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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 Sick because you feel uncomfortably full? Do you worry you have lost Control over how much you eat? Have you recently lost more than One stone in a three month period? Do you believe yourself to be Fat when others say you are too thin? Would you say that Food 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 Newbridge 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, Birmingham and York offer highly specialised treatments for children, teens and adults.

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, Birmingham and York offer highly specialised treatments for children, teens and adults.

There is an emerging understanding of a developmental disorder called Pathological Demand Avoidance (PDA) which can lead to serious eating difficulties, together with many other social, educational and relational problems. If you need support, please feel free to contact our team. A key feature of PDA is overwhelming resistance to the ordinary demands and activities of daily life. Activities such as getting dressed, leaving the house and eating meals are met with complete opposition; regular parenting strategies will not help. The child is likely to seem controlling, dominant and impossible to persuade. In resistance to a demand, they may become suddenly aggressive or go into a form of lockdown. If the avoidance of food becomes a core feature of a child or young person’s PDA, the restriction can become severe and very harmful to physical and mental health. Restrictive symptoms towards food in PDA may appear to have some similarities with anorexia nervosa, but if pathological demand avoidance is the primary profile, this needs to be identified and incorporated into care and treatment. Unlike anorexia, poor body image is not a precipitating or maintaining feature of PDA. Is PDA a type of autism? PDA is now recognised as being a sub-type of Autistic Spectrum Disorder (ASD). However, there are some significant differences: a child or young person with PDA may seem to have social and communication skills which are within normal parameters. There may be little or no appearance of ‘autistic traits’ and as such, PDA may persist as a hidden disorder, with parents feeling they are failing and ineffective, while the child’s behaviour becomes increasingly entrenched and controlling. In PDA, it is anxiety that drives the expression of inflexible, oppositional behaviour: unable to process and adapt to their environment, the individual expresses a rigid, overwhelming expression of control. Negotiation techniques, using concepts of rewards and best interests, will be ineffective. What works for people with PDA? At Schoen Clinic, we are experienced in working with young people who have a PDA profile and equally, in undertaking clarifications of the diagnosis for an individual. To test for a PDA profile, the same assessment will be undertaken as for ASD, evaluated by a multi-disciplinary team. If a person has a PDA profile, it is important to recognise the relationship between the disorder and anxiety. For parents, this means reframing the perspective: they are not acting primarily in opposition to you, they are struggling to adapt to their environment and expressing this as a need for absolute control. Supporting a child to feel less anxious will enable them to gradually take a more flexible approach to situations. For professional services (health and education), a person with PDA may not respond well to routine and rules but may be more accepting if relationships improve and their anxiety is reduced. Care, treatment and support need to consider the PDA profile and how it frames a person’s experience of their world. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

About Avoidant Restrictive Food Intake Disorder (ARFID) ARFID is a relatively new term, which stands for avoidant restrictive food intake disorder, now officially recognised and described in diagnostic criteria. It involves the avoidance of a large number of foods to the extent that there is nutritional deficiency and health impairment. There is an intense fear of many foods and this usually results in social disturbances, such as being unable to join friends for school dinners or meals out. The symptoms of avoidant restrictive food intake disorder, can seem very similar to a better-known eating disorder, anorexia; notably low body weight, weight loss and emotional disturbance. However, there is a critical difference: unlike anorexia, the driver of the disorder is not anxiety about body weight, shape and image. The three main causes of ARFID are low interest, sensory difficulties, and fear/trauma. These are explored in the next section. The positive news is that now avoidant restrictive food intake disorder is firmly established as a diagnosis (included in the 5th edition of the American Psychiatric Association’s classification of disorders, called DSM-5 or DSM-V), it is increasingly better recognised and understood. With this improved awareness and diagnosis, those affected are more likely to benefit from targeted and effective therapy and support. Common causes of ARFID The first causal category in ARFID is very low interest/poor responsiveness to food. This