Connect-ED – Eating Disorders

Eating disorders involve disturbed eating habits and weight control behaviour that disrupts a person’s physical and psychosocial functioning. Disturbed eating habits may take the form of restricted food intake, strict dietary rules, preoccupation with food, and altered mealtime behaviours. Disturbed weight control behaviour can include excessive exercise, self-induced vomiting and misuse of laxatives.

Sufferers can experience dramatic personality changes, fatigue, apathy, social withdrawal, and extreme preoccupation with food, weight and shape. Eating disorders are serious as they carry medical consequences including growth problems, heart problems and, in some cases can be fatal.

Boys and girls can both suffer from eating disorders and may even be underdiagnosed in males because they are less likely to seek help. Types of eating disorders treated at Connect-ED include Anorexia Nervosa, Bulimia Nervosa and Atypical Eating disorders.

Getting help early is important.

There is considerable evidence to show that the earlier treatment begins, the more successful it will be, but the first signs of an eating disorder are subtle and are often meticulously concealed by the sufferer. Parents, carers and friends may notice changes in behaviour and these should not be ignored. Some reasons for getting help early:

• Improve the chances of recovery. The sooner you seek help at the first signs, the sooner a young person can recover.
• Can help you feel less isolated by talking to those who can help and empower you all as a family to tackle recovery head on.
• Reduce the risks of developing lifelong problems that are associated with eating disorders.
• Reduce the practical, and emotional difficulties in relation to parenting a young family member with an eating disorder.

Where to Find Help?

Go to your GP

Request a referral to Child and Adolescent Mental Health (CAMHS). Full assessment and treatment is carried out in your local child and adolescent mental health team, where all children and young people with eating disorders are given an urgent first appointment. It is important to tell the GP about:

• Behaviours – what your child is doing around food and drink /exercise/vomiting – tell them what you have been observing over the last weeks and take any notes you have made with you.
• Thinking and Emotions – describe the changes, and how your child was before and is now. Your child might not be able to describe a fear of being fat, so explain how scared they are to go on the scales or can be seen checking or pinching their body. These behaviours tell us more than what the young person is able to actually talk about.
• Physical changes – point out the changes in weight/clothes fitting, hair loss, skin changes, coldness, changes in menstrual cycle etc. The GP will take your child’s weight and height and also complete other physical checks such as blood tests and blood pressure and pulse.

Other Doctors/Practitioners

In addition to your GP, school nursing and guidance staff, and other doctors your child may see can refer your child to CAMHS.

If you require any more support contact Connect-ED on 0141 277 7407.

Support and Help While you Wait for Treatment

Any young person referred with a potential eating disorder is considered a priority by all CAMHS teams in NHS Greater Glasgow and Clyde. However, any wait for a first appointment is stressful and feels too long. It is important that your child continues to attend the GP surgery for physical health checks; these may include monitoring of weight, height, pulse and blood pressure and blood testing.

There is excellent information, advice, resources and links to support networks on this Scottish Website. The more informed you are as a parent about eating disorders the better. The skills part of the site is particularly helpful to familiarise yourself with. In addition, the UK Eating Disorders Charity has helplines and support. Check out our Useful Links section for further resources.

For any additional support or advice at this time phone the Connect-ED team on 0141 277 7407.

CAMHS teams are based at clinics within the North, South, East and West of Glasgow and in East Renfrew, Renfrewshire, Inverclyde and West Dunbartonshire. You can be referred to your local CAMHS team by your GP, hospital doctors, school, school nurse, psychologist, or social worker. You would normally know that you or your young person is being referred to the service as referrers are required to discuss this with you first to get your agreement. CAMHS teams are made up of highly qualified staff from a variety of professional backgrounds and have different skills and training. They all have experience working with children & young people who have mental health difficulties.

Staff Roles in CAMHS

Individual teams may vary, but the types of people you would see in CAMHS include:

• Psychiatrist: A child & adolescent Psychiatrist is a medical doctor who specialises in working with children and young people who are experiencing emotional, behavioural and psychiatric problems. They are the only members of the team that can prescribe medicine or use the mental health act. All CAMHS teams have a Consultant Psychiatrist (the most senior grade of doctor) as well as other grades of doctors working with them.
• Nurse Therapists: Mental Health Nurses are registered nurses who have had specialist child mental health training. They will also often have additional training in various psychological therapies such as Family Based Therapy or Cognitive Behavioural Therapy.
• Clinical Psychologist: A Clinical Psychologist has a doctoral psychology degree and is trained in assessing and treating emotional and behavioural problems. Clinical Psychologists are trained in different types of therapies, including Cognitive Behavioural Therapy.
• Psychotherapists: Psychotherapists use detailed observation and understanding of child behaviour, development and communication to help children and young people to understand why they feel the way they do and look at what lies behind their thoughts, feelings and behaviours.
• Family Therapists: Family Therapists work with families focusing on their strengths and successes and helping family members find constructive ways to help each other, by understanding the interaction between the child or young person, their family or carers and their community.
• Occupational Therapists: Occupational Therapists use age appropriate activities to facilitate emotional growth and positive mental health. Their role is to help children and young people build up the confidence and skills needed to live a fulfilling life.
• Dieticians: Dieticians translate the science of nutrition into practical information about food. Working with people to promote nutritional well-being, prevent food-related problems and treat disease. In NHS Greater Glasgow and Clyde, many CAMHS teams have Dieticians that specialise in children and young people with eating disorders.

Each clinician brings to the team his/her own therapeutic knowledge, skills, abilities and interests and together the team provides case management, mental health assessments, therapeutic treatment and interventions.

Assessment or “Choice” Appointment

When your referral is received, you will be contacted by letter or phone call inviting you/your child/young person and your family to attend for an initial assessment, also called a ‘Choice’ appointment. As your referral is likely to be considered urgent, your appointment will be carried out at your local CAMHS team and will normally last 1-1 1/2 hours. This will be your chance to meet members of the team and to discuss the current concerns/difficulties your child/young person is experiencing. Any of the multidisciplinary team can carry out this choice assessment, but it is most likely to be a nurse therapist. The assessment may include your child/young person being seen on their own, parents/carers being seen on their own and the whole family being seen together to:

• Identify signs and symptoms of the disorder and diagnosis.
• Evaluate strengths and vulnerabilities in the child/young person and their family.

The assessment, diagnosis and treatment planning phase usually takes 2-3 appointments. As part of a comprehensive assessment, you may also be offered an appointment with other members of the team such as a psychiatrist and dietician. The appointment may include important physical health checks. Information may also be sought from others such as GPs, schools, and paediatricians.

Formulation and Diagnosis

Assessment may result in a number of outcomes:

• A clear diagnosis and formulation of the young person’s difficulties are made.
• The child/young person is accepted for treatment and mental health case coordination within the CAMHS team.
• The child/young person and their family are given information and advice about their problems or are referred to another organisation.
• The referrer is provided with consultation and support.

Case coordination: Each child/young person involved in CAMHS will be assigned a case coordinator, who could be from a variety of professional disciplines as listed above. The role of the Case Coordinator is to coordinate all aspects of the child/young person’s care in collaboration with the child/young person and their family or carers.

