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Wellen Court, Schoen Clinic York, part of the Schoen Clinic UK Group, is delighted to announce the appointment of Rosie Martin as its new General Manager, overseeing operations and care delivery at the York-based specialist dementia care home. With extensive experience in dementia care leadership, Rosie has spent her career supporting people living with dementia and improving standards across residential and nursing services. She has designed and delivered resident-experience and staff-training programmes focused on embedding person-centred care, ensuring every individual receives compassionate, tailored support. Rosie describes herself as “cheerful and optimistic, with a ‘can-do’ attitude,” and says her “heart lies with people living with dementia”, a reflection of her personal and professional commitment to care. “Rosie brings warmth, expertise and an evident passion for high-quality dementia care,” says Andy Davey, Managing Director at Schoen Clinic UK Group . “Her approach aligns perfectly with our values of compassion, integrity and excellence. We’re thrilled to welcome Rosie to the Wellen Court team.” Rosie has connected well with residents and colleagues, offering her insight into enhancing daily experiences and community engagement. Her leadership will focus on maintaining clinical quality, strengthening person-centred practice and continuing Wellen Court’s commitment to providing safe, supportive and dignified care for every resident. “I’m really looking forward to working with the fantastic team at Wellen Court,” Rosie commented. “My goal is to help every resident feel valued and understood, while supporting our team to deliver the best possible care every day.” --ENDS-- About Wellen Court Dementia Care Home, Schoen Clinic York Wellen Court is part of the Schoen Clinic UK Group and specialises in high-quality residential and nursing dementia care in York. The service provides a safe, comfortable and compassionate environment where residents receive individually tailored support from a skilled multidisciplinary team. With an emphasis on person-centred practice, wellbeing, and dignity, Wellen Court aims to enrich the lives of people living with dementia through expert care, meaningful activities and family involvement. To learn more, visit Wellen Court, Schoen Clinic York

To properly diagnose an eating disorder, a full assessment needs to be made by your GP, a specialist nurse, psychiatrist or psychologist. This will include details about your symptoms and feelings, food intake, weight and blood tests. If you need support, please don't hesitate to contact our team . Although there is no single test for an eating disorder, there is a very good screening tool which is often used by GPs and other people working in healthcare. A screening tool means it shows whether you are likely to have an eating disorder and therefore should be referred to a specialist who will be able to make a diagnosis. The SCOFF questionnaire This screening test is called the SCOFF questionnaire, which consists of five simple questions: Do you make yourself  S ick because you feel uncomfortably full? Do you worry you have lost  C ontrol over how much you eat? Have you recently lost more than  O ne stone in a three month period? Do you believe yourself to be  F at when others say you are too thin? Would you say that  F ood dominates your life? There is a point for every “yes” – a score of 2 or above indicates a likely case of anorexia nervosa or bulimia. How reliable is the SCOFF test for an eating disorder? The SCOFF test was devised in 1999 by a team working under the leadership of Schoen Clinic Medical Director Professor Hubert Lacey during his time at St George’s Hospital. It has since been translated into many different languages and used by hundreds of thousands of clinicians across the world. Assessment of the SCOFF test concludes that it is 100 per cent effective in terms of identifying people with anorexia or bulimia. However there is a 12.5 per cent ‘false positive’ rate, which means that around one in eight people taking the test and found to be positive will not have an eating disorder. Although the SCOFF test for an eating disorder is widely available, including online, it is not intended for use by the public independently. Although using it in this way may be helpful for you, it is strongly recommended that you take your results to your GP and discuss it with him or her. The intention was for the test to be used by GPs and others such as school nurses who may be the first professionals to see someone with an eating disorder. They can then use the test to decide whether the individual should be referred to an eating disorders service for a full assessment. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

5 warning signs to look out for We all want the best for our children and sometimes it can be hard to tell if they're struggling with their mental health. If they are struggling, it's important to get them the help they need, but also recognise that they may feel embarrassed or ashamed to talk about what's going on. The good news is, there are signs to look out for so you know when to seek professional advice. 1. They're not sleeping or eating If your child is not sleeping or eating, it could be a sign that they are suffering from a mental health condition. Depression in particular can cause changes to appetite causing the sufferer to gain, or lose weight. This can lead to eating disorders like anorexia nervosa. It’s estimated that around 1.25 million people in the UK have an eating disorder. Depression can contribute towards other eating disorders such as anorexia nervosa, bulimia nervosa, and orthorexia nervosa (an obsession with healthy food), with eating disorders developing as a means of coping or self-medicating mental health issues like anxiety or depression, in an attempt to gain control. 2. They're isolating themselves Isolation is a common symptom of depression and anxiety and it can be difficult to recognise. Your child may be isolating themselves in an obvious way i.e. away from you or other family members, but without telling you why. They may also lose interest in activities they used to enjoy, and not engage with others as much as they used to. This isolation will be less obvious if they’re isolating themselves from friends or activities outside of the home. 3. They're experiencing low mood If your child has a low mood or is more negative than they usually are, this can be a sign of depression. It's important to remember that sadness is a normal emotion and everyone feels sad from time to time. Depression is different from normal feelings of sadness; it's low mood for an extended period of time which interferes with daily activities such as schoolwork or socialising with friends. Symptoms of low mood include: feeling down feelings of hopelessness increased irritability 4. They're acting out, but can't explain why. If your child is acting out, it could be a sign they are struggling with their mental health. Acting out can include anything from getting into fights, to self-harm or drug misuse. The best way to tell if your child is struggling with their mental health is by asking them directly and listening carefully for red flags like "I don't know what's wrong" or "I just feel like I'm falling apart." Acting out (beyond the typical realm of typical teenage behaviour) is not normal behaviour for children and is often a symptom of something deeper going on, needing