can be something which is evident from a very young age (some specialists will give a diagnosis from the age of two, others younger). The second cause is sensory-based food avoidance, which might refer to a strong aversion to particular colours and textures of food or being unable to eat properly because of wider sensory disturbance (noise, light, difficulty sitting). There is a close correlation between ARFID and other disorders such as autistic spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Some studies suggest that a majority of people with ARFID have other sensory or neurological disorders. Difficulties with eating may be the first symptoms to appear or may emerge after other issues have been identified. The third main cause is extreme fear/trauma, for example, an intense belief that eating will cause choking, vomiting or abdominal pain. Although difficulties usually become apparent in childhood, specialists emphasise it is not a disorder exclusively of childhood and that adults can be affected too. Boys are slightly more at risk than girls, probably due to its correlation to disorders like ASD and ADHD, which more often affect boys. What are the warning signs or ARFID? In truth, the majority of parents might describe their children as fussy or picky eaters at some stage and this may cause real concern for them. But can we differentiate between normal patterns of choosy eating (which are usually temporary and do not impair health) and a defined eating disorder? There are two markers which help distinguish someone who is simply a fussy eater from an individual with a serious eating disorder: The individual fails to eat an adequate diet which leads to a nutritional deficiency. There is a clear impairment to their health, well-being and development. Fussy eating is very difficult for parents to deal with and many children eat a much narrower range of foods than their parents would like. But the threshold for having a nutritional deficiency and a resulting impairment to health is high: patients seen in ARFID clinics might only eat five foods or less, together with rigid brand requirements (only a certain type of chocolate spread, for example). In terms of the warning signs, it is important to consider social disturbance as a key symptom: is a child withdrawing socially, because of fear of meals at friend’s houses, at school and therefore avoiding social interaction and normal, enjoyable activities? How is ARFID diagnosed? These are the criteria set out in the DSM-5/DSM-V: Significant weight loss (or failure to gain weight or faltering growth in children); Significant nutritional deficiency; Dependence on oral nutritional supplements; Interference with psychosocial functioning (fear of food leading to social withdrawal and isolation). It is important to gain a really full picture of the patient, considering their development and feeding history, for example, if they have always eaten poorly, any sensory difficulties they may have, family context (consider dieting and cultural practices like fasting), their temperament and social functioning. Consider whether there are any other reasons for their avoidance of food. Are there any body image issues? Are there any medical conditions or medication which might affect their eating? Although some individuals may have very low body weight, like those with anorexia, it is also possible for affected individuals to be a normal weight or overweight. What treatment is there for ARFID? It is really important to properly diagnose ARFID and then to provide treatment and support that is specific to the condition. Because of the way child and adolescent eating disorders services have developed (particularly inpatient hospitals), many young people with avoidant disorders have ended up in hospitals originally designed for the treatment of anorexia. However, treating someone with ARFID as if they have anorexia is likely to make their condition worse and certainly not better. Another challenge in terms of designing therapy and support is that because this is a recently classified eating disorder, there is a lack of evidence base for treatment. Certainly, there are plenty of ‘tools’ which can be used: behavioural approaches such as food exposure and de-sensitisation, parent and family work, cognitive behavioural therapy, nutritional and medical interventions and approaches to support patients by addressing sensory difficulties. However, specialists in this field emphasise: defining the aims of treatment and targeting your interventions. Realistically, a person with an avoidant disorder who had a limited diet since infancy is not going to progress to a very broad and adventurous diet. The aim might be to achieve a nutritionally sufficient diet (sometimes including a supplement) and some alleviation of the social disturbance caused by the disorder. If you or someone you know needs help with an eating disorder like avoidant restrictive food intake disorder, please get in touch with our caring team today. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

