Eating disorders

For health professionals

What are eating disorders?

Eating disorders: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder (compulsive over-eating) are serious mental illnesses affecting 1.6 million people in the UK. They are most likely to develop during teenage years and although more girls are affected, around a quarter of those who experience an eating disorder at school age are boys.

Why not give our podcast a listen?

In addition to the information on this page, you might also find our podcast, Understanding Teen Minds, useful, in which stem4 founder and Consultant Clinical Psychologist, Dr. Nihara Krause, shares her extensive knowledge and experience in several episodes developed for GPs on eating disorders in young people. Click here for more.

What signs and symptoms indicate an eating disorder?

Eating disorders are a group of mental illnesses characterised by a severe disturbance in eating habits with an aim for weight (and other) control. They cause significant distress to the sufferer and their families and need both physical and psychological intervention. They include Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED) and atypical variants.  Eating disorders have the highest mortality, so early identification and intervention is invaluable.

The SCOFF questionnaire is an early screening tool useful for GPs Ref: Morgan J. F. (1999). British Medical Journal, 319: 1467.

Anorexia Nervosa

Anorexia Nervosa is an illness where there is a clinically established weight loss, measured either using the Body Mass Index (BMI) or weight and height criteria. There is a relentless aim for weight loss, mainly through restricted eating; excessive exercise and other behaviours aimed at weight control may also occur.

  • Extreme tiredness and lowered immunity
  • In females the absence of at least three consecutive periods
  • Other physical effects such as low blood pressure and low body temperature, osteoporosis markers, skin dryness, hair loss, gastrointestinal changes

  • Obsessive or perfectionist thinking
  • Difficulty concentrating and memory lapses
  • Low self-esteem
  • Thinking and feeling fat

  • All efforts are completely focused on maintaining low weight
  • Avoiding social situations especially if food is involved
  • Ruminative behaviour
  • Anxiety over social situations especially if food is involved

  • Feeling alone and trapped by the condition
  • Mood swings
  • Increased irritability
  • Increased anxiety and/or depression

Bulimia Nervosa

Bulimia Nervosa is a condition where there is a relentless pursuit of thinness, which includes periods of starvation mixed by periods of binge eating. The person thinks and feels fat. A number of behaviours are carried out to lose weight and these may include vomiting, the use of laxatives or diuretics and excessive exercise.

  • Variable body weight
  • Sore throat and stomach pains
  • Swollen face and dental problems
  • Blood anomalies especially electrolytes

  • Constant thoughts around food
  • Body dissatisfaction
  • Difficulty concentrating
  • Low self-esteem

  • Bingeing
  • Getting rid of food in different ways
  • Secretive shopping and eating behaviour
  • Avoidance of social situations especially if food is involved

  • Depression
  • Shame
  • Anxiety
  • Irritability and anger

Binge Eating Disorder

Binge Eating Disorder is a condition where the person regularly binges, usually with weight gain. This can lead to obesity.

  • Weight gain
  • Risk of ill health, e.g. higher risk of diabetes and heart disease
  • Fertility affected
  • Bones affected

  • Over focus on body shape
  • Low self-esteem
  • Body dissatisfaction
  • Difficulty concentrating

  • Bingeing
  • Restricted physical activity
  • Avoiding social situations
  • Secrecy around eating activities

  • Shame
  • Depression
  • Helplessness
  • Anger at self

Four steps to bringing about change

ACCEPT IT

  • As a professional, you can work with helping a person accept they have an eating disorder. This might take several meetings

Encourage ways in which Children and Young People can support themselves. These include encouraging them to:

  • Work on moderation – try and find ways to slowly hold back from your bad eating related habits
  • Stop trying to diet – eat a healthy meal without feeling the need to calorie count
  • Eat regularly – aim to have 3 full meals a day
  • Exercise in moderation – exercise a few times a week to help calm you down, but don’t overdo it
  • Stop taking laxatives and diuretics straight away
  • Encourage them to stop being sick – explain how throwing up gives an excuse to binge
  • Encourage them to work on ways to improve self-esteem – for example, to note some positive comments that people say about them regularly that are not related to weight or shape

Most importantly refer them to a specialist unit for a physical and psychological assessment – CAMHS will assess and make suggestions.

Contact Beat – the UK’s Eating Disorder Charity. They have a useful website with HelpFinder, an online directory of eating disorder services, allowing you to search for specialist care in your area, and Youthline 0808 801 0711.

  • Maintain regular contact with the child or young person throughout their treatment. This may also include the need to regularly monitor their physical wellbeing

  • This means keeping regular contact, creating a safe environment where people can bring their difficulties to you without feeling they have done something wrong, being able to help them problem solve and making relevant referrals as necessary

CAMHS, Specialist Eating Disorder Service, Community Eating Disorder Service

The referral form should include as many details as possible. Essential information required to accept the referral is as follows:

  • Current weight
  • History of weight and any current changes to weight
  • Height
  • Eating behaviours: dieting, vomiting, laxative, bingeing
  • Outcome of physical investigations

Criteria for urgent assessment:

An urgent referral to the Eating Disorders Service reflects the level of risk and severity of problems associated with the eating disorder. Our criteria for urgent assessment include the following:

  • Body Mass Index below 17.5 or above 40
  • Rapid weight loss i.e. 1kg per week
  • Physical Investigations reveal abnormalities indicating significant risk to health
  • Severe vomiting or laxative misuse
  • Diabetes
  • Pregnant
  • Recent or imminent discharge from eating disorder inpatient services
  • Recent or imminent discharge from Child and Adolescent Services

Why not suggest our Worth Warrior app to your patients?

This clinician-developed app can be downloaded free from the App Store or Google Play. It can be password-protected and uses principles of Cognitive Behaviour Therapy for Eating Disorders (CBT-E) to manage negative body image, low self-worth, and related early-stage eating difficulties or disorders.  Find out more at https://worthwarrior.stem4.org.uk.

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Further Learning

Visit our Further Advice page for details of other organisations that can help.

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