attention before they begin to struggle even more. 5. They have changed their appearance and behaviour. If your child has changed their appearance and behaviour, it could be a sign that they are struggling with mental health issues. Here are some ways to tell: They may be dressing differently than usual. They could be wearing clothing that is more or less revealing than they would normally wear. One typical sign of trying to hide an eating disorder is to wear baggy clothing. They may be acting differently than usual, for example, by being more outgoing or withdrawn than normal. They may spend more time alone and less time with friends/family as well as express a lack of interest in activities such as sports teams or clubs at school (or even online). If you notice any changes in your child's appearance or behaviour over the course of several weeks then this could indicate something bigger going on beneath the surface – many people who suffer from depression often feel isolated within themselves so won't necessarily show symptoms externally. Seek help and support If you are concerned that your child is struggling with their mental health, talk to them and seek help from a professional. Mental health issues are common and can be treated but often do require specialist help to overcome. It is important to remember to take time with your child when talking to them as they may be feeling vulnerable and may not want to talk to you. If this is the case, try to encourage them to open up to someone else they trust, such as a relative or teacher and seek help from a professional. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults with mental health conditions or eating disorders. To find out more about Place 2 Be’s Children’s Mental Health Week, visit https://www.childrensmentalhealthweek.org.uk/

In our image-obsessed culture, we spend a lot of time thinking and talking about our body image. But you may have a friend who seems to have gone one step further, becoming obsessed with food and dieting. You're concerned that your friend might have an eating disorder and are not sure what to do. This article explores how you can broach the subject and offer support for your friend. Need help? Please don't hesitate to contact us today. How do I know if my friend has an eating disorder? It's important to open an honest and judgement-free conversation with your friend. Be aware that they may deny having a problem, especially if you're concerned that they have an eating disorder or an unhealthy relationship with food. People with eating disorders typically try to hide the problem and find it hard to admit they need help. Eating disorders affect the way people feel and behave and can have a terrible effect on their health. Here are some signs which may suggest that your friend has an eating disorder: Does your friend talk about food and weight all the time? Your friend exercises more than anyone else you know, even when they are feeling tired or unwell. Your friend avoids being around when everyone else is eating, such as at lunchtime in the school or college cafeteria. They don't join in anymore if you go for a meal at the weekend. Your friend starts to wear big or baggy clothes all the time. When you eat with your friend, they cut food into tiny pieces or move food around on the plate instead of eating it. Is your friend proud of how little they eat? Does your friend go to the bathroom a lot, especially right after meals? Have you heard your friend vomiting after eating? Your friend always talks about how fat they are, even though they have lost a lot of weight and are one of the slimmest people you know. Is your friend very defensive or sensitive about their weight loss and eating habits? Does your friend take laxatives, steroids, or diet pills? Does your friend tend to faint, bruise easily, are very pale, or complain of being cold more than usual? How do I talk to my friend about eating disorders? If your friend has some or many of the symptoms listed above and you are worried, it is a good idea to talk to them about your concerns. It is a sensitive subject to discuss and your friend may feel ashamed, confused and be very secretive about her eating habits. She might be defensive or even angry when you bring up the subject. The most important thing is to tell your friend that you care about them and want to help and support them. Try not to become frustrated if they don’t listen to your advice. It is normal for people with eating disorders to take a long time to come to terms with the fact that they have a problem. How can I get help for my friend with an eating disorder? If your friend is willing to get help, offer to go with your friend to see a GP. A GP can assess your friend and refer him or her to counsellors and other health experts who can help. Your school nurse or college counsellor would also be a good start. It is very important to have the support of experts because eating disorders are very serious and rarely get better on their own. Your friend will be given the right treatment for their individual needs. This may involve seeing a counsellor, psychologist or psychiatrist to talk about their eating disorder and find a way to overcome it. People with eating disorders sometimes need to go to hospital, but others can be treated while they continue to live at home. There are also many good support groups where your friend can meet other people who have eating disorders and talk about their experiences. Friends are often welcome to attend groups and this can be a valuable way of continuing to support your friend. I’m sure my friend has an eating disorder but they are in denial Eating disorders are serious illnesses which can have very serious effects on sufferers. If you are very concerned but your friend denies they have a problem, you should talk to an adult. This may be difficult and feel like betraying a friend. But if your friend does have an eating disorder, he or she needs help from specialist health experts. Perhaps you can talk to your parents about your concerns or your friend’s parents. Your school or college counsellor is there to help with problems such as eating disorders and would be a good person to speak to. My friend has an eating disorder but I’m not sure how to support them Once your friend has been diagnosed with an eating disorder, health professionals will be responsible for helping your friend to overcome her illness. But your friendship and support are very important and will play an important part in helping him or her to beat their eating disorder. Here are some things that you can do to help: Talk about your friend’s strengths – the things that she enjoys and is good at. Try to avoid focusing on how your friend looks physically. Simple questions like “What can I do to help” and “What would make you feel better” can start positive conversations. Try not to talk about food, weight, diets, or body shape (yours, your friend’s, or even a popular celebrity’s). Try not to be too watchful of your friend’s eating habits, food amounts, and choices. Try not to say things like “If you’d just eat or stop going to the gym all the time you’ll get better.” Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