Mirror exposure therapy is an approach recognised as being effective in reducing body image distress. It can be used as part of a treatment programme for people with eating disorders who experience high levels of body dissatisfaction. This might be expressed in very frequent body checking in the mirror, or mirror avoidance, due to the high levels of anxiety caused when the individual sees their own image. Mirror exposure works on the same principle as other forms of exposure therapy: when something provokes overwhelming anxiety, rather than avoiding it, if you are exposed to it in a supported way, you become better able to manage your emotions and over time, anxiety will decrease. Feel free to contact our team if you need support. What do we mean by body image? To understand how mirror exposure therapy works, we need to explore the concept of body image, which is more complex than it might seem. There are three components of body image: cognitive, which means your perceptions of your body, for example, a person may look in the mirror and see their own image as being much larger than it really is. The affective component means the emotional experience in relation to their body image, for example, a person may experience an overwhelming amount of distress in response to seeing their image in a mirror. The behavioural component describes actions in response to body image, for example, checking a particular body part repeatedly in the mirror to the extent that it becomes a dominating behaviour, or avoiding mirrors to an extreme extent (which perhaps means an individual is unable to go clothes shopping). Why mirror exposure therapy for body image problems? There are a range of interventions to help address the thoughts, behaviours and feelings around poor body image, using a cognitive behavioural therapy (CBT) based approach. It is recognised, however, that body image programmes which include mirror exposure therapy are more effective than those which do not (Morgan et al., 2014). This is sometimes described as practical body image, with the practical element of the programme being the mirror exposure. It seems that mirror exposure is very important in helping the individual to tolerate and accept their body at a healthy weight. How does mirror exposure therapy work? At Schoen Clinic Newbridge, we developed the first Practical Body Image Programme for adolescents which has been tested and refined through clinical trials. Mirror exposure is one module of our Practical Body Image programme which is undertaken at the final stage of weight restoration. Young people must be more than 90 per cent of a healthy weight because the programme is about accepting your body when you are at a healthy weight (not normalising being underweight). During mirror exposure therapy, the individual stands in front of a mirror for 30 minutes, wearing tightly fitted clothes. They need to look at the whole body (not ignoring difficult parts or only focusing on one area). Every five minutes, the practitioner will ask the individual to rate the anxiety they are feeling on a scale of 0 to 10. After 30 minutes have passed, the individual is asked to draw a line on a graph showing their anxiety levels. The idea is to support reflection on what increases or decreases anxiety and for the overall experience of exposure to reduce anxiety in the longer term. This is repeated for a further five sessions, occurring twice weekly. Does mirror exposure therapy ever make things worse? Mirror exposure therapy can be very challenging and it is possible that during the programme, a participant may feel worse before they feel better. Practical body image programmes ask participants to expose themselves to things they find very difficult and scary, but in a supported way to reduce anxiety overall in the long term. There needs to be careful supervision to monitor anxiety levels and possible weight changes. Mirror exposure and body acceptance We recognise that some degree of body dissatisfaction is normal and widespread within the general population. Mirror exposure within the Practical Body Image programme is about promoting tolerance and acceptance of the body at a healthy weight which will significantly support the individual in the process of achieving and sustaining recovery from an eating disorder. References Morgan, J. F., et al (2014) Ten session body image therapy: efficacy of a manualised body image therapy, European Eating Disorders Review, 22(1), 66-71. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

Diabulimia is a term which has come into recent usage to describe people who are suffering from Type 1 diabetes and a related eating disorder. Specifically, it means people with Type 1 diabetes who omit or reduce their intake of insulin to lose weight. This makes diabulimia extremely dangerous: if people with Type 1 diabetes fail to take the correct amount of insulin, they place themselves at risk of many serious complications which can include eye problems (including risk of blindness), kidney problems, nerve damage and even amputations. If you're worried and need support, please don't hesitate to contact our team today. Diabulimia treatment is challenging because of the way it requires multi-disciplinary expertise across medical services which do not ordinarily need to come together. Diabetes professionals may not recognise that a patient’s persistently poor diabetes control reflects hidden diabulimia symptoms. Equally, even if they suspect this could be the case, professionals