SWEDA Somerset & Wessex Eating Disorders Association 18-25 Student Support
"serving those affected by eating disorders"

	Please bear in mind that SWEDA's 18-25 Project has now ended. Much of the work of the project has been taken on by SWEDA and its Schools Project and student support work. These leaflets are not current or made available for download and are provided for reference only.

Healthcare Professionals
and
Eating Disorders


"Serving those affected by Eating Disorders"

Eating disorders affect people in many ways.

With them come emotional symptoms like anxiety, depression, hopelessness and low self esteem; they bring psychological symptoms such as constant thoughts about food, weight, shape and exercise; they put strain on relationships; and they cause physical problems which can lead to serious illness and even death. This leaflet provides information about the physical problems that may result from maintaining a low body weight.

Your patient may be feeling uncertain about what to do about their eating disorder. They may wonder if it is ok to tell you whether you will believe them especially if they are not at a critically low weight or BMI. They may wonder if they can trust you and if you will understand anyway. You may find it difficult to know what to do or how to help.

Eating disorders are very complex and are an indication of the struggles that the patient is having with other issues in their world. The weight, misuse of laxatives, diuretics and exercise will be their way of compensating and numbing their inner feelings.

Many patients may come to you once and not return for a while or may be dragged in by a partner or parent or friend who is in desperation.. It is important to hear what these caring people have to say and help them find a counsellor or group to talk about their thoughts and feelings so that their feelings are not perpetuating the problem.

"Do you wait for a child to cross the road and die before we help them cross? Or do we predict the danger and find a safer way to cross the road?

Do we wait for our patients to be rock bottom thin or can we meet them when they ask?"

Understanding Eating Disorders
Eating Disorders are an expression of psychological and or emotional problems. People with Eating Difficulties use food in different ways to cope with and manage their distress, as they feel they are unable to deal with it in another way. It is therefore, essential to address not only the very real and distressing problems around food and eating that the person is struggling with but also the underlying problems for which the eating disorder is providing a way to cope.

Assessments
Full formulation not a diagnosis. Clear and informed. Not a one off snap shot. Repeated regularly to take change and changing needs into account Personal and social issues and values need to be recognised and respected.

Engagement
The person has to make a clear choice to want to change. Motivational work is a keystone. Give clear information . Use a common language. Do not fudge. Offer ways forward and choice.

Intervention
Don’t battle Don’t collude. Self esteem, emotional control, identity and the spiritual self are key areas. Clear well held boundaries are VITAL. Allow time for assimilation.

Recovery from an entrenched eating disorder can take 3-5 years.

Some people have described feeling like the baton on a relay race, each health professional trying to pass them on to the next and they don’t know where they are in your race of their life.

The client is real not a baton and it is a relay and communication between you that will help the person move on. One professional cannot hold everything.

Endings
Be clear from the start that there will be one. The first task of the relationship may be to overcome the resistance that this causes! A bad ending can wipe out the gains of a successful therapeutic Alliance.

Take care of yourself
Strong supervision is necessary, know your own issues, Know your own limits, peer support is important. Value your own body.

If Only I had known that!
Whatever chronological age the clients is there is a part of them stuck at the development stage they were when the eating disorder began. The child needs to heal and be enables to grown and hold themselves in an age appropriate way. They also need to know it’s ok to keep growing up. The process of growing up and reassurance to do this can take a lot of support and the separation and individuation can be painful for both health care professional and client.

Sometimes now is not the right time for them to make changes. If it is not and they are not in a place to do this, and you try to help them make changes, you will be fighting and not working together .

Attention needing behaviours is an indication of a legitimate need having been ignored. It means the client/ patient needs attention. They may not need the attention for what they are getting it for. Sometimes people cannot ask for what they need and will use food behaviours, stealing, absconding etc to ask for this.

Some families have ways of functioning that don’t work for some of their members. It may not be anyone’s fault it may feel as if it is.

Some family members seriously damage other family members. Others collude. Sometimes it is someone’s fault; it may or may not be worthwhile for the patient/ client to act on this.

The cycle of Motivation is good to keep in mind

Pre-contemplation, where clients are not ready for change but may need intervention to help them live and get into a place where they may be ready to make choices and change. Other people will choose to live as they are with their eating disorder and not make changes but find a way to live with life and get the best out of their life as it is. This is their choice.

Ready to make some changes of think about what change may mean to them. This stage may be considering what their eating disorder gives them what its costs and benefits are and how it may be to not live by their eating disorders rules. What can they swap the Eating disorder for? What would fill the time and give them the same cosy inner feelings and fill up their time?

Action where the client is actively seeking therapy, dietetic input and want to make changes in their life and break free from their eating disorder. This will take time and a lot of energy and determination. People may go between different stages on different days and within a day.