The first step is to discuss your concerns with your child. They will be experiencing many difficult emotions and may deny there is a problem, become angry with you, or withdraw. You may need to raise the subject several times before your child takes on board your concerns. Each time, emphasise that you want to offer help and support. If you need support, please don't hesitate to reach out to us at Schoen Clinic. If you have concerns, it is very important that you raise them, however difficult that may be. Eating disorders  rarely get better without treatment and if left without intervention, can become increasingly resistant to treatment. Once your child agrees to discuss their problems with a professional, your GP is the best person to see together. Your GP can refer you to a range of specialists with extensive experience of treating eating disorders. These specialists include psychiatrists, psychologists, counsellors, dieticians and nutritionists. Will my child have to go into hospital? Once your child is diagnosed as having an eating disorder, he or she will be given a treatment programme to address his or her individual needs. This may involve sessions with a psychiatrist, psychologist or counsellor to understand the cause of the problem and how the eating disorder is best treated. Your child will only be admitted to the hospital if this is in their best interests. What else can I do to help my child? You have taken the most important first step and will have the support of a range of specialist health professionals. The process of treatment can often take up to two years and raise some difficult issues for the whole family. You may be asked to take part in family therapy. This is not because you have done anything wrong as a parent. Family therapy is important because family relationships shape the way young people experience the world and need to be explored as they seek to overcome their eating disorder. As your child progresses through his or her treatment, you will be given advice on how to manage mealtimes. Mealtimes can be the most stressful experiences for the child with an eating disorder, their parents and siblings. Every child and family are different and professionals will help you to find ways of making mealtimes as calm and positive as possible. Try not to police your child’s eating or engage in battles over food consumption. Your child’s health professionals will be responsible for their overall nutrition and physical well being. There are many good support groups for both people with eating disorders and their families. Dealing with an eating disorder is an extremely stressful experience for the whole family and you are likely to need support, as well as supporting your child. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

Recovery from an eating disorder is possible. Get in touch with our specialist team today . Eating disorder recovery Recovery from an eating disorder is a long process which requires specialist, effective treatment, consistent support and time. It is important to recognise eating disorder recovery is achievable. Many people recover fully from anorexia or bulimia and feel their eating disorder is firmly part of their past. For others, some difficulties remain, but to a lesser extent than the original eating disorder. In this article, we consider the key elements of sustained, long-term eating disorder recovery. We consider some of the specific features of an anorexia recovery and bulimia recovery , together with work such as a relapse prevention plan which are essential for all forms of eating disorder recovery. We consider how long it may take to recover from an eating disorder, discussing the different stages involved and key elements of treatment. Anorexia treatment and recovery In  anorexia treatment , the first stage will focus on stabilisation and weight restoration. If an individual is severely underweight, they will not have the cognitive capacity to undertake the psychological or educational work involved in anorexia treatment. The first phase of treatment must focus upon re-feeding and weight restoration, together with early motivational work. More complex parts of treatment , such as body image work and psychological therapies, can only effectively commence when weight is restored, or close to being restored, so an individual is better able to think, process information and start to manage emotions. This second stage is where treatment can be challenging, for example work to help the individual accept their body at a normal weight and reduce body image distress. One-to-one therapy will seek to understand the different causes of an individual’s anorexia and how this understanding can be built into treatment and relapse prevention. The third stage of anorexia treatment is focused on maintaining a healthy weight and developing a relapse prevention plan. A study by Berends et al (2016)  shows that a personalised relapse prevention plan does reduce levels of relapse after anorexia treatment. With a personalised relapse prevention plan, they found that 11 per cent of the participants experienced a full relapse, 19 per cent had a partial relapse and 70 per cent did not relapse. This compares with reported general relapse rates of 35 to 41 per cent. When we consider these statistics around eating disorder recovery, it is important to keep in mind other known parameters: the sooner an eating disorder is diagnosed and effective treatment commenced, the greater the prospects of a full, sustained recovery. Eating disorder relapse rates tend to be higher in adult populations than in child and adolescent patients  (Carter et al, 2012) . Bulimia treatment and recovery Unlike anorexia, which may require inpatient treatment, bulimia is almost always treated without hospital admission, in community services.  Broadly, recovery from bulimia may occur more quickly than anorexia (programmes are typically 20 weeks, with therapy for one or two hours per week), using a Cognitive Behavioural Therapy approach. Treatment is based on building an understanding of the triggers for the binge, purge cycle and developing healthier ways of managing difficult feelings. It is perhaps surprising then, that some studies suggest similar relapse rates for bulimia as for anorexia (30 to 40 per cent, two years after treatment). However, there is ongoing debate about the definition of a relapse in bulimia. This is sometimes defined as two episodes of binge and purge within a month. Some experts argue this is too narrow and patterns would need to be repeated over three consecutive months to equate to a full relapse. The importance of a relapse prevention plan For all types of eating disorder recovery, a relapse prevention plan is essential. A relapse prevention plan will consider what are the particular risks and triggers for the individual and how might these be addressed. It will consider their personal support network and environment, for example, how to address risks if the individual is moving away to university. An effective relapse prevention plan needs to be highly personalised: for example, an individual may enjoy sports, but compulsive exercise may have become a symptom and maintaining factor in their eating disorder. Their relapse prevention plan would need to encompass how they can enjoy exercise safely and enjoyably and recognise if their exercise pattern is becoming unhealthy and compulsive again. A relapse prevention plan needs to consider what actions need to be taken if triggers are identified. This needs to recognise personal circumstances: for example, a teenager who has been treated for anorexia may avoid talking to parents about concerns because of fear they will worry they are becoming ill again; they may be tempted to hide any difficulties they are experiencing. However, it is important to plan who