may feel they lack the expertise and confidence to speak to a patient about their concerns or to raise mental health issues. Warning signs and symptoms Identifying diabulimia warning signs as soon as possible is very important, although this can be difficult because poor diabetes management may be caused by a number of different factors, especially in adolescents and young people. Some reports suggest up to 40 per cent of young women with Type 1 diabetes restrict their insulin with the intent of weight loss. It is also recognised that diabetes control among adolescents and young adults can be poor for other reasons (moving away from parental control to managing themselves; moving away from home and leading less structured lifestyles). The following symptoms, both physical and psychological, could be considered as potential diabulimia warning signs: Severe fluctuations in weight Repeated incidences of hyperglycemia (high blood sugar level) leading to hospitalisation Elevated HbA1c (a blood test which reflects diabetic control) Missing meals or avoiding eating with others Secrecy about diabetes management/avoidance of diabetes appointments A fear insulin ‘makes you fat’ Frequent yeast or urinary infections Drinking abnormally high amounts of fluids Irregular periods or no periods at all Deteriorating or blurry vision Dry hair, skin and dehydration Loss of appetite Preoccupation and anxiety around body image Avoidance of carbohydrates in order to lower insulin doses Health consequences Diabulimia health consequences are serious and multiple, affecting both physical and mental health. The consequences listed below can be caused by diabulimia, although they may also be a result of poor diabetes control due to other factors. Short-term consequences The short-term consequences of diabulimia can include: Fatigue Dehydration Poor immunity, leading to repeated infections Ketoacidosis, a dangerous medical condition in which there are high levels of glucose and the blood. Diabetic ketoacidosis (DKA) often requires admission to the hospital and can be life-threatening. Long-term consequences The long-term consequences of diabulimia can include: Irreversible damage to eyesight (retinopathy) Nerve damage leading to pain, tingling or numbness of the limbs (neuropathy) Damage to the kidneys (nephropathy) Treatment and support Once identified, diabulimia treatment requires a multi-disciplinary approach, addressing the emotional and psychological difficulties the individual is experiencing. Diabulimia cannot be effectively treated within the scope of diabetes management alone. Diabulimia treatment is dependent upon the underlying emotional issues being identified and addressed at the same time as measures to improve diabetes control. Treatment and support must incorporate acknowledgement that diabetes necessitates a greater focus on specific food intake than is ordinarily necessary and this can quickly become tangled with weight and body image issues. Skilled diabetes management and eating disorders expertise are required for effective treatment and full diabulimia recovery, avoiding harmful and potentially dangerous short and long-term health effects. It is important to recognise that people with Type 2 diabetes also experience eating disorders which are serious and debilitating but with a different presentation to diabulimia. Typically, people with Type 2 diabetes are affected by binge eating disorder (with the resulting problem of poor diabetes control and obesity). Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

It's recognised that there is wide variation in eating disorder services, both in terms of who is treated and the treatment itself. In many cases, services have developed their own models using different approaches and although they may originally have been a clear rationale for doing things in a particular way, it is hard to compare and measure what works best and what may not be working. From a patient and parent's point of view, it is difficult to know what the standards for eating disorder treatment might be and therefore to know what to expect and what a good service looks like. Recognising these issues, NICE (National Institute for Health and Care Excellence) has developed new quality standards that will apply to all assessments and services for children, young people and adults with an eating disorder. The NICE guidelines are not yet finalised; they are currently being considered by all eating disorders services in a consultation, which will be completed in April (2018). From a Schoen Clinic perspective, they are very welcome: providing a clear, single framework for standards of eating disorders treatment. Critically, for people seeking help for eating disorders, the quality standards provide a set of measures to expect: assessment and treatment at the earliest opportunity, and a discussion about their options in terms of psychological treatments for eating disorders. We particularly welcome the recognition that if people have early intervention, their chances of making a full and lasting recovery are greatest. We also welcome the way the NICE guidelines focus on the fact that one individual may have support from more than one eating disorders services; for example, our patients move from community to inpatient