available? National Institute of Clinical Excellence (NICE) General expert consensus Family Therapy/Work Maudsley Model Individual Work Cognitive Behavioural Therapy (CBT) Interpersonal Psychotherapy (IPT) Dietetics/Nutritional Interventions Ongoing physical monitoring

Family Therapy/Work Maudsley Model Individual Work Cognitive Behavioural

13 What treatment is recommended/available? Inpatient vs outpatient? Specialist vs generic? Coercive vs collaborative?

14 What you can do to help Spot the early signs Take it seriously and talk to the child Consider a regular eating pattern Agree weight monitoring Try and establish an honesty pact Encourage child to share worries and create time/space to do this

pattern Agree weight monitoring Try and establish an honesty

15 What you can do to help Be clear about boundaries and be consistent Be aware of splitting (e.g. good parent/bad parent) Take to GP if lack of progress /involve others e.g. school (and agree this from outset) Remember behavioural change needs to be first Remind child of their bigger goals in life Remember that your child s personality may have temporarily changed

(and agree this from outset) Remember behavioural change needs to be first Remind child of

16 BEWARE At least she s eating something/a little is better than nothing I don t want to be controlling I don t want to upset her

17 What Animal Are You? The jellyfish: Too Much Emotion and Too Little Control. Impact: child loses confidence in parent and need for control through eating is reinforced.

18 What Animal Are You? The ostrich: Avoidance of Emotion/head in the sand. Impact: child copies/misinterprets this as parent not caring

19 What Animal Are You? The kangaroo: Trying to make everything right. Impact: child fails to learn how to cope themselves

20 What Animal Are You? The rhinoceros: uses force and logic to win the day. Impact: child goes into battle mode

21 What Animal Are You? The terrier: uses persistence. Impact: child usually perceives this as nagging, irritating, white noise

22 What Animal Are You? The dolphin: Just enough caring and control: parent gently leads the child, at first swimming ahead, then moving alongside and gradually drops behind showing trust and confidence

23 What Animal Are You? The St Bernard: Just enough compassion and consistency. Reliable through their consistency, warmth and nurturing.

24 Final Thoughts. Nobody gets it right all the time; every mistake is a treasure You don t have to see the whole staircase, just take the first step (Martin Luther King) Just 5-10 minutes a day of constructive interaction with an emphasis on listening pays dividends

25 Useful Reading Skills based learning for caring for a loved one with an eating disorder (Janet Treasure, Grianne Smith and Anna Crane) Eating Disorders:Helping your child to recover (S. Bloomfield) Eating Disorders: A parent s guide (Rachel Bryant-Waugh and Bryan Lask) Eating with your anorexic (L. Collins) Anorexia nervosa: A survival guide for sufferers and those caring for someone with an eating disorder (Janet Treasure) Eating Disorders; CBT with children and young people (Simon Gowers &L ynne Green) Childhood Onset Eating Problems (Claudine Fox & Carol Joughin) Hunger for Understanding (Alison Eivors and Sophie Nesbitt)

26 Contact Us Dr. Lynne Green CAMHS Clinical Lead: Kairen Creighton: Community CAMHS Service Manager: TEL:

Eating disorders what, who, why and how to help

Eating disorders what, who, why and how to help St Andrews House, 48 Princess Road East, Leicester LE1 7DR, UK Tel: 0116 254 9568 Fax 0116 247 0787 E-mail mail@bps.org.uk Website www.bps.org.uk What is