they will talk to and what they would do if they experience a recurrence of anorexic feelings or behaviours. Recovering from an eating disorder Studies suggest that the time of greatest relapse risk is four to 18 months after treatment. As a specialist hospital group treating children, teens and adults, at Schoen Clinic , we recognise that for our patients, once they are discharged, they enter the increased risk of relapse phase at the time when they may also be leaving home to go to university. What this means, for each individual, will vary according to their needs and risks, but in some cases, a gap year may be helpful, or certainly planning which recognises the relapse risk in this early phase after treatment. There can also be a long period between treatment and recovery, with symptoms returning at a much later stage. For example, a person who developed and recovered from bulimia during their twenties. In bulimia recovery , an individual may experience no symptoms for many years but find a stressful life event, such as the death of a partner or friend, triggers a return to the binge-purge cycle. Vigilance, therefore, is important, even at a stage when an individual may feel their eating disorder is a thing of the past. In common with the initial development of an eating disorder, anyone experiencing a relapse, or symptomatic feelings, should seek help as soon as possible so that support and treatment can be put in place. References: Carter et al, (2012) . A prospective study of predictors of relapse in anorexia nervosa: implications for relapse prevention. Psychiatry Res. 2012; 200:518–23. Berends et al (2016)   Berends et al. (2016) Rate, timing and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study BMC Psychiatry 16:316 DOI 10.1186/s12888-016-1019-y Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

Having a child with anorexia impacts the whole family. The mother of a 15-year-old who recently spent six months at Schoen Clinic for inpatient treatment shares her experience in the hopes that it will help other parents who may be going through a similar experience. If you need support for your child, get in touch with our caring team today . The route to diagnosis One of the first things you reflect on is why you, as the parent, did not pick up on problems and act sooner. We did have some concerns about our daughter’s weight, but it is very difficult to judge what this means, (especially as she had grown taller quite quickly and was eating normally at home) and whether there is a possible eating disorder. We live in a big house and it was a particularly cold winter, so my daughter was always covered up in lots of layers. It was the school nurse who first raised concerns, and this started the process of diagnosis and treatment. So the first thing I would want to express to other parents is you should not feel shame or blame yourselves for not noticing or acting earlier. In February 2011 our daughter was diagnosed with anorexia and it became apparent that her thoughts had become anorexic some four to five months before that. She started outpatient treatment in April but continued to lose weight for a further four months. The search for treatment By July, I took four weeks out from work to support our daughter who, by this stage, was too poorly to be at school. We were open to the likelihood that she may need inpatient treatment and were told that about 70 per cent of people diagnosed with anorexia do end up having a period of inpatient treatment at some stage. That helped to prepare us for the possibility and soften any sense that we hadn’t done our best for her and by trying to manage at home. We visited our local inpatient unit in the East Midlands where we live. My husband and I had a strong sense that it was not an environment where we wanted out daughter to be for six months, quoted as the average stay. It was a mixed adolescent psychiatric unit, with young people who had a wide range of different mental health problems and felt cramped and under resourced, with only one small room for family visits shared between 12 patients, and a lack of supportive therapies. While we were away on a family holiday in August it became clear that our daughter would need urgent inpatient care. I felt disappointed not to have been able to provide the support she needed at home. I am a GP and it is in my nature when I see a problem to want to be proactive and sort things out. For me, part of this experience has been finding it is not always possible to do everything yourself as a parent and accepting this without feeling guilty or inadequate. Our local consultant had previously suggested Schoen Clinic as an option for in-patient care. We looked at their very informative website and felt strongly that this was where we would like her to be treated. We made contact immediately on our return from holiday and with the help of our consultant and local healthcare commissioners, she was admitted two days later. Admission and early stages of treatment There was a sense of relief when our daughter went into inpatient care at the start of September. She was very underweight and poorly, we were stressed, frustrated and exhausted. Despite our sadness, we did feel really confident in Schoen Clinic in their role taking over responsibility for her care. The day of admission was emotional and tiring. We felt very welcomed and looked after by all the staff we met. It helped enormously that the environment at Schoen Clinic is so homely and not institutionalised. From the start, we felt there was a definite plan for our daughter. The services at Schoen Clinic are very well integrated, so she had all the appropriate support and treatments as needed. So, for example, she was not well enough to engage in individual psychotherapy for the first few months, but supportive counselling and dramatherapy were available, which helped to prepare for psychotherapy. Family therapy was established for us right from the start and that was really important to help us all (both parents and two siblings) feel supported and involved. We live 50 miles away, so we would visit twice a week. We would also frequently telephone and I never felt a nuisance, no matter how often I called, and there was great understanding and support when conversations frequently became tearful and emotional for her. The first priority was getting her out of the physical danger zone. Immediately before admission, our daughter’s BMI had fallen just below 13. I would often go into her room at midnight and check her pulse, afraid she might have a cardiac arrest during the night. Once she was in and started to gain weight, there was a huge sense of relief. But at this stage, after a month or so, behaviour becomes more difficult because their thinking has not yet changed and they are battling against increasing weight. This can be an emotionally challenging time so having the unit to share the burden of care was invaluable. What worked well? What helped? Family therapy was enormously helpful. We didn’t feel we were being criticised for our foibles as a family being unpicked. It was about supporting the treatment and finding different strategies to apply with our daughter at home. It was good to be able to reflect on experiences and things that had been said, but also good to have very practical advice, mainly through the programme for parents which runs in addition to family therapy. We were also very grateful that family therapy encompassed our other children too and gave them an opportunity to talk