then back to community services and often, depending on age, from child and adolescent services to adult. The standards recognise these transitions are a challenge which needs to be carefully planned and managed. What are the NICE eating disorders quality standards? The NICE quality standard is comprised of these six statements: Statement 1: People with suspected eating disorders referred to an eating disorder service should start assessment and treatment at the earliest opportunity. Statement 2: People with eating disorders have a discussion with a healthcare professional about their options for psychological treatment. Statement 3: People with binge eating disorder participate in a guided self-help programme as first-line psychological treatment. Statement 4: Children and young people with bulimia nervosa are offered bulimia nervosa-focused family therapy (FT-BN). Statement 5: People with an eating disorder who are being supported by more than one service have a care plan that explains how the services will work together. Statement 6: People with an eating disorder who are moving between services have their risks assessed. The principle behind the first statement is very important for people seeking help for eating disorders. Research by the national charity Beat found on average, there are three years between the first signs of an eating disorder appearing and people seeking and actually obtaining treatment. Yet we know, from the evidence, that a close association between early treatment and full recovery. It is good to see the NICE guidelines set out the psychological treatments for eating disorders specific to each condition: guided self-help is established as the first line treatment for people with binge eating disorders and children and adolescents with bulimia nervosa should be given bulimia nervosa-focused family therapy (FT-BN). As a provider of eating disorders services for children and adolescents with anorexia requiring inpatient treatment, there is much complexity and no single psychological treatment will be sufficient alone. A broad-ranging resource of interventions is needed to address the multiple causes of the disorder and we recognise the NICE guidelines for anorexia (2) stating individuals need to discuss with a health professional to explain their options for treatment, with choice if it is appropriate and in the best interest of the patient. How does Schoen Clinic Newbridge comply with the NICE quality standards? As a specialist inpatient service (young people are admitted to stay at Newbridge House for 24/7 treatment and care), we are not normally the first service people contact if they are worried their child may be showing signs of an eating disorder. Typically, when someone needs help for eating disorders, they see their GP or a school nurse first. This professional would then refer the young person to CAMHS (child and adolescent mental health services) to carry out a full assessment. There can be delays in these two processes for many different reasons and the NICE quality standards are a welcome focus on ensuring treatment commences at the earliest opportunity. The assessments we undertake are to judge whether a child or young person needs inpatient treatment. They normally have a diagnosis (of anorexia) and are under the care of a community team; our assessment is whether they are responding to community based treatment or whether we need to ‘step up’ their treatment in an inpatient eating disorder service. We are asked to do these assessments by NHS commissioning teams (specialists in managing care and resources) and we always carry out our assessments within 48 hours of a request, usually earlier. We put a great emphasis on discussing psychological treatments with our patients. Any individual being treated in an eating disorder service needs to have an understanding of how they are being treated and why; this is essential if they are going to engage with services and achieve change. Our patients can be as young as eight years old, so we have to ensure our treatments are age-appropriate and explained fully. We have adapted several treatments for younger patients (for example the LEAP programme from Loughborough to address over-exercising). Choice can be offered, if it is appropriate and in the patient’s best interest. For example, our one-to-one therapy encompasses both CBT (cognitive behavioural therapy) and psychodynamic therapy-based approaches. Quality standards five and six are ones we recognise and wholeheartedly support; there is always a transition between services for all our patients. They will normally come from community-based eating disorders services and in every instance, will be discharged to community services. Poor transition carries a risk of relapse and must be carefully planned and delivered. Community teams are invited to and usually attend our CPA (care plan approaches) every four to six weeks, so transition is planned for and considered throughout treatment, not just in the period close to discharge. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York 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 Bulimia 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, Birmingham and York offer highly specialised treatments for children, teens and adults.

