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Anorexia (Anorexia Nervosa) has very serious physical effects and complications, as well as a devastating impact on psychological wellbeing. If you need support for anorexia, please reach out to our team for help. The physical effects of anorexia are both short and long-term. There are immediate physical effects as the body struggles to function without the nutrients and fuel that it needs. The sufferer is also at risk of developing long-term and potentially life-threatening health problems, particularly if the condition is untreated for many years. Schoen Clinic has over 37 years' experience providing leading mental health treatments for various conditions including eating disorders. As industry leaders in the field of clinical research, our treatments include exceptional care for our patients and their families. How many people require eating disorder treatment in the UK? Record numbers of young people require eating disorder treatment. According to figures from the NHS, more young people than ever before are receiving treatment for eating disorders. With a record demand for services, about 10,000 children and teenagers began treatment between April and December 2021, up nearly two-thirds from before the pandemic and a quarter more than during the same period last year. If you or your loved one are currently battling an eating disorder, we're here to help. Get in touch with one of our specialist eating disorder hospitals today. Who is at risk of developing anorexia? Girls and women are more likely to show signs of and develop anorexia − but eating disorders are becoming more prevalent in boys and men, likely due to societal pressures. Although anorexia is uncommon in people over 40, people of any age can show signs of anorexia. Due to all the changes that their bodies undergo during puberty, teenagers may be more vulnerable. Additionally, they could experience more peer pressure and be more sensitive to criticism or even innocuous remarks about their weight or body type. LGBTQ+ youth are also at a higher risk of developing an eating disorder. According to research by the National Eating Disorder Association (NEDA) more than half of LGBTQ+ youth between the ages of 13-24 have been diagnosed with an eating disorder at some point in their life. What are the physical signs of anorexia nervosa? Food deprivation has a range of physical effects as the body struggles to cope with insufficient nutrients and calories. Like other eating disorders, anorexia may control your life and make recovery very hard. With therapy, you may rediscover your identity, adopt healthy eating practises, and undo some of the side effects of anorexia. Because what is considered a low body weight varies from person to person (and some people may not seem exceedingly thin), it may be challenging to identify the signs and symptoms. Diagnosing anorexia can also be challenging as many people as possible with anorexia frequently conceal their health issues, eating patterns and thinness. What are the physical effects of anorexia? People suffering from an eating disorder may have several undesirable side effects. Anorexia sufferers can suffer some or all of the following: Constipation Dizzy spells and faintness Abdominal pains Muscle weakness Poor circulation resulting in feeling constantly cold Dry, yellow coloured skin Early morning waking Bloating People with anorexia often develop long, fine downy hair on face and body Disrupted menstrual cycles or no periods at all Is there a link between anorexia and health problems such as osteoporosis? Osteoporosis − or ‘soft bones’ − is a disease which results in the density of the bones reducing. This leaves sufferers prone to painful fractures, particularly in the spine and hip, plus persistent and disabling pain and loss of height. People with eating disorders are at risk of developing osteoporosis because their bodies are deprived of the vital nutrients that bones need to grow and remain strong. Calcium is the most important nutrient for the bones. The risk of osteoporosis is particularly serious for people with eating disorders. This is because dangerous eating patterns commonly develop from the age of 13 and throughout the teens when the bones are still growing and reaching peak strength. What are the effects of anorexia on fertility? Infertility is a serious and common side effect of anorexia for people who have a uterus. Anorexia is a known cause of amenorrhea, which is where menstruation stops for three or more months. A dramatic reduction in body fat halts the production of the hormone, oestrogen, which is necessary to stimulate ovulation. If the menstrual cycles and ovulation are suppressed for a very long time, this can