and reflect. Our daughter engaged brilliantly with the drama therapist and psychotherapist. Our experience is that Schoen Clinic has staff of the highest calibre. During the whole six months of inpatient treatment, there was not one member of staff who we didn’t get on with. Everybody has their own personalities and it is inevitable that we all had our favourites. But with every member of staff, there was a consistency of fairness, respect, kindness and sympathy. We were also very pleased with and grateful to the school on site. Like many young people who develop anorexia, our daughter needed inpatient treatment at a key time in her education, in her case during the GCSE year. The liaison with our daughter’s own school was very good. School education gave our daughter an alternative focus to anorexia and something she could feel in control of. Home leave during treatment When we first considered the prospect of inpatient treatment, I found the idea of our child going away for six months very difficult. It seems such an enormous chunk out of their life and your family life. I had been due to take our daughter out to the cinema for the first time off the unit at the end of September. The weather was wonderful and warm, so I asked instead to take my daughter home for a few hours where we could sit in the garden together. She was still pretty poorly but I was so grateful for that opportunity. There was always an enormous amount of consideration and flexibility when it came to home leave, providing it was medically advisable. There was no sense that there was a prescriptive single approach. By the start of October, our daughter would come home every Friday and Saturday night. By December, we felt we had reached another turning point, with our daughter showing some normal social behaviour, such as being able to go out for a meal and having friends over for sleepovers. She was at home for four nights each over Christmas and New Year and by mid January, was able to come home and go to her local school on Thursdays and Fridays, stay with us over the weekend, then return to Schoen Clinic from Sunday to Wednesday. That helped enormously in terms of our daughter integrating back after inpatient treatment, rather than it being a sudden shock at the end of a long period away. Beyond Schoen Clinic Our daughter left Schoen Clinic at the end of February. We felt very strongly that we wanted our daughter to continue her outpatient care there because she had such strong, established relationships with the therapist and we were not sure whether there would be the same degree of consistency locally. We feel very fortunate to have ongoing outpatient sessions with the psychotherapist and nurse consultant commissioned through the NHS. A couple of months after our daughter returned home, we reached another turning point. Normal life now outweighs anorexia and several days can go by without a thought about the illness coming into my mind or being discussed. If someone had told me last year this is where we would be in little more than 12 months, I would have found it very hard to believe. Overall reflections If you look at the statistics for anorexia, the mortality rates are frightening. The percentages reported of people who achieve full recovery leave you feeling pessimistic. After our experience, my husband and I feel the model of care at Schoen Clinic gives you and your child the best chance of over-riding those statistics. I would say to other parents that a supportive GP or healthcare professional is invaluable. Your GP may not be an expert on anorexia but you need someone who will listen to you, support you and arrange for the help you need. You may need to be very pushy before you find the support you need especially as good eating disorder services may not available on your doorstep. Also make sure that you access support for yourself wherever you can – anorexia in the family is extremely demanding and stressful, and keeping yourself well is imperative for your child’s recovery. There is no quick fix for anorexia – its treatment will take time and although there are some things you can do, there is much that you cannot do alone, and the most important thing is getting the right specialist care in place for your child. * Names have been changed in order to protect parent and child’s identities. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

Having a child with anorexia impacts the whole family. The mother of a 12-year-old who spent three months at Schoen Clinic for inpatient treatment shares her experience in the hopes that it will help other parents who may be going through a similar experience. If you need support for your child, get in touch with our caring team today at che-privateenquiries@schoen-clinic.co.uk The route to diagnosis It was about June when I noticed my daughter had lost weight. It was difficult to judge what to say and how to intervene because she has always been sporty and a healthy eater, with a tendency towards being a little anxious and obsessive. I remember my mother, who hadn’t seen her for a few months, was shocked by the weight loss, whereas for the parent, it is more gradual as you see your child every day. We were already in contact with my daughter’s school because she was struggling to settle into secondary school . I had a chat with the school nurse and she described her as being “fragile and delicate”. But there wasn’t really any guidance about what to do next. We went to see the GP, who simply told her to put on weight. The GP was talking about eating full-fat everything and I remember seeing the terrified look on my daughter’s face and realising how far things had gone. She promised to try and I believed we could manage as a family, but she went downhill very rapidly after that. At the end of August, our daughter was admitted to our local general hospital. I thought she would be coming home that day, but she ended up spending two weeks there. They were very concerned about her heart rate and her low blood pressure and she was also feeling constantly cold. The search for treatment She was in the general hospital for two weeks, which was an incredibly difficult, emotional time, I must have spent the whole time in tears. The staff didn’t know how to work with someone who had anorexia and I had to be with her 24/7 as I was the only one able to help her to eat. We were offered a bed in a NHS unit where young people with anorexia are treated alongside young people with many other psychiatric problems. I felt very strongly that I wanted her to be treated at a specialist eating disorder centre and we live close to Schoen Clinic. At first, we were told she couldn’t come to Schoen Clinic because another NHS bed had been offered to us. But I then spoke to another person in the commissioning team who agreed an assessment could be carried out. The Nurse Consultant came out on the August Bank Holiday to do the assessment and two days later, it was confirmed that she could come to Schoen Clinic. It was the best thing I have ever done in my life. I was very pushy – and sadly I think parents often have to be pushy. But my daughter was only 12, still very much a child, and your instinct is very strong about where you want them to be. Admission and early stages of treatment The other girls being treated had made my daughter cards to welcome her. She would go on to have such supportive, understanding friendships with the girls at Schoen Clinic, who were going through the same thing. Of course, the early days and first