Eating disorders can develop at any age, but most often affect people from the age of 14 to 25. Eating disorders commonly start at a time when you are becoming more independent, changing the way you eat and possibly feeling different about your body. You may have changed your diet to lose weight, perhaps turned vegetarian or started trying different foods. You are likely to have more control over what you eat and have more of your meals and snacks with friends or on your own, rather than with your parents. “I just don’t want to eat big meals with my family – I’d rather choose my own snacks. It doesn’t mean I’ve got an eating disorder.” If you're concerned that you may be developing an eating disorder, please don't hesitate to contact our caring team today. So what’s the difference between eating differently and an eating disorder? Eating disorders can develop when you start to use food in order to deal with difficult feelings and emotions. Food plays a big part in our lives and it is natural to reach for our favourite snack for comfort or a little boost at the end of a long day. But if you find that every day, food becomes the way that you deal with worry, sadness, loneliness and any other painful emotion, you may be developing an eating disorder. “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.” It is often hard to recognise when eating patterns become damaging because they can slowly develop and seem like changes in your eating habits. Changing eating patterns can develop into harmful behaviour in many different ways. The two most commonly known types of eating disorders are anorexia and bulimia. There are however varying types of these as well as other recognised eating disorders, including Other Specified Feeding or Eating Disorders (OSFED) and Avoidant Restrictive Food Intake Disorder (ARFID). Here we look at the two most recognised: What are the different types of eating disorders? Anorexia involves severely restricting what you eat 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. People with anorexia have a 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 and then inducing vomiting. Bulimia involves eating large amounts of food, and 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. You are likely to become more withdrawn, secretive and have sudden mood swings. "I know I’ve got a bit of a problem with food, but it’s not serious enough to be an eating disorder." What are the ‘warning signs’ for an eating disorder? Ask yourself the following questions: Do you make yourself sick because you feel uncomfortably full? Do you worry you have lost control over how much you eat? Have you recently lost more than one stone in a three month period? Do you believe yourself to be fat when others say you are too thin? Would you say that food dominates your life? If you answer ‘yes’ to two or more questions, you may have anorexia or bulimia. I think I have got an eating disorder – where do I go for help? Eating disorders rarely get better on their own. Many different professionals have a lot of experience in helping people with eating disorders. The hardest step can be recognising the problem and asking for help. You could see your GP – he or she can refer you to specialist psychiatrists, psychologists, dieticians, nutritionists and counsellors. Your GP is the best person to help you because he or she will know all the local services and support that is available. Talking to a health professional does not automatically mean that you will be admitted to hospital. Your doctor will help to find you the right treatment for your individual needs. This may involve seeing a counsellor, or a psychologist or a psychiatrist to understand how your eating disorder has developed and help you overcome it. There are also many support groups with young people who are facing similar problems and may help you, alongside professional care. If you find it difficult to see your GP and talk about your eating disorder, you could speak to your school nurse or a teacher at school or college. Try to discuss your eating disorder with your family and friends. Your eating disorder will have affected your relationship with them and you probably find it hard to share your feelings with them. But they are likely to know you are experiencing problems and will appreciate your decision to include 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, Birmingham and York offer highly specialised treatments for children, teens and adults.