The Role of the Connect-Eating Disorder Team in Assessment and Treatment Planning

The Connect-Eating Disorder (Connect-ED) team is a specialist eating disorder team that works with children and young people within all CAMHS teams in Greater Glasgow and Clyde. Connect-ED clinicians work closely with all the CAMHS teams and should be viewed as part of the CAMHS team that you are being seen in. All CAMHS staff regularly communicate about their patients to ensure the best care for them. A Connect-ED clinician, most often the dietician, will often discuss treatment options with you along with your CAMHS team and case coordinator. You will decide together what treatment is best and a plan will be made for commencing treatment (see intervention and treatment). The case coordinator will be your central point of contact throughout you and your child’s care in CAMHS.

Treatment in NHSGGC is Based on the Best Research Evidence

Eating disorders are serious and potentially life threatening conditions affecting a young person’s physical, emotional and social development. The serious nature of an eating disorder, in childhood or adolescence, makes it very important that assessment and treatment are offered as early as possible. It has been shown that early identification and treatment of eating disorders improves outcomes and promotes full recovery for young people. Connect-ED works to support Child and Adolescent Mental Health (CAMHS) teams to ensure that the best possible treatment is offered to young people and their families at the point of need. Tackling an eating disorder can be a long and difficult journey. It is important to have the right kind of help and support.

Treatments available are based on the most up to date research. Organisations such as The National Institute of Clinical Excellence (NICE) publish treatment guidelines based on the best research, see the most recent 2020 guidelines below:

• NICE – Eating Disorders – The Care You Should Expect
• NICE – Eating Disorders – Recognition and Treatment

In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) has recently (January 2022) produced eating disorder guidelines. You can find the full guideline and a patient publication here: SIGN 164 Eating disorders.

In addition, NHS Education Scotland published The Psychological Therapies Matrix in 2015, which is a guide to planning and delivering evidence-based Psychological Therapies within NHS Boards in Scotland, and includes a section on eating disorders.

These types of guidelines and good quality research are what tell us about the best treatments available for children and young people with eating disorders. It is these treatments that have good research evidence that we aim to provide in Greater Glasgow and Clyde.

Treatment Planning

The young person’s diagnosis, individual difficulties and situation will be taken into account when treatment options are discussed. The young person and parents/carers then decide, with clinicians, which will be the most effective and most suitable treatment. A treatment plan can be drawn up which may involve one or a variety of therapists and treatments.
The best place for all young people to be treated is at home, the research evidence shows that young people who are treated at home start to recover early in treatment have a very positive recovery.

The main treatment options are explained further below:

Family Based Treatment

Family Based Treatment (FBT) is the therapy with the strongest research evidence. FBT is a manualised therapy that is provided only by clinicians working within Connect-ED, who have had a high level of training and supervision. The whole family is invited to attend sessions. The treatment typically is for 12 months duration with 3 phases. The first phase of weekly appointments focuses on the restoration of physical health and empowers the family to make important decisions for the young person. The second phase of fortnightly appointments focuses on returning control of the eating disorder related behaviours to the young person, and the final phase aims to ensure the young person is back on their developmental track. FBT is a well-established treatment within NHSGGC CAMHS and increasingly across Scotland. The majority of patients with Anorexia Nervosa presentations, approx. 95%, will commence FBT.

Family Based Treatment (FBT) Leaflet for Anorexia Nervosa and Atypical Anorexia

CarED Scotland

Cognitive Behavioural Therapy – Enhanced for Eating Disorders

Cognitive Behavioural Therapy (CBT) works to help the young person understand how thoughts, feelings and actions link together. CBT – enhanced for eating disorders (CBT-ED) is an approach that enhances traditional CBT for eating disorders and coaches the young person how to challenge unhelpful/negative thoughts and feelings and change their behaviours over time. CBT-ED normally consists of 20 sessions over 1 year. CBT-ED is identified as the second line treatment. In NHSGGC, this is primarily adjunctive to or following FBT when high levels of eating disorder thoughts and/or body image distress persist. In addition, when FBT has not been opted for, CBT-ED may be chosen instead. However CBT-ED is demanding and requires sufferers to be motivated to change and work hard to understand how they think, feel and behave. Connect-ED has one full-time CBT-ED clinician. In addition, some CAMHS clinicians are trained in CBT-ED.

CBT-ED leaflet

Journal article about the role of CBT in treating Eating Disorders

Specialist Supportive Clinical Management

Specialist Supportive Clinical Management (SSCM) is graded similarly to CBT-ED in the adult part of NICE 2017 guideline with a small amount of evidence in the adolescent literature, therefore is considered only when the other 2 therapies have been exhausted or not taken up (this is a very small proportion of cases).

Essential elements of SSCM include an: assessment, including psychiatric, medical and dietetic; clinical management with a persistent focus on weight restoration, normalised eating, symptom reduction, and understanding about the impact of the disorder has on the person; supportive psychotherapy driven by the young person where the therapist is supportive and focuses on the young person’s strength, in a flexible and holistic way.

Nutrition and Dietetic Care

There are specialist eating disorder Dietician’s within the community and inpatient CAMHS in NHSGGC. Dieticians have a key role in supporting young people and families with eating disorders. They do this in the following ways:

• As part of the physical assessment, they will help to assess the impact nutritional deficiencies have on young people, particularly at the start of treatment and give advice. One aspect of this assessment will include assessing and managing “refeeding syndrome” which occurs in cases of severe malnutrition and needs careful management. Refeeding Leaflet
• Support families with nutritional information including assessment of nutritional requirements for a return to health and practical advice about what this looks like in meal plans. High Energy Tip and Feeding Support Leaflet
• Use their expertise to support and motivate young people to move towards recovery. Including using an early intervention package and providing Specialist Supportive Clinical Management (SSCM).
• Work with families to meal plan for young people if they require mealtime support at home from the Intensive CAMHS service.

Medical and Psychiatric Treatment

These are the elements of treatment that are managed by the doctors in CAMHS teams. The following guidance Medical
Emergencies in Eating Disorders: Guidance on Recognition and Management is used to manage the risk of the eating disorder and make decisions regarding care.

Physical Health Care

Eating disorder behaviours often result in physical symptoms, which can be severe. Careful monitoring of these physical symptoms is an important part of the treatment of eating disorders. Common tests include; pulse and blood pressure, blood tests for biochemistry, physical examinations and bone scans. As eating disordered symptoms improve the physical risks reduce and less and less testing is required. However early in treatment physical health monitoring is a frequent aspect of treatment.

Medication in Eating Disorders

The above therapeutic interventions are the first line of treatment for children and young people with eating disorders and will always be the ‘go to’ treatments before medication. However, if the child or young person with an eating disorder has another psychiatric condition such as depression, then medication can be helpful.

Inpatient Treatment

Inpatient treatment can be required either in an acute or psychiatric hospital. This is always avoided if possible, but may be needed if the young person is physically compromised due to their eating disorder.

Acute Hospital Admission

NHS CAMHS and the Royal Hospital for Children have a care pathway for under 16 year olds with eating disorders. At the start of treatment, a young person may require admission to be medically stabilised in the hospital so that they are safe to return home to commence or continue treatment. The admission is typically for 14 days and parents/carers remain very much part of their care team. Paediatric staff and CAMHS mental health staff work together to support all aspects of the young person and family’s needs during admission.