couple of weeks are difficult and there are a lot of tears. Living nearby, I visited every day and also phoned a lot, but was never made to feel like I was being a nuisance. What worked well? What helped? My daughter accepted meals and snacks from day one. She has a cooperative personality and gelled with the staff very well from the start. From finding her school quite threatening and difficult, Schoen Clinic became a comfort zone for her, with other young people who understood her and the warmth and care of all the staff. She engaged well in her sessions with the psychologist – she has a logical, scientific mind and so she valued the sessions and found them interesting. For me, the programme for parents was brilliant. The practical tips were very important, such as how to manage supporting your child with the eating disorder along with the needs of the other sibling and work. I also found it helpful the way that staff helped and supported the whole family. I became very focused on supporting my daughter, while members of the wider family found it hard to understand and wondered “Why doesn’t she just eat.” On one occasion, when my father came to visit and my daughter didn’t want to see him, the staff were incredibly supportive and enabled him to better understand what was happening from her perspective. Home leave during treatment By about the six-week stage, my daughter started to have some leave for short trips out and by two months, she was able to come home for an overnight stay. Although she was the youngest girl in the hospital at the time, she became a role model for others because she was so cooperative and was getting on really well with her treatment. It was wonderful to see how her confidence grew through her friendships at Schoen Clinic because she had found it hard to settle in secondary school. Leaving Schoen Clinic My daughter spent three months at Schoen Clinic and came home in early December. We were all very excited knowing she would be home for Christmas but the day she left was very emotional because she had built up such great friendships. Schoen Clinic had been a much-needed comfort zone and now she was moving back into the ‘real world’. Overall reflections We were very, very fortunate and having pushed for treatment at Schoen Clinic, my daughter has made a strong recovery within six months of starting treatment, having spent three months within inpatient care. I am so grateful for the treatment she received and also for the fact that because the treatment was so effective, she only needed to be an inpatient for three months, as I know it can be much longer. I would say recovery is a different process for the child and the parent. I am still very watchful. My daughter’s weight is checked every week and she is very accepting of that. It is important for me, because if I find myself worrying that perhaps she isn’t eating at school, I know I have the fact that her weight is remaining stable. I know that my daughter’s personality means she is prone to anxiety and stress and that will always be the case. But I feel that her treatment at Schoen Clinic has given her new skills and a level of maturity to cope with the things that she finds threatening and has equipped her for what lies ahead in life. * Names have been changed in order to protect parent and child’s identities. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

The issue of exercise can cause a lot of worry and uncertainty when an individual is recovering from an eating disorder. Overexercising is often a feature of anorexia, carried out compulsively as a tool in weight loss and maintenance of the disorder. Get in touch with our team today. Eating disorder inpatient hospitals provide an environment where exercise is very precisely managed. Zero exercise will be allowed at low weight and further into treatment when exercise is slowly introduced, it will be gentle and carefully managed activity. At Schoen Clinic, young people join Leisure Group, which enables them to gradually begin yoga, before moving on to other physical activities (undertaken in conjunction with body image work). How should reintroduction to exercise be managed? Once a young person leaves inpatient care and returns home, it isn’t possible to control exercise in the same way. “This is something parents are very concerned about as they prepare for discharge,” explains Gill Williams, Newbridge nurse who runs the Programme for Parents. “We advise it is much better for young people to take up organised activities and team sports because these are structured activities within specific time frames and there are social benefits in being part of a team or group.” The structure nature of team practices and organised activities makes it more feasible to plan and agree on additional snacks to compensate for the energy used and to ensure the exercise is contained within clear limits. “We would be much more concerned about a young person in recovery going running alone,” explains Gill. “There is the risk of runs getting longer and more frequent and no benefits of socialising with others.” If a young person prefers going to the gym to team sports, see if you can join them at the gym so their exercise is not a lone activity without time limits. Exercise after discharge from eating disorder treatment Normally, it is the compulsive approach to exercise which may still need to be considered after discharge. “Think about the motivation an individual has for exercising,” explains Sue Taylor, HCA, who also works on the Programme for Parents at Schoen Clinic. “Your daughter or son might say – ‘It makes me feel better’. This is exactly the role of sports and exercise for many, many people. But if the individual feels bad and guilty and bad if they don’t exercise, that is an indication they still have a problematic relationship with exercise.” All sports and activities are not the same in terms of risk for individuals in recovery from an eating disorder. Endurance sports such as long-distance running and triathlons present a raised risk because of the very high levels of energy and dedication they demand (and how this can be expressed in a person predisposed to eating disorders). Aesthetic sports such as dancing and ice skating are at higher risk for young people in recovery because of their potential to maintain body image anxiety. But it is widely agreed that even though exercise presents challenges for the recovering anorexic, it isn’t possible or advisable for individuals to permanently avoid exercise. “Often, sport and exercise is a big part of young people’s lives before they became ill,” explains Sue. “Sport and exercise became a tool of anorexia while they were ill, but in recovery, young people are often very keen to enjoy exercising again.” Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

