The type of treatment available and the pathways to such treatment vary from region to region in the UK. Many, but by no means all, regions have specialised eating disorders unit.
Many people are initially taken, or more rarely take themselves, to their GP. A GP should confirm the diagnosis of an eating disorder, assess its severity and evaluate and put into practice the best course of action.
Contact beat (formerly the Eating Disorders Association), for help and advice and encourage the individual to do the same. beat can:
- Provide area specific information
- Names and contact details of specialists and support groups
- The charity also runs a Helpline: 0845 634 1414
Further information about how you can support a person suffering from an eating disorder or seek self-help can be found below:
Role of family, friends, teachers and lecturers
Role of your GP
A person with an eating disorder may deny that there is a problem. It’s often up to parents, siblings and friends to notice symptoms and gently challenge them. However, be warned, any challenge related to food, weight loss, eating habits or exercise may be met with fervent protest and anger. Many parents and friends will find the hostility unbearable.
Try to create openings for the individual to talk freely.
For example, you could say:
- ‘I can’t help noticing that things are quite difficult for you at the moment, would you like to talk about or is there anything I can do?’...
- ‘Is everything ok at school, work, university, at the moment?’...
- ’You seem slightly anxious, low, distracted.’
Build trust and pass no judgement.
Remember, challenges and concerns are likely to be met by:
- ‘nothing’s wrong’;
- ‘I’m fine, everything’s okay thanks’;
- ‘I just haven’t really felt like eating much recently but it will pass, don’t worry.’
Don’t give up and continue challenging, voicing your concerns and watching.
- Let the individual know that you know they have a problem.
- Breaking the secrecy of the illness removes some of its power.
Make a list of signs that you have observed that make you think your child, relative, partner or friend has an eating disorder (see ‘Signs of an eating disorder’ page).
- Talk to them about your worries, confusion and uncertainties.
- Give them the opportunity to express their point of view.
- Ask them to come to the GP with you.
Teachers and lecturers have a role to play too and should take any initial suspicions they have seriously. If concerned about a student it would be advisable to raise awareness in meetings and ask other staff to look out for characteristic behaviours. These include:
- Absence from lunch
- A faultless academic record and thorough, meticulous written work
- A keenness for physical education and calorie consuming sport
- Enthusiasm for academic work related to food like home economics
- A nutrition degree or aspirations to be a dietician.
Show concern but focus talk away from food issues. Look at the wider picture: friends, family life, bullying, academic work.
- Contact the institution or school counsellor or head of pastoral care. Talk to beat for advice and encourage the individual to do the same.
- The Royal College of Psychiatrists website includes readable and well-researched information about eating disorders for teachers, as well as for parents and young people.
If the situation continues to deteriorate, tell the individual of your concern and gain consent to involve their parents. At home too, they may have been aware of difficulties. Occasionally, confidentiality may have to be breached regardless of an individual student’s wishes.
Assessing the illness
Talking to your GP is a good start. He or she can refer you to specialist professionals like psychiatrists, psychologists, dieticians, nutritionists and counsellors, and it may not be possible to access this support without seeing a GP first. Or you could talk to a practice nurse based at your GP’s surgery, or someone you trust at school or college.
Your GP will look for signs of an eating disorder, including:
- low weight or recent significant loss of weight;
- excessive concern about weight;
- problems with periods;
- regular vomiting
He or she may refer someone with eating disorders to a specialist team, a psychiatrist or a psychologist, a community mental health team or community child and adolescent mental health team if the individual is less than 18 years of age. Sometimes these teams do not have specialist knowledge and skills in the management of eating disorders, but they do have generic skills and resources that can be useful in managing some of the more general symptoms people with eating disorders have, such as depressed mood, high levels of anxiety, low self confidence and social isolation.