Exercise is recognised as being important for physical and psychological wellbeing. It is recommended that everyone takes part in exercise for at least 30 minutes three times a week. Many people exercise much more frequently than that and their activity levels are not harmful. They may be working towards sports or aerobic goals and gain a high degree of satisfaction from their exercise. If you're concerned your exercise habits are more a symptom of disordered eating and would like some support, please reach out to our team today. How can you tell when someone is over-exercising? "My daughter has always been more sporty and active than her friends. She goes to the gym every day for two hours – should I be worried?" A person who is over-exercising in a harmful way may show some or all of the following signs: They exercise regardless of all consequences – missing social activities or important school, college or work commitments. They have an emotional attachment to exercise and become extremely anxious if they miss an exercise session. The goal of exercise is to lose weight and feel worthwhile, rather than for athletic goals, enjoyment or social interaction. Their schedule is rigid and if they miss one exercise session, they will do twice the amount next time. They will exercise even if they are injured. They will exercise alone. What are the consequences of over-exercising? People who regularly over-exercise are at risk of the following physical side-effects and complications: Degenerative arthritis Osteoporosis Stress fractures Fatigue Breakdown of muscle mass Dehydration Cardiovascular complications There are also several social side-effects of over-exercising as the problem becomes a dominant influence in the sufferer’s life: Deterioration of social relationships Failure or difficulties at school, college and work due to the demands of exercise regime Social isolation Anxiety and depression Poor self-esteem and self-image Specialised treatments for eating disorders Schoen Clinic is renowned for delivering highly specialised eating disorder treatments and therapies. We have clinics for people who are suffering from anorexia, bulimia or OSFED who want effective, proven treatment. At Schoen Clinic Newbridge in Birmingham, you have the assurance that your treatment is provided by a service which has been rated Outstanding by the Care Quality Commission (CQC) for the second consecutive time. At our leading eating disorder clinic in London, Schoen Clinic Chelsea, our specialists work together as a multidisciplinary team to provide comprehensive, holistic treatments for children, young people and adults with eating disorders. At Schoen Clinic York, our specialists have extensive experience in supporting adults to recover from a range of eating disorders, such as anorexia, bulimia and OSFED. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York 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, Birmingham and York offer highly specialised treatments for children, teens and adults.

Laxatives are a form of medication taken to treat constipation. There are many different types of laxatives and most are available over the counter without prescription. Laxative misuse involves taking this medication to get rid of food to lose weight. Some people with anorexia and bulimia take a large amount of laxatives as part of their harmful food behaviour. If you need support for yourself or a loved one, please don't hesitate to contact our team. Why do people with eating disorders misuse laxatives? People with eating disorders frequently complain about constipation and bloating. This is because their bowel has slowed down as a result of a poor supply of food and fluid. So taking laxatives does not address the real cause of their constipation. People may observe a decrease in their weight after taking laxatives to induce diarrhoea. However, this weight loss is entirely the loss of body fluid. There is no loss of body mass tissue, fat or calories. The effects of laxative misuse Laxative misuse causes dehydration, which results in a range of serious problems. When you are dehydrated, you are likely to feel faint and tired and develop painful headaches. The loss of fluid is likely to result in bloating, particularly around your stomach and ankles. You lose essential minerals which are present in the fluid within the bowel. The most important mineral which is lost is potassium. Potassium plays a vital role in the function of nerves, particularly the nerves of the heart. If potassium levels fall, the heartbeat may become irregular. Potassium levels can be checked with a blood test and heart rhythm with an ECG (electrocardiograph). People with low levels of potassium may be given potassium tablets or if their condition is more serious, be admitted to a hospital where potassium is given through an intravenous (through the veins) drip. Many laxatives work by stimulating the muscle wall of the bowels to contract and push the contents through quickly. But such artificial stimulation eventually leads to loss of bowel tone and the muscle wall becomes thin and flaccid. At this stage, bowel function may be permanently weakened and slow. Many people end up suffering severe and long-term constipation, which will not respond to more laxative medication. The benefits of giving up laxative misuse Your physical appearance is likely to improve noticeably and quickly after stopping or reducing laxative abuse. Your skin will look better and your stomach is likely to become less bloated. Advice on giving up laxatives If you only take a small amount of laxatives or have been misusing laxatives for a short amount of time, you may be able to stop in one step. Some people find they can throw away the packets of laxatives they have and stop themselves from buying more. If you have been misusing laxatives for a long time and take them every day, it is more realistic for you to gradually reduce the amount you take. Perhaps you can keep a few days laxative-free, or aim to cut down your overall use week by week. Tips for giving up laxatives: Eat plenty of fruit and vegetables and high-fibre, wholemeal food Drink lots of water Don’t eat large quantities of bran because this can stop your body from absorbing minerals Try not to panic about putting on weight. If you do gain a little weight, this is rehydration. You will not become overweight if you maintain a healthy diet. Remember, laxatives do not reduce body mass, fat or tissue. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.