About a quarter of people with anorexia or associated eating disorders deliberately harm themselves. Please don't hesitate to contact our team for support. The most common way of self-harming is cutting with a sharp object. People may also burn themselves, pull out their hair and take dangerous amounts of medication, drugs or alcohol. Why do people with eating disorders self-harm? Self-harm is a way of dealing with difficult and painful feelings which build up inside. Eating disorders use food to express emotions which they are unable to cope with. Self-harm can be another form of dangerous behaviour expressing inner pain and unhappiness. Some people who self-harm say they feel anger or tension bottled up inside which is released when they hurt themselves. Many people who self-harm have feelings of guilt or shame which they find hard to bear. Self-harm is a way of punishing themselves. People with eating disorders take comfort in rituals, even though these rituals hurt their physical wellbeing, because they provide a sense of control. Self-harm can be another ritual, along with other dangerous behaviours such as laxative abuse , over-exercising , vomiting and food denial. The effects of self-harm There are physical dangers of self-harm. Many people are taken to hospitals each year for emergency treatment because of deliberate self-harm. There can be permanent damage to the skin and internal organs. There is also the impact on mental health. Self-harm is carried out in secret, isolating the sufferer. They are likely to be involved in other eating disorder behaviours which also isolate them from family and friends. This can lead to deeper depression , fueling the patterns of self-harm and dangerous behaviour towards food. The sufferer is unable to deal with stress or painful feelings in any other way. Getting help for self-harm Self-harm of any type is a dangerous form of behaviour which will be taken seriously by health professionals . Understanding of self-harm has improved greatly in recent years and a GP, school nurse, teacher or other adults responsible for young people will be able to refer sufferers to professional help. Effective treatment involves understanding the feelings which make the sufferer want to self-harm and find other ways of coping with those feelings. A person with an eating disorder who also self-harms needs to have an integrated programme of treatment which addresses the cause of all of their dangerous behaviours. If you, a friend or family member are affected, it is best to discuss needs and appropriate treatment with a GP. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

This video has been developed with the ideal audience range of 10 to 16 in mind. This is a very wide age range; we believe the film is suitable for this age range, but follow-up discussions and work would need to be age-adjusted. We suggest that for younger age groups, the focus could be on body image and feelings about body image, together with the second section on eating and lifestyle. Older groups could have a discussion more specifically on eating disorders. However, we have developed a broad set of resources to enable teachers to judge what would suit their pupils best. Video: "Someone Said I was Fat" The video starts with the young people talking about feeling ‘fat’ or being called ‘fat’ Aim of this session:  to help younger groups discuss what is body image and what influences how we feel about our body image. We know that children and young people are increasingly conscious of their bodies and how they compare with others. In the past, girls were more likely to be critical of their own bodies than boys. Now, studies show that boys are becoming more like girls in that they too are likely to be critical of their own bodies. Suggested practical exercises Pupils to write down whether they feel happy with their body shape. Answers anonymously in a box. Options: yes, no, don’t know. Show answers on a chart on the board and discuss the results. Could also ask them to write down their gender and see whether any differences between boys and girls. Show pupils photos of celebrities with different body shapes. Whose body shape do they think looks best and why? Follow-up discussion: do they think that celebrities, sportspeople, magazines and media have an influence over how they think of body image and their own body image? What is healthy eating? Aim of this session:  children and young people can get confused with ‘healthy eating’ messages, seeing others on diets and the role of exercise. They will quickly recognise that over-eating and eating too much of certain foods is harmful. But they may not recognise that eating too little can also be harmful. This material is more focused on developing awareness of what eating disorders are and how to get help. This could be more relevant to the older age groups with the overall age range. Activity:  describe the following three characters, their typical food patterns and lifestyle. Ask pupils to discuss who is ‘healthy’, leading to discussions about what is ‘healthy’. Zoe  is 11 years old. She has always eaten a wider range of fruit and vegetables than her friends and is proud of this; it makes her feel healthy. Zoe has an older sister who has gone on a diet. The older sister told her crisps and chocolate are ‘junk’. So Zoe has stopped eating those too and always gives them away to friends. She often doesn’t finish her sandwiches because she doesn’t feel hungry enough. But she always eats loads of fruit and vegetables. Sophie  is 12. As a child, Sophie was always very slim and used to wear clothes that were labelled a year or two younger than her actual age. But as she started secondary school, she noticed she needed clothes at least her actual age and sometimes these were a little tight around her waist. She wonders whether she is getting fat, although her Mum says she isn’t. She always has a chocolate bar as a treat on a Friday and pizza with her family on a Saturday night. Robert  is 12. He has always loved playing football. His football team have recently started training twice a week as well as matches on a Sunday. Some of the team also go for runs together. Robert worries that he isn’t as fast as the others and never misses a training or running session. He lives two miles away from his secondary school. His friends often get the bus, but he always walks or cycles there. He is so busy with different sport clubs and football training, that sometimes he misses lunch, but if he is asks, he says he has eaten. Discussion Zoe:  she is not eating enough. Eating a diet based on fruit and vegetables is not healthy – you need to have a good, balanced mixture of food to give you enough energy for school and all activities during the day. Her sister’s diet may be affecting her – it sounds like her feelings are changing the way she feels about food and influencing her appetite. Sophie:  she is perfectly healthy. It is normal for girls at this age to change shape and this can involve carrying a bit more weight, especially in the tummy and hip areas. Pizza and chocolate are not ‘bad’ food. No food is bad – it is only bad if you eat far too much of it and don’t have a mixed, balanced diet. Having pizza with your family or chocolate at the end of the week are lovely treats – enjoy them! Robert:  like many sporty young people as they reach secondary school, Robert’s activity levels have gone up. He ought to be eating more, because he needs more food to fuel him through all this activity. But he is actually eating less and doing more. Two things are signs that he could be at risk of an eating problem – he is feeling worried about keeping up with others in his football team and he has started to lie about having eaten. What is an eating disorder? Food plays a big part in our lives and sometimes and the way we eat can be affected by our feelings. For example, we might eat chocolate to cheer ourselves up after a bad day at school, or not feel like eating because we feel nervous about an exam. This is normal. But having an eating disorder means you have difficult feelings and emotions that completely dominate the way you eat in a harmful and dangerous way. This can happen in different ways with different