Often the resources of community mental health teams are limited and those who have the most severe types of illness are prioritised. If the severity of the eating disorder is such that the individual has to be admitted to hospital under the Mental Health Act (see Mental Health Act: compulsory treatment on this page), then there is no doubt that she or he is entitled to community care from one of the teams.
Carers have expressed some concern about GPs’ lack of experience of eating disorders, which can lead to a delay in diagnosis and an appropriate referral.
Guidelines on treatment for eating disorders provided by the National Institute for Health and Clinical Excellence suggest making a second appointment with a GP within a month if an eating disorder is a possible diagnosis, or if parents are very concerned.
Find out more about the NICE Guidelines. A downloadable leaflet tells you what treatment you can expect from your GP and from other NHS services.
Specialist services at South London and Maudsley NHS Foundation Trust
Before any treatment begins, there will be an assessment of the illness. The assessment should include an evaluation of the medical risk – a physical examination and some investigations, such as blood tests.
The severity of the medical risk is an important guide to treatment – for example, if there is high medical risk, inpatient treatment could be needed,.
The assessment will also look at an individual’s psychological and social needs, any psychological risks, and their understanding, motivation, readiness and ability to change.
Information from the assessment is used to determine a treatment plan.
The work of the Section of Eating Disorders at the Institute of Psychiatry, Psychology & Neuroscience is closely interwoven with clinical services run by South London and Maudsley NHS Foundation Trust (SLaM), which serve a population of two million people in south east London and take specialist referals from throughout the UK.
SLaM’s services include:
- Inpatient and rehabilitation (‘Step up to Recovery’ programme) services at the Bethlem Royal Hospital in Kent
- Outpatient and day-care services at the Maudsley Hospital in Camberwell, south London .
The Unit offers a range of evidence-based psychological therapies designed for eating disorders of all degrees of severity. Much of the research underlying these treatments has been carried out in collaboration with the Eating Disorders research team at the Institute of Psychiatry, Psychology & Neuroscience. The Maudsley Model of family therapy, for example, was developed here and is universally considered to be the gold standard of care for young people.
GPs can refer you to these services if you live in one of the areas in south east London which fall within SLaM’s catchment area (London boroughs of Bexley, Bromley, Croydon, Greenwich, Lewisham, Lambeth and Southwark). If you live elsewhere in the UK, your GP will refer you to a local psychiatrist who can refer you to SLaM’s specialist national services.
For more information, visit www.slam.nhs.uk
Treatment of eating disorders involves dealing with the emotional as well as the physical issues and individuals should be offered psychological treatment – talking to a therapist or counsellor.
Cognitive behaviour therapy (CBT) is the psychological therapy most often used for bulimia. This can be delivered one-to-one, in groups or online.
A range of psychological therapies are offered to treat anorexia, including MANTRA (Maudsley Model of Anorexia Treatment for Adults), CBT, interpersonal therapy or specialist supportive clinical management. In inpatients, Cognitive Remediation treatment (CRT) or Cognitive Remediation and Emotional Skills Training (CREST) and skills training for care givers may be offered as adjuncts to the refeeding programme.
Psychological treatment is usually available in an NHS team.
If you opt for private therapy, we recommend you choose someone who has a UKCP (United Kingdom Council for Psychotherapy) accreditation and some expertise in eating disorders.
Mental Health Act: compulsory treatment
beat (formerly the Eating Disorders Association) offers many services that can be accessed via its website. These include message boards, a Help Finder Directory and a Self Help Network that operates across the UK for people whose lives are affected by eating disorders, their carers and their families.
Visit our useful links page to find other organisations that offer help and addresses of websites created by people who have been affected by eating disorders.
Our resources page also includes books that may be helpful.
There is legislation in the UK that ensures no individual can put his or her life in danger because they have anorexia nervosa.
If the anorexia is so severe that help at home is insufficient, or the illness is so severe it is causing great medical risk, more intensive care such as day patient or inpatient treatment will be required.
If necessary this may need to be given on an involuntary basis under the Mental Health Act (Department of Health).