Maintaining wellness, this is hard because the person has to live and manage the new way of life and be with others and not let their old patterns of thoughts take over. People can need a lot of support and reassurance in this stage of life, and may well revisit other parts of the cycle from time to time and rediscover why they want their recovery.

Health Checks and Advice/Education

Your patient will probably want to run many miles from you scales or from being judged by their body. It is important that they understand you care and are wanting to have an understanding of how their physical body is so that you can keep them alive and as healthy as possible to enable them to have the chance to make choices about what they want and how they can get this in their lives.

Checks you need to gain trust from them to let you do them

• Weight and BMI Sometimes people cannot bear to know their weight and knowing it will drive them to want to loose more weight and become more "invisible" so they may be happier being weighed backwards. It is better to work openly with them but if they cannot at this step manage it backwards it better than no way!
• Blood test especially someone who is vomiting or very low weight because of their potassium level and u’s and e’s
• Blood pressure as dizziness and fainting and tiredness are symptoms people may have.
• As well as listening an ECG will help check their heart rhythms.
• Dexa scan for bones and osteoporosis

Education

• People with eating disorders are often cold and have poor circulation even in a hot environment.
• Periods will often be absent and hormone levels imbalanced.
• Growth may also be stunted or at a changed rate.
• Look out for dry skin, swelling in ankles, hair loss and marks on their knuckles as signs of having vomited.
• Laxative misuse may also mean that the person has stomach troubles and they may not be able to give this up immediately and may need you help and reassurance around this and educating about the effects of long term severe laxative use on their body.
• You may advice them to go to their dentist and make sure that he helps them care for their teeth as acid will erode their enamel and cause decay.
• Absent or irregular periods are no guarantee against getting pregnant. You should take precautions to avoid an unwanted pregnancy.
• Poor sleep patterns and difficulty to relax will often go hand in hand with an eating disorder.
• Do they self harm?
• Do they use other substances?
• Family patterns or illnesses?

Sometimes people go to their GP and are afraid of being judged and seen as an eating disorder and not a person and feel like it is all their fault and that they do not deserve and are not worth your time.

From our feedback it seems to be really important to people that you take time to listen to them and try to understand what is going on for them. This helps them to feel as if you care and understand and that they are not an animal you want to feed up and dose up with antidepressants to.

Living with and recovering from an eating disorder is like sailing round the world single handed on a boat too big for one, you need help that will stick with you and let you try to steer your own course with guidance from VHF.

There may be some stormy seas to sail through, some people will die, some will get blown off course, some will lose their way and many can make it through with your help belief, support and hope.

• What does the client want need and aim for?
• What are your aims and needs for your client?
• Are you or your client concerned about how things are?
• What are the concerns why?
• Are we helping the client?
• Is the client ready and wanting to change?
• What will be the complications is the client does not make changes?
• Have you told them?
• Does you clients know why you need to do?
• Does the client know how serious their eating difficulty is?
• Do you hear them even if they are not critically low weight?
• What can you offer a binge eater?
• What can you offer a Compulsive eater
• If you offer a self help book and no skilled helper.
• Is that really enough?
• How do they feel about just having a self help book?
• Was that what they wanted needed and expected?
• Would you be happy if that is what you, your partner or child or best friend was offered?
• Do you have a counsellor they can see to help with supported self help books?
• How does the counsellor feel about working with people with eating disorders or difficulties?
• Do they know that they need to see their dentist regularly to help keep their teeth and gums as healthy as possible
• Listen to what your client wants and needs
• What are the predisposing , precipitating and perpetuating factors of their Eating disorder?
• What advice and local organizations are available?
• To support this person day? By Night?
  • Drop in?
  • Groups?
  • Email?
  • Email discussion group?
  • Web sites?

How can we be proactive?

Can you set up some Patient forums to hear about what your patients want and need in your area

What self help groups are around?

How will patients in your surgery/ clinic find out about these?

Do you have a self help library system?

Do you have a space for Patients to feedback suggestions and comments?

Do you have copies of the Nice Guidelines for patients to read and take away? www.nice.org.uk

Do you have nutritional advice for people who are trying to re eat or change their eating patterns?

How do you feel about working with people with eating difficulties?

Somerset and Wessex Eating Disorders Association offer services to help people affected by eating disorders. If you would like to find out what services are available to you then contact SWEDA on 01458 448611. There is a helpline on 01458 448600. This helpline is available for people with personal experiences of eating disorders, for their families and friends as well as professionals working with people who have eating disorders.

You may want to check out the website and forum pages on http://www.swedauk.org

SWEDA are able to offer training to professionals and families.

We have a supported living house for people who are wanting to move in in their lives and need individual support to make have the best opportunities possible for them. For information of this or to request leaflets and information contact 01458 448611.

Somerset & Wessex
Eating Disorders Association
Strode House
10 Leigh Road
STREET
Somerset
BA16 0HA


www.swedauk.org