What are eating disorders?

It can be common to worry about weight or diet on occasion, but when these worries become a constant preoccupation or obsession it can cause concern.

It is also concerning when children or young people lose a lot of weight or use dangerous methods to lose weight, such as inducing vomiting or taking tablets.  Low weight, vomiting or using tablets to lose weight can have very serious physical/medical effects and can be life threatening. 

The most common eating disorders are
Anorexia Nervosa and Bulimia Nervosa.

Possible symptoms and signs:

Self imposed and induced weight loss
Unusual weight changes
Low body weight, without medical cause
False beliefs of being very overweight
Preoccupations with food and weight
Intrusive fears of gaining weight
Intrusive beliefs of being overweight
Irregular or absent periods
Excessive exercising
Inducing vomiting
Regularly visiting the bathroom after meals
Taking tablets to induce weight loss
Avoiding to eat in public
Eating large amounts in a short time

Possible causes of eating disorders:

It is not entirely clear what causes eating disorders.  

The following factors may increase risk:
Family history of an eating disorder
Female
Previously overweight or extreme wt loss
Sensitive, anxious or obsessive personality
Perfectionist attitudes
Major life events
Abuse or environmental stressors
Feeling a loss of control in life
Families struggling to cope with conflict, change or to communicate, or families who
are unusually close and over-protective

It is important to know that many of these risk factors, such as family history of a mental health problem, personality traits, major life events, abuse, environmental stressors and family conflict and communication difficulties, are also relevant for other mental health problems and not unique to eating disorders. 

Parents or carers often feel they should have been able to prevent their child's mental health problems and they often blame themselves; this is often not helpful and not accurate.  It is important to remember that the cause(s) for an eating disorder, like most mental health problems, is most often multi-factorial with relevant medical (for instance genetic), psychological and social factors interacting together.  It is important for families to stand together and work together to reach their goals, as this would allow the best prognosis for the child.  

How are eating disorders diagnosed?

Child Psychiatrists are trained and have experience in assessing and diagnosing eating disorders.  Child Psychiatrists often work with colleagues who offer diet management and weight monitoring as well as individual psychotherapy and family therapy. 

GPs can refer young people to CAMHS for an opinion on whether the child or young person presents with an eating disorder.

Sometimes the diagnosis is made during the first appointment and sometimes it takes a few appointments to make the diagnosis.  The clinicians will take a detailed history and will often meet with the young person by themselves and also with the family.  A physical examination is often completed to check blood pressure and consider possible complications. 

Medical causes such as chronic infections will also be considered and ruled out.  

Differential diagnoses (problems or disorders that look like eating disorders, but are not) are also ruled out.  

Differential Diagnoses: 
Developmental problems or disorders
Mood, anxiety and psychotic disorders
Attachment and personality problems
Abuse and psychosocial stressors
Medical problems and medication

This list is not comprehensive. 

How are eating disorders treated?

Some CAMHS teams have specialist eating disorder teams.  Many CAMHS teams do not have specialist teams; the professionals with specialist skills to assess, diagnose and treat young people with eating disorders, work in a generic/general team.  There are benefits to both options. 

A multi-disciplinary approach (involving different disciplines, such as specialist nurses, doctors and dietitians) is often helpful.

Regular appointments to monitor weight, diet and physical/medical health are important.  Family work and individual work are essential and are offered to give the family and the young person the time and opportunity to discuss their concerns and think about possible strategies to move forward. 

Medication may be considered when, for instance, the young person is presenting with symptoms of Severe Depression.

Eating disorders can have very serious medical/physical health complications, which is why young people are occasionally admitted to hospital for feeding and monitoring of their physical health.  Most professionals try to avoid admission, because it is often in the child's best interest to remain in the family and community, but sometimes admission is crucial to avoid serious and possible fatal complications.

Psychoeducation sessions to discuss the possible risks of the disorder with the young person and family is very important.