Psychiatric Admission

A small proportion of children and young people in NHSGGC require admission to a psychiatric hospital for their eating disorders. However, it is an important backup if young people are not recovering in the community.
The types of reasons for admissions are:

• Lack of progress in the community leading to increased medical risk to the young person.
• Other risk factors that make treatment in the community unsafe such as self-harm and suicide.

In Glasgow and Clyde, there are 2 general psychiatric wards, one at the Royal Hospital for Children for under 12 year olds and one at Stobill Hospital for 12-18 year olds. Both these wards are experienced in treating eating disorder patients.

• Skye House – Adolescent Unit.
• Ward 4 – Child Unit.

Young people who are discharged from inpatient units will not be fully recovered, and a lot of work is required after discharge to continue to treat and support them to recovery. Young people will work intensively in CAMHS for at least 12 months, and often much longer, after discharge.

Intensive Child and Adolescent Mental Health Team (ICAMHS)

There is a home intensive treatment team called ICAMHS that supports children and young people with psychiatric illness across Greater Glasgow and Clyde Health board. Nurses in this team, work with patients of all diagnoses and the aim of their interventions is prevention of admission to a psychiatric hospital and support a discharge from hospital should it happen. For young people with eating disorders, they can support meal times, help manage eating disorder behaviours or other risk taking behaviours and provide physical health monitoring. They are able to work with young people for a 6 week period only.

What is discharge from Child and Adolescent Mental Health Services (CAMHS)

Discharge from CAMHS means that you will no longer have appointments in CAMHS. Your GP and other professionals will be told about your discharge, usually by letter.

How is discharge decided?

Discharging from CAMHS will be discussed with you as a family. A good discharge should be a joint decision that everyone agrees with. Reasons for discharge are:

• Treatment is complete and in most cases the patient is in full recovery.
• Treatment is to continue in another service e.g. in a new location or adult services.

If the young person reaches 18 years and requires transfer to adult mental health services to continue their care, there is a transfer process. Find more information about Transition Care Plans at NHS Inform.

What if we need to be re-referred again?

If you need to be referred again in the future your GP can do this so you can start a new treatment episode with the team. Often you will work with the same therapists as before, but this will be discussed with you at the first appointment.

What is recovery?

Full recovery can be summarised within 3 areas:

• Physical – Weight restored or stable, regular menstruation and or normal pubertal development, growth resorted, bones recovered.
• Behavioural – Normal eating /exercise and no compensatory behaviours. (Normal being what was normal for them before the eating disorder and what is normal in your family).
• Emotional/Psychological – Healthy attitudes to weight and shape, able to deal with emotions and feeling as a similar aged young person.

Full recovery also means that young people lead a normal life for someone their age. The majority of young people who have had eating disorders will fully recover and be discharged when fully recovered. Partial Recovery is when young people continue to have some eating disorder symptoms, see examples below:

• Physical – Maintain a low weight, but without immediate risk, menstruation may be irregular or absent, puberty disrupted.
• Behavioural – The young person does not eat a normal variety of foods or does not eat in a normal way. (Again normal being what was normal for them before the eating disorder and what is normal in your family). May over-exercise or have other behaviours that are driven by the need to control weight.
• Emotional/Psychological – Concerns regarding weight and shape persist. Emotions and self esteem may still be problem areas. It is often this area that takes the longest to become normal.

In partial recovery the young person, in other ways is managing to have a fairly normal life, for example, they are going to school and having satisfactory social lives. It is possible that a decision is made to discharge a young person even though they are only in partial recovery. The risk of a relapse into a more severe eating disorder is higher if discharge occurs in partial recovery.

What is relapse?

A relapse of the eating disorder is when symptoms; physical, behavioural and psychological, worsen again. Relapse is not a failure and is often considered part of the cycle of recovery.

When might it happen?

It mostly happens in the first year of apparent recovery, although it can happen within the first 5 years after recovery. Young people are especially vulnerable at times of stress.

Who might relapse?

Those who are not in full recovery are more at risk of relapse. Although of those that fully recover we do not know why some people relapse whilst others do not. There will be some relapse in approximately 1 in 3 young people.

What do we do if relapse occurs?

Before discharge, a relapse plan is likely to have been put in place with clinicians. Its content will be very individual to the young person’s needs.

What I need to do to prevent setbacks?

Examples might be: eat regularly, beware of exercising alone, not comparing myself to others, keep meeting up with friends and maintaining interests/hobbies.

What might increase the risk of setbacks for me?

Examples might be: weight changes, going to university, or feeling alone.

What are my early warning signs of a relapse?

Examples might be changes in eating; not eating certain foods, not eating regularly, or avoiding eating out. Thinking about weight and shape issues; dissatisfaction with weight and shape and want to change it. Physical changes; weight changes, menstrual cycle changes etc.

My Action Plan for Dealing with Signs of Relapse

Examples might be: Identify what is happening, talk about it to Mum/Dad, and get a plan in place straightway that deals with the areas that have changed. Plan example; eat regularly, stop exercise/vomiting, keep talking about difficulties, stop watching food programmes on television, and go out with friends. If your relapse plan has been misplaced, there is a Break Free from ED workbook and relapse plan you can fill in. Acting quickly with the relapse plan should improve things quickly. If you have any concerns, even though you have been discharged from CAMHS, your case coordinator or therapist would be happy to give you advice and support or call the Connect-Eating Disorder Team (0141 277 7407). There are other support lines such as those at Beat.

If there are no improvements within a short period of time, re-referral should be strongly considered.

Eating disorders don’t discriminate between people. Anyone can be affected- any gender, ethnicity, religion etc. You may be wondering what the fuss is all about. It is possible that you may not feel particularly unwell. You may be normal weight or even manage your everyday activities such as school, hobbies and friends.

What should I do if I think I have an Eating Disorder?

If you are worried you may have an eating disorder, it is important to talk to someone about your worries. This could be your parent or carers, your guidance teacher, a relative or family friend, someone you trust and who will listen to you. Beat (the eating disorders charity) has good information to help you recognise signs and symptoms in yourself and a helpline and web forum for young people that you may find helpful. If you remain concerned that you have some signs of an eating disorder you must go and see your GP. It would probably be helpful to take a parent/carer to the appointment with you. See section on Getting Help.

What should you do if you are worried that a friend has an Eating Disorder?

It is friends who often realise there is a problem before the actual sufferer does. Part of having an eating disorder is not being able to see the eating disordered behaviours as a problem, which can make helping friends difficult. You can try to tell your friend about your concerns and in particular, the differences you see in them, give examples of the “old them” and the “new them”, to illustrate how much they have changed.

Help them to go to a parent or guidance teacher to ask for help. If your friend will not speak to someone, it is ok for you to do this for them, even if they don’t want you to. This does often happen and your friendship will survive as you are doing the right thing for your friend, getting support and treatment will be vital for them to get better. You can find more information about what to do if you are worried about a friend.

Have a look at the Real Lives page to hear what other young people have to say!

This section is for young people who may have an Eating Disorder. We hope to fill this section with many accounts of other young people’s experiences of managing and recovering from their eating disorders. We hope that reading about what happened to other young people will be useful for you.

A teenage boys journey and experience

The first of our articles come from a teenage boy who describes his journey and experience of having an Eating Disorder.

“Thank you to the people who take time to read this.

This is my story not for attention but to let people know what I went through and by me doing this it could help other people or at least someone.

It all began in 2017 – Near the end of my second year in school, when I came face to face with mental health problems. One of the reasons it started was for me to feel comfortable in myself (body) but the main reason which triggered it at the very start was other people’s opinions calling me fat. I let their opinions get the better of me and I would punish myself but I never thought it was that serious missing out on my lunch a few days. But the few days increased and it would be every single day, I’d just be having breakfast at 7 in the morning and then not eating again till 6 at night when I’d have dinner. I never told anyone what I was doing but my mum noticed because I was coming back from school with all the money she would give me and wasn’t buying anything during my breaks in school.

She would notice other signs and that things were getting controlling therefore we decided to go see a doctor and from that day I was diagnosed with a mental illness (Eating Disorder). It’s mostly common in women but a small percentage of men suffer from eating disorders too. I then got referred to CAMHS (Children and Adolescent Mental Health Services). I wasn’t too keen on going but I had no choice but to go and see them and see what they would say or do to try and help me. But I didn’t accept that I needed help and refused to take any of their help on board because a voice in my head was telling me not to let them help me!

It was only a matter of months before I had zero control over it at all, At this point, the CAMHS appointments were going on for about 7-8 months but I would just go and sit there and not talk. I wouldn’t listen and would always say “they’re wasting my time” so I ended up getting discharged, but a few months down the line in September 2019 my thoughts started to get really really bad and I was saying I no longer wanted to live. My life as I felt trapped and wished I didn’t wake up in the morning. So I went back to see a doctor and was referred back to CAMHS for a second admission but would be seeing different people try to help me and change my way of thinking. I had appointments every week sometimes even two a week. At every appointment, I would get my weight taken and every time it was going down getting lower and lower and was damaging my body. But people would still be horrible and call me fat and I would think to myself “what do I honestly need to do for people to stop saying this to me!” I was already suffering enough but all I heard in my head was “you’re not sick enough”. I was going from bad to worse and deteriorating quickly as I started going 24 hours without eating because I was only having dinner at 6 and then eating nothing after that till 6 the next night. I wouldn’t have any crisps, chocolate or fizzy juice. I haven’t had any of that in 3 years and people thought it would be good to call me Bobby Sands !!! Boils my blood how people can make jokes about that. Once CAMHS found out I was going 24 hours without eating they told me I would end up getting put into hospital. But me being me I never listen and thought it wouldn’t happen to me.

It only started to hit me a little when in October 2019 my eating disorder stopped me from doing the thing I loved and that was playing football. I had to stop because I realised I had no energy to play and was too weak, so drained and tired all the time. I would need to get weekly blood tests and every time they were getting worse and worse too as the weeks went on.

But it turned out CAMHS weren’t kidding and were being serious because on the 23rd of December 2019 I got put into hospital and because I was trying to refuse I was detained and had no choice or power to stop them from putting me in. I was put in due to my bloods being so bad, kidneys at risk of starting to fail, and how much damage and strain I was putting on my heart (that’s why I got loads of ECGs done too). The hospital admission was when it hit home and one of the worst experiences of my life – away from family members, not allowing my phone to even message my family, just a room with a bed and toilet- no telly or anything at all. It hit me that I need help ASAP. Their idea in the hospital was to introduce a meal plan for me to follow to make sure I was getting everything I needed to be healthy again, but after every meal, I had to sit in a room where they could see me and wasn’t allowed to move or do any type of exercise, and when I was back in my room day and night the nurses would come to check on you every 15 minutes. It was worse at night trying to sleep and they would shine a torch in your face to check on you. Because I accepted their help and was doing well with the things they wanted me to do I was let out after a week and a half and was let back to my work, but when I went back to work I relapsed and didn’t stick to the meal plan and was putting stuff in the bin and said to the doctors I was eating it when I wasn’t and then I was back to square one. It took control over me again, when the doctors would ask me how I was getting on with the meal plan I said I was doing good but I was lying. CAMHS found that because nothing was improving it was going downhill again so I got put on sick leave as I wasn’t “fit to work”. I had a meeting with my work and told them how I was feeling and everything going on in my head and how it was affecting me and we discussed how they could help me and how we would move forward. All it took was that meeting with my boss everything was so positive and he helped me “Flip the switch” in my head. Before I just started to waste away and potentially die.

And I was told to not let the people who made me feel this way win and to make changes to help myself. People should honestly think before they speak because you never know what your words will do to people, how it will affect them and what it can do to them mentally! So many horrible people in the world.

But something I have just started working on since the 10th of March 2020 is my long road to recovery on medication to help me get back to being happy healthy and enjoying my life again, Each day is a step closer one step at a time or as I like to say another step up the ladder. It may take time but I will get there and it will be worth it this is just the beginning. “My Story Isn’t Over Yet”.

But…… A message to those who have taken their time to read this is if you are struggling with a mental illness, please seek help it’s the best thing you could do! Never ever struggle in silence open up and talk to the people you trust and feel comfortable talking to you will honestly feel so much better just by talking and getting it off your chest and I never believed it but can confidently say there IS light at the end of the tunnel and happier days to come! But most importantly always be kind, ask twice if someone is okay, because yeah it’s ok not to be ok, Mental Health Is Nothing To Be Ashamed Of … MENTAL HEALTH MATTERS!!

Change your Attitude, Change your way of thinking … Be Positive!

Speak out!”

2020

A teenage girl’s experience and recovery

The second of our articles comes from a teenage girl who describes her experience and recovery from an Eating Disorder.

“For most of my childhood, I can remember being a happy, carefree and fiery person. Not worrying over what others would think. I look back on my childhood and remember being so happy, I miss that feeling! I look back on photos and sometimes get a little upset with the realisation of how I had nearly completely destroyed that person.

My self-confidence issues have always prevented me from achieving things. I have been a doormat to so many people, allowing them to disrespect me and call me names, without being able to call them something back or defend myself. Because I know how much it hurts to be called “ugly” “stupid” and “chubby” and despite people’s horrible comments towards me, I would not wish that feeling on anyone else. Because hearing those words, especially from someone you thought was a friend is the most heartbreaking thing to hear.

However, the only person I SHOULD blame for ending up in this position is myself! I should never have allowed those words to get into my head.

The more you allow comments or thoughts to get into your head the more you feed this ‘voice’. Which is possibly the worst thing you can do. It began to ruin my relationship with my body. I didn’t worry about how my body would function. I didn’t think about how I could’ve ended up in a hospital bed. My main concern was whether eating a piece of bread would make me put on weight. The voice inside my head would constantly make me question whether or not I should eat something. It was so tiring and mentally draining.

Looking back I now realise how I was not in control of my own body or mind. It was controlling me. At the beginning of going to CAMHS, the psychologist and my parents constantly told me that. Which I did not believe, I did not see how bad the problem was.

I remember one occasion where I walked to the kitchen and then left a total of 7 times. I’d go to the cupboard as I was craving chocolate. I got as far as picking it up and then would put it back and tell myself that I didn’t need it I just wanted it, and usually, that feelings would fade. The fact I did that 7 times and still didn’t just eat the chocolate shows how I had reached rock bottom. I was completely controlled by this voice.

It wasn’t until my parents and I had a long-brewing argument over the whole situation till I saw how bad I really was both mentally and physically. It took my mother to tell me how she couldn’t look at me, that I was skin and bones with “an 8 year olds shoulders”. She literally had to shout at me to get in my head that I was too skinny and was slowly killing myself.

I dismissed all the signs and carried on as though everything was okay. Like not having a period for 9 months was normal, that every time I would get out of a chair I’d feel as though I was about to faint, having to pull up my once fitted school skirt as it had become too baggy, brushing my hair which was beginning to fall out more and more. CONSTANTLY thinking about food, fantasising about eating it and then not doing so. Yet I didn’t care. I didn’t care that my body was beginning to shut down. I didn’t care that my clothes were becoming too big to wear, I was happy that I was losing weight; I saw it as a success. I wasn’t bothered by all of these things. Now that I look back I see how mentally messed up I was. How this is a dangerous and odd way to think. How I should’ve considered myself lucky to have a body, I should’ve looked after it and loved it. But I didn’t because my mind was fuelled with this daunting voice telling me to continue this way. Praising me for losing weight, punishing me with hours of worry and fear when I disobeyed it by eating something. Ruining relationships with friends and family, causing a huge drama at mealtimes, watching your parent’s heartbreak over it.

I now am so much stronger than I once was. I have control over this voice; it’s definitely still in me. It’s always been there. Yet I AM STRONGER THAN IT. I know the voice will always be there yet I am now in control. There are moments when it comes out of nowhere and old habits will try to creep up on me. But I know how unhappy I was. I know that this voice is simply just a fear that eating a piece of bread isn’t going to affect me. That a number on a scale is JUST A NUMBER.

Anorexia, bulimia, anxiety, depression and all mental health issues are mentally and physically draining. The road to recovery is not at all smooth, yet you have to know that obeying your ‘voice’ is not going to help you. The only ‘benefit’ I got was losing weight, I was not happy.

Now I am no longer losing rapids amounts of weight and have a healthy relationship with food I see the brighter side of things. I realise how lucky I am.

I am now beginning to feel carefree; I am far more fiery than I was 6 months ago. I will not allow people to make negative comments about my appearance, my intelligence or the person I am. I do not retaliate with hurtful comments as I would not wish this feeling on anybody despite how hurtful it feels and angry it makes you. The world can be a cruel place, yet you do not have to be cruel to yourself or others because of this.

Recovery is possibly the hardest thing I’ve ever had to do, having experienced it twice the second time around was far more difficult. So if you are in recovery or have relapsed please understand that despite how difficult it is, choosing recovery over the voice will result in you feeling happier and stronger, your family and friends feeling happier and stronger and overall showing how it can’t control you!

I hope this has helped anyone who is struggling, I could’ve gone into so much more detail however, I now choose to try not to think about old habits and would prefer to look forward.”

2020

A young person’s experience with Anorexia

This is story of an experience with anorexia comes from a young person in Glasgow who came out of recovery a few months ago and has written a recovery story with a message in it to encourage others to not give up.

“Focused on my main aim, to lower the 2 figures on the scale, this tiny little electronic box that had no feelings, emotion, love for me or care, but it controlled my life and meant more than my family, friends, everything. The aim to feel thinner and feel like I was able to have so much control and power for once became obsessive.

I thought I was the envy of people, you always hear people talk about diets and wanting to be thin and I thought I had it, what I didn’t know was I looked gaunt and frail. People didn’t look with envy but with shock or worry. I was seduced into a world unlike reality, where there were no worries or many emotions the lower the digit that’s all that mattered. What was a trustful friend that filled me with pride when I pleased her, became no longer good enough. I was scared of the consequence that I would become fat. I was isolated and felt lonely and worthless.

Ana was a coping method for problems I didn’t want to face, but hiding and running away from problems in the real world was never going to help me, they were still there. I also didn’t know if it was worth getting better because I felt so far from the point of getting everything back that I had lost. I realized that obeying “Ana” takes away everything and the only thing that she can offer is being thin, but when that’s the only thing you own is it really that special?

When you’re being forgotten by friends and missing out on the fun you see others have in life. I would question why I am doing this to myself? With help from therapy and my strength, I started to eat foods I was more comfortable with and tried to socialise with my friends. They were considerate as I told them how I felt so nervous being around food because I would think of the calories and consequences. Now I know the fear of getting fat and ugly, is only a fear, nothing more. I felt alive when I ate, it was like stepping out of a bubble and I was able to giggle and have the energy to socialise with my friends. That feeling felt 10x better than lowering the digits on the scales.

When coming back into the real world where other things mattered like relationships and school, it was daunting as I had excluded myself from a lot of things for so long. Eventually, days weren’t planned around what I’d eat and how many calories I would burn, Instead, I lived life in the moment and things in life became more fun when getting out of a regimented exercise and food plan, I felt free.

I must tell you if your recovering I know at first you’ll be totally against it, halfway through you might not be sure and you’ll have your bad days, but you will see that you are happier when you’re eating. By the end, you don’t want to ever turn back. I promise you it’s completely worth it in the end. The only thing Ana can offer you at your lowest weight is either a bed in hospital or a grave 6ft under. But recovery can offer you a life that you wanted to live, what you dreamed of doing when you finished school or university, having friends and people who care about you and having a relationship. We’re only on this earth for a short time, why waste any more time living by restrictions and rules that take away things you enjoy. I have recovered and I have a completely new life that I am much happier in, I fought Ana, sat my Highers and I am going to university next year to study Law, I would never have had made it before, don’t let Ana stop your dreams. Ana is like a prison built in your mind.

Break out and let yourself free, I did, you can too.”

Pre-2020

A young person’s experience of a Multi-Family Group

This is a story is about a young person discussing her experience of a Multi-Family Group which is part of the treatment process you get when you come to the Connect-ED team.

“Hi, I have suffered from Anorexia. I started to lose weight when I had recently turned ten. It started off that I was restricting my food and swimming about 40 lengths three times a week at Parklands swimming pool. The number of lengths I was swimming slowly worked its way up to 60 lengths three times a week then to 100 lengths three times a week until it reached its peak when I was swimming 100 lengths four or five times a week.

That year we went on holiday to Israel and I asked my mum if she could get me help because I was feeling particularly down. At the time I thought it might have been depression since my grandmother suffers from depression but obviously, it was the anorexia working its way into my life. I eventually went to the CAMHS (Child and Adolescent Mental Health Service) team and they diagnosed me with Anorexia Nervosa. For a while, I continued to lose weight and I reached about 30kg before I made what I call my recovery road. My recovery road helped me to get motivated to start putting on weight and increase my food. As I made my journey down my recovery road, many things helped me along the way – like the Multi-Family days.

At Multi-Family days I enjoyed getting to meet the other girls that had the same problem as me. It was fantastic to go on a journey almost with them because every Multi-Family Therapy day I go to see most of the girls getting better and better. The Multi-Family Therapy days made me feel less isolated and it meant that I got to talk to girls I understood. It was interesting getting to hear the other parent’s and girls’ stories and it was fun when Charlotte took me and the other girls out to do something arty or play a game so that the day did not seem so dragging. On the first day, I have to admit I was quite sceptical about the Multi-Family Therapy but it really worked well for me. It was amazing to see each of the girl’s personalities grow as they got better, all of us became different people.

The journey through anorexia is definitely a hard one, but with the help of the CAMHS team, I managed to get to the right weight. I still have issues to deal with but I know that I can depend on the CAMHS team to help me every step of the way that I have left. You might be feeling terrible and it might seem like this nightmare will never end but trust me it will eventually. The journey through Anorexia is probably one of the hardest things you and I will ever have to do, but with determination and motivation, we can get through it!”

Pre-2020

Poem about Anorexia

The poem below was written by a patient of the Eating Disorders service which captures the emotional aspect of Anorexia.

ANOREXIA I hate you. You know who you are. You know yourself so well; you’ve made me forget who I am.
You tell me that I am you, Mock me when I say I am not you. You claim that I will always be you, that it is impossible to ever be free from you.
You control my every move, a dictator to the extreme. You came uninvited at a time when I was young. Now it is clear you are not wanted, yet you refuse to go away.
You hurt those I love the most, this is my greatest hate.
You have no limit, you can never be satisfied. You demand my full attention, 24 hours a day, 365 days a year.
You are one long list of restrictions.
Never failing to deal out punishment when disobeyed.
I fear I will never make it out, out of this black hole you have dug for me.
I HATE you and all that you stand for.
Anon, age 17

A young person shares her story and hope for everyone with an eating disorder

This is a piece written by a young person who was treated in Greater Glasgow and Clyde Child and Adolescent Mental Health Services (CAMHS), she shares her story and hope for everyone affected by an eating disorder.

“Anorexia I would just like to write this to hopefully help and influence other young people who are suffering from an eating disorder to let them know from a (recovered anorexic) that there is light at the end of the tunnel.

The first thing I would say about an eating disorder is that you feel very isolated and alone. You are not alone there are many others out there just like you suffering from the same problem.

I was lucky that I had a family that cared so much about my health and welfare that they never gave up and eventually that is what got me through (and my own determination to succeed in life). Although my family tried to help me I kept pushing them away making myself more isolated. Now looking back on it all I know that was the worst thing for the eating disorder because it just dug a deeper hole into my life. I had a strong relationship with both my sister and father but my obsession with food and weight loss caused a great strain on the relationships and broke my family to pieces at times. For any young person who might read this, don’t make the same mistakes I did. Although it might seem like your loved ones are just getting on your nerves or upsetting you by forcing you to eat, or always commenting on how you look, they are doing it to try and help you move on from the eating disorder because they love and care about you and don’t want you to ruin your life with the illness. The next time you skip a meal or throw up in the bathroom think about what that is doing to the people you care about. It’s ruining their lives and killing them as much as it is you. The eating disorder controls their lives as much as it does yours.

One piece of advice I would give to anyone with an eating disorder is you think you are fine and that you don’t need help and that everyone is out to get you. I know I have been there and felt those same thoughts but you are fooling yourself and deep down you know you are. I know that it is not an easy thing to admit that you have a problem and that you need help. It is easier to pretend that nothing is wrong and that you are fine but you are not. Most of you reading this probably think like that at the moment. The best thing that you can do for yourself is admit that there is a problem and that you need some help. Don’t push away the people you love. Don’t make yourself isolated, because it’s only going to make things worse for yourself. I will tell you of a few family breakdowns that happened in my family due to my obsession with food. When I was 15, I came home from school one day to see that my little sister at 13 years old had written up on a whiteboard size piece of paper a weekly meal plan of what my mum, dad and family ate and what I ate and the calorie intake of what I ate and they ate. I read it and asked my sister to get rid of it because I didn’t want to know. I didn’t care. All I wanted to do was go to my room and get on with my homework. I walked into the study a little later to find the poster stuck on the wall. I asked my sister to take it down she said “no she wanted it there”. I said “I don’t care I don’t want to see it.” She said she wasn’t taking it down, so I pulled her hair to make her. She screamed but still didn’t take it down. I got upset and told her she was horrible and a terrible sister. I ran upstairs crying to my mum and dad telling them what an awful thing my sister had done. They looked at me with great sadness in their eyes and they said she did it because she is so worried about you. I gave the classic anorexic excuse. “What’s she worried about I’m fine”. My parents told me that she had told them what she was thinking of doing and they said that they didn’t think it would work. However, she thought that with us being close she might be able to get through to me with it to show her concern. I went back downstairs and cried in my bedroom. I eventually couldn’t take it and I got angry I went into the study, I pulled the poster off the wall and I picked up a stapler and threw it at the wall I continued doing it shouting at people to leave me alone and let me live my life and stop constantly getting on my back. Eventually, I made a dent in the wall and broke a chair. The poster got taken down and my sister went to her room crying and my mum and dad went back upstairs and they don’t know that I heard them also crying and arguing over what they were going to do with me. Later on that night I went into my sister’s room and she looked at me as if she hated me. She said she was sorry for what she had done. I felt so selfish at that moment and I said to her that it was okay I knew that she was just trying to help me and that she was worried about me. I sat her down on her bed and told her that I loved her and that I was going to be okay, that she didn’t need to worry, but she looked at me and both she and I knew that what I had said was a lie. Neither of us thought I was okay and neither of us knew that I was going to be okay. She just looked at me and said what happened to you. You are not okay and I don’t know if you ever are going to be again. I left her room and I just felt so selfish and isolated and guilty that I had hurt my whole family and I was killing them as well as myself yet the only thing I did was cry. I didn’t do anything about it. At that moment in my life, I felt incredibly isolated and vulnerable probably the same as a lot of you are feeling. I was so angry and frustrated with people (my family and friends) always going on at me about food. I was so far into an eating disorder that I couldn’t see their side of it and how they were trying to help me. That incident changed my views; that was the moment in my life when I realised that things were bad. I had had a nervous breakdown because I couldn’t cope with it anymore. At that moment I just wanted everything to go away.

With my experience of anorexia, I used it to control other things in my life that I couldn’t deal with. I used food to block out other things in my life that had hurt me and the emotional pain was too difficult for me to deal with. I used eating as a way to forget about these other things as I was constantly thinking about food and my diet instead. For me, not eating made me feel better about myself and gave me more confidence as I felt I looked better. I would go on the scales and be 7 stone and feel good that I had lost a few pounds. I would go into a shop and be able to fit into size 6 clothes. There were days that eating just an apple and doing 2 hours of exercise felt worth it as I had achieved something in my eyes. As a recovered anorexic I know now that there did feel like there were a lot of benefits. Even today I still believe that there are a few parts of an eating disorder that can be good. It made me feel better about myself; it gave me more self-confidence and determination. I was more driven and had a set goal and due to the amount of exercise, I did a day I was fitter. Most of you probably think that the way you currently eat is better. Maybe you feel some of the same things I did. However, I remember at the time that I felt that there was nothing wrong with me. I felt good and I thought that the eating disorder I had was great and that it just made my life so much better. Now though I know that I was just fooling myself. I know that there was nothing good about it. It gave me so many different health problems. Due to me not eating, I didn’t have a period for 5 months and when I did finally get them back they were irregular and hurt a lot more than they had previously. I often felt faint and dizzy when at school. I was constantly drinking diet coke to stay awake and give me energy. I had terrible constipation and basically couldn’t go to the toilet because my body didn’t have enough in it. I often found it difficult to sleep. I constantly felt angry and irritated by people. I was tired and moody. People used to annoy me a lot. Often I would shout at people and got very techy when they talked about food. My hair became very thin and straggly. I had bags under my eyes often and was very boney. You could at times see my ribs etc.; however, I did not think this. I was always cold, complaining about the cold or shivering. Finally, I was often in and out of hospitals getting my blood taken and my heart and pulse and blood pressure checked. I am sure that many of you reading this may have felt a lot of the same things recently or possibly worse. Yet you are still saying to yourself I am fine, there’s nothing wrong with me. All these health problems are caused by your diet and eating. There may be the odd few advantages to your current diet but there are so many more negatives. It took me 2 and a half years to realise that there was more to life than just food and my obsession with it. Although I am now a healthy individual doing well in life, some of the health problems that I contracted due to my eating disorder will take me a long time to recover from. I know that food will always be something that I keep a watchful eye on. However now, I am a lot happier and healthier and really enjoy life. Looking back on my time with anorexia I know that I was miserable. I was killing myself and my family. I know that for anyone reading this.

You can get better and life is much better once you overcome you’re eating disorder. I know it is not easy to do; in fact, it is the hardest most difficult challenging thing you will ever have to do in your life. However, it can be done and life is so much better afterwards.

I hope that anyone reading this will take the advice that I have just given them. Stop now whilst you can. Don’t give in to the eating disorder. Don’t let it kill you. Believe in yourself that you can do it. The next time you starve yourself think of all the problems you have due to your diet and lifestyle. I hope that some people reading this might have been given some hope from my experiences that you can recover from your illness and that there is light at the end of the tunnel.

Finally, the first step to recovery is admitting that you have a problem and that you need help. Don’t be afraid to ask for it as you will regret it if you don’t. Think about what you are doing to your family and friends, you are killing them as well as yourself. Don’t push your family away, believe in yourself. Believe that you can overcome your illness.”

Pre-2020

Reflections from a young person of how it feels to have Anorexia Nervosa

This is a piece from a young person around ‘Reflections from a young person of how it feels to have Anorexia Nervosa.

“‘I am Not Invincible’

‘Somewhere behind the athlete you’ve become and the hours of practice and the coaches who have pushed you is a little girl who fell in love with the game and never looked back…Play for her.’ – Mia Hamm.

Sadly, that little girl was lost, somewhere in the blur of the present. Scared, alone and broken by the devastation; what I can only refer to as a disease; brought to me and the ones I hold dearly. It bulldozed my illusion of invincibility and shattered my humble bubble. That is what shocked me the most. ‘Anorexia’ is a term loosely thrown about, almost in a disrespectful, fun poking way. I can assure you, it is in no way a ‘fun’ experience. In fact, it’s quite the opposite. ‘It doesn’t’ happen to people like me. I play sport. I can’t get it.’ I couldn’t have been more wrong. Believe it or not, I am not invincible. Although not fully diagnosed, the tone in which the doctor muttered ‘We can go to the psychiatric family unit’ said it all. I needed help quickly before my health deteriorated to a point of no return. Unfortunately, at this particular point in time, I saw nothing wrong with the way I looked, or my eating habits. In fact, I saw it as normal. Normal for my trousers (once fitting) to constantly slip down, normal to be able to grasp my collarbones like handlebars on a bike, normal for my ribs to protrude through my frail skin like cold metal railings running along a tired building. It all seemed normal to me. Sitting in the doctor’s surgery, it never really hit me. That place always just seemed to creep me out more, if that was possible. It wasn’t until my parents threatened to send me to Skye house, a psychiatric residency for young people with ‘eating disorders’ that I took notice. However, to me, it’s not a ‘disorder’. It’s not controllable, which is what shocks a lot of people. It’s not a life choice, it just seems to be your body’s way of saying ‘Enough, I can’t take this anymore.’ The stress, fear, anxiety, it all amounts to something, and in some cases, this is an ‘eating disorder’.

The road I was heading on is one which I rarely think about. Perhaps because what I can now only imagine was in fact, at one point, hand in hand with reality. A dark, twisted road, no lights, no other passersby. Just me, on my own, was what was lying ahead. That split second decision to have that packet of chips was probably that one trigger that ultimately saved my life. I’ve never spoke truthfully and honestly about this with anyone which is probably another contributing factor to the proliferation of this mind shattering illness. The place it puts you in is horrible. One which I never wish upon anyone. It’s like crying when no one can hear. Inside your kicking, screaming, squealing for help yet outside. Nothing. No one notices. No one cares. Horrible. The place I once found myself is a corner. It’s in a dark, cold room and you are backing into this corner, except there is not a wall behind you. It’s… Nothing. An empty space. You become so caught up in everything else around you, trying not to stand up to this possessive mind controlling demon that you begin to accept the fact that you’re heading straight for the empty space. The corner with no wall. You know the feeling you get when you wake up and it’s raining and nothing is going right for you? That is the feeling you experience all the time. Every minute of every day. Relentless in its attempt to overturn you and control you. Anorexia can’t be treated with tablets, it’s up to you to make yourself better which again adds to the pressure. You have a distorted view, not only of yourself, but of the world. Nothing is pleasurable. Nothing at all. This brings me back to Mia Hamm.

My love of football has been moulded into a way of life throughout my high school years. I live for it. It was when I began finding football, a chore and a hassle, that I knew something was seriously wrong. I no longer found the fun in it and started to see only the one dimensional side of life. It was hard to see something I loved so dearly be snatched away from me by the disease. This is what hurt the most. My love, my passion, my whole word for ten years crumble beneath me. Helplessly, I grasped on to the hope things might change. I might be free of this someday. It was this, last grasp that aided me in my ongoing recovery.

To think this only happened just under a year ago shakes me. I think of it as a thing of the past, something that’s locked away with all my childhood memories, in the distant part of my mind when really it’s still a huge part of my life today. However, it has taught me many life lessons. I realised the strength of my mind both good and bad. How my mind was near able to drive me to a psychiatrist yet it was also that very same mind that saved me. Ever since I was a little girl my father always used to say ‘Your mental strength is amazing. Watch out for that, it could kill you one day.’ I always thought he was trying a Martin Luther King moment. Pondering me with his wise words yet the truth behind them is fascinating. It was in fact my mental strength that did, not kill, but caused severe damage. Miss-directed but still as strong, it ripped my world apart. This disease however also taught me how life is short.

We don’t get second chances. Every day gone by is one less you are here. Take every day as it comes. If you want to have a packet of crisps, have them and don’t look back. As pathetic as that sounds, that is the point I found myself. Near tears over having one individual crisp. Helpless. When you’re in that dark place you realise the sheer importance of love and family. No one else in the world matters at that point, apart from them. Without my dad throughout this whole disaster, I would no doubtedly be very far down that long, twisted, lonely road. He was the wall behind the empty corner. Just when I was accepting the empty space, he was there. It was him. No one can go through life letting everything bounce off them, having nothing go further than their surface. We are human. We make mistakes. No one is ‘invincible’.”

Pre-2020

Families are in the best position to help and are key to aiding their child’s recovery from an eating disorder. It may seem overwhelming at first when a diagnosis is given but in time you will gain knowledge of how to help and what needs to be done. Reading and gaining knowledge is essential at the beginning of the treatment journey.

Please see links on this site and CarED Scotland for information that is essential when learning about eating disorders. In addition, ongoing support is available from the eating disorders charity Beat Eating Disorders.

What should you do if you are worried that your child has an eating disorder?

Eating disordered thinking and behaviour is often hidden and not seen as a problem by the sufferer. This makes it different from other illnesses and makes getting young people the help they need more difficult. Parents play a big part in helping their child get the help they need. Firstly they need an assessment by the GP, including a thorough physical examination. The GP can then refer them to get treatment in child and adolescent mental health services. Following these steps will help:

• Be clear on what are the signs and symptoms of eating disorders.
• Watch and take note of changed behaviour/physical signs.

Over a period of a week, watch out for your child’s behaviours, especially around food and drinks; meal/snack times/secret eating/food disappearing etc., exercise or activity, and visits to the toilet. Think about their emotions: are they more withdrawn, quickly annoyed, more secretive, lower in mood, preoccupied? Physically are there signs of weight loss, are they feeling the cold, are their hands cold and or red? Do the things that you have observed fit with the signs of an eating disorder? If they do or you think that they might be the next step is to talk to your child openly about your concerns.

If you are clear in your own mind that your child has a problem, your aim here is to ensure that your child attends an appointment with their GP, preferably with you in attendance. In a warm, non-blaming way, talk openly and honestly with your child about your concerns. Your child may not see a problem and may also see the eating disorder as a positive in their life, so this approach will help to engage them in talking rather than push them away. Your child on the other hand might be relieved to be able to talk to you about it. Your aim is to go together to see your GP, to be further assessed. If you remain worried but still are not sure if there is a problem, your aim when talking to your child is to find out more from their perspective. Again be warm and non-judgemental when you ask them about the changes in their behaviour, tell them how they have changed, what you have noticed in their recent behaviour and that you are worried about them. Their response will help you to know more about the level of the problem. If you face anger or immediate strong denial, remain concerned. One way to learn more and engage your child is to say that you want to be with them for all meals and 2-3 snacks every day for the next week. If there are eating problems, they are likely to surface during this time. Use a united front with your child when insisting on a GP appointment. If there are 2 parents come together and insist together, even if you are not living together or for single parents use a grandparent or family friend. If you are unable to get your child to go to the GP you can go on your own to tell the GP of your concerns.

A story about getting help…

“When our daughter Lorna* was 13 she became ill during the summer holidays, she began exercising; cutting down on the amount of food she ate; vomiting and using laxatives. When we became suspicious of an eating disorder, she denied this adamantly, although by this stage the weight loss was becoming obvious and her periods had stopped. Lorna confided in friends about her condition and they contacted her guidance teacher who immediately let us know. Within a few days, I took Lorna to our GP who immediately referred us to the CAMHS team who diagnosed anorexia nervosa.

We were seen very quickly as things were deteriorating at home. Lorna was furious that everyone had found out about anorexia. Within weeks of diagnosis, she stopped eating completely; drank very little; and vomited after eating anything. She was self harming; her mood was low and she felt suicidal. We had intensive support from the community team and her GP, however, the situation had reached a point where this was no longer enough. We felt completely helpless watching our daughter dying in front of us. She had changed so much that it was like having a stranger at home.

Eventually, Lorna had to be admitted to the inpatient unit. Immediately a team of caring professionals were able to take over her care and keep her safe. She refused to eat and required a feeding tube. We started attending the Carers support group which was another huge help for the two of us. We heard other parents’ stories and we realised that we had done nothing different to anyone else at the meeting. We also realised that as parents, we were not to blame. Other families experienced hospital admissions, while others were battling at home. It was great to be able to speak openly and not be judged by anyone. Everyone there understood. Six months on and we still attend meetings for support, advice and education about eating disorders.

After input from Nurses, Doctors, Psychologists, Dieticians, Family Therapists, Occupational and Art Therapists; Lorna has maintained a normal weight now for 2 months. She is excited to be back at home and we are continuing treatment with our local CAMHS team. I hope that we can continue helping our daughter choose the right path; however, I know our friends at the Carers meeting will be right behind us and that helps us as we know there is no quick fix to this illness”

Lorna’s Parents (*names have been changed)

General Practitioners

GPs are key to identifying children and young people with eating disorders and supporting them in treatment early for the best prognosis. Eating disorders are frequently hidden and very confusing for children and adolescents making early consultations with the GP difficult. Parents and carers are frequently required in the consultation and their view of their child’s thoughts, behaviours and physical changes will be critical in helping to decide if there is a potential eating disorder present.

All children and young people with a potential eating disorder will be prioritised for assessment in NHSGGC CAMHS.

Even early, sub-threshold presentations of an eating disorder can be associated with health impairment and physiological complications including growth retardation, pubertal delay and deficiencies in bone mineral acquisition, as well as significant psychological distress and impairment, equivalent to full threshold illnesses and are therefore treated as urgently in CAMHS.

Below are a list of resources and guidelines to help detection and diagnosis of eating disorders:

• GP’s Guide to Eating Disorders.
• National Institute for Health and Care Excellence (NICE) guidelines: Eating Disorders: Recognition and Treatment.
• Scottish Intercollegiate Guidelines Network (SIGN) eating disorder guidelines: SIGN 164 Eating Disorders.
• Guidelines in Practice: Top Tips – Eating Disorders (this link has useful information but is orientated more to adult patients).

Do not hesitate to telephone your locality CAMHS team or phone the Connect-Eating Disorder team on 0141 277 7407.

Schools

School staff are often also key in recognising that a young person is suffering from an eating disorder and then supporting them in maintaining their education and social development whilst they are in treatment. The Beat Eating Disorders charity offers online training for school staff.

See also School Nurse Guide to Eating Disorders.

Training

If you would like training for your school or GP practice please contact the Connect-Eating Disorder team on 0141 277 7407.

• The UK’s Eating Disorder Charity – Beat.
• The CarED Scotland website has an up to date and regularly reviewed list of resources including websites, books, helplines and support groups.
• NHS 24 is an NHS operated call centre that provides callers with physical and mental health advice and helps over the phone when your usual GP services are closed (or if you don’t have a GP). Call 111.
• Samaritans offer free confidential emotional support for anyone struggling. The service is available 24 hours a day, seven days a week. Call 0141 116 123.

For further information about the Connect-ED team and for information on eating disorders, contact:

Connect-ED, Templeton Business Centre, 62 Templeton Street, Bridgeton, Glasgow, G40 1DA

Telephone – 0141 277 7407

NHSGGC CAMHS Teams