types of eating disorders: Anorexia: This is when someone restricts what they eat to lose weight. It often starts with a diet but having anorexia means someone cannot stop trying to lose weight. They want to lose more and more weight and to do this, they eat less and less. They might hide what they are doing, by wearing baggy clothes and going to clubs rather than the diner hall. Even though they are losing weight and becoming very thin, they think they are ‘fat’. Bulimia: This is when someone is caught in a cycle of trying to lose weight, then having a binge, which means eating a large amount of food in one go then feeling guilty about it and trying to make up for it by doing a lot of exercise or making yourself sick. People with bulimia often feel very ashamed of it and keep it a secret. Because of the cycle of binging then trying to make up for the extra food, they are often a normal weight, but having bulimia can cause many serious health problems. How you do know if you have an eating disorder? It can be hard to know when you have an eating disorder. Many people try to lose a bit of weight at some point. But these are some warning signs that you may be in danger of having an eating disorder: Do you think about food all the time? Know exactly what you have eaten and how many calories? Does it feel like it is dominating your life? Do you feel like you are fat but other people say you are thin? Do you ever lie about what you have eaten? Have you lost more than a stone in the last three months? How can I get help or help a friend with an eating disorder? If you think you might have an eating disorder, it's really important that you speak to someone as soon as possible. Of course, this won’t be an easy conversation, but the longer you live with an eating disorder, the harder it is to treat. Try speaking to your parents. They may have noticed something is wrong and are worried about you, but aren’t sure what the problem is or what to say. One young person who was treated at Newbridge House explained it like this: “Mum – I wanted to lose weight, so I went on a diet and I did lose weight. Now I can’t stop.” There are also professionals who can help you. You could speak to your school nurse, a teacher or your GP. All these people can give you advice and make contact with specialist services to treat eating disorders. If you think your friend might have an eating disorder, you may feel that you want to help them, but you feel talking to an adult might be breaking trust and making them angry. It is very difficult, but they must get help if they have an eating disorder. One young person in our film describes how her friends knew something was wrong when she lost a lot of weight. Her friends didn’t know what to say to her, but they did speak to the school nurse. She says she is so grateful that her friends did this because that is how she got help and became better. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

Eating disorders commonly develop from the age of 14. This is a time when young people are becoming more independent and parents often have less control over the food they eat. It can also be a time when your relationship with your child goes through many changes, often resulting in difficult conflicts. Equally, your child may become more distant from you. If you need support please don't hesitate to reach out to our caring team today. It can be difficult to know whether changes in your child’s behaviour are the result of normal teenage development, or whether they are signs of an eating disorder. “My son has lost over a stone and become very distant and moody. But my friend says he is just a normal teenage boy.” What is an eating disorder? An eating disorder is not primarily about food and weight. Eating disorders develop when a person becomes dependent upon food to cope with difficult feelings and emotions. “I felt I had lost all control in my life. My friends had moved on and I wasn’t doing well at school. Losing weight was the one thing I could do – food became the one thing I could control.” There are a number of recognised eating disorders, but two of the most well-known are anorexia nervosa and bulimia nervosa: Anorexia involves severely restricting what you eat in order to lose weight. Sufferers lose a large amount of weight but believe themselves to be fat and have a great fear of putting on weight. The intensity of this fear is profound and usually described as a phobia of normal body weight ie an irrational fear, not of being fat, but of being a normal weight. People with anorexia can either be restrictive – they restrict their calorie intake and engage in excessive exercise or bulimic, eating a large amount of food at once then inducing vomiting. Bulimia involves eating large amounts of food, then making yourself sick so your body does not absorb the food. Bulimia involves binge eating but at normal body weight. It occurs at an average age of 18. All eating disorders are likely to change the way you live your life. Your child is likely to become more withdrawn, secretive and have sudden mood swings. What are the signs that my child has an eating disorder? Eating disorders are complex problems which are expressed in behaviour, emotions and have a physical impact upon the sufferer’s body. Signs will vary for each type of disorder and every individual is different. However, if your child displays a large proportion of the physical, behavioural and psychological signs, he or she may have an eating disorder. Anorexia Physical signs Behavioural signs Psychological sign Sudden/severe weight loss Secretive and distant Intense fear of gaining weight ie a phobia of being a normal weight Periods stop Wearing baggy clothes Frequent references to “being fat” Difficulty sleeping Over-exercising Depression Dizziness Lying about eating meals Mood swings and emotional Stomach pain Difficulty concentrating Diet obsession Feeling cold Constipation Bulimia Physical signs Behavioural signs Psychological signs Sore throat Eating large quantities without gaining weight Depression, anxiety and anger Stomach pain Vomiting after eating/going to the toilet immediately after eating Guilt Irregular periods Being secretive Mood swings Difficulty sleeping Feelings of loss of control which extend to other parts of life Mouth infections Sensitive or damaged teeth What should I do if I think my child has an eating disorder? It's important to open an honest and judgment-free conversation. Be aware that your child may deny having a problem if you're concerned that they have an eating disorder or an unhealthy relationship with food. People with eating disorders typically try to hide it and find it hard to admit they need help. Speak with your GP and write down your main worries before the visit. The GP will conduct an evaluation, and if they determine that your child requires specialised care, they'll be able to give you a referral to a specialist , like those at Schoen Clinic. Depending on the type of eating disorder and the symptoms, there are numerous treatment options. Treatment options may involve family and individual counselling as well as food modification to address underlying emotional issues. The young person may need to spend some time in a hospital or a special facility where therapy may be more carefully monitored if they have lost a significant amount of weight or if other help seems to be failing them. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London offer highly specialised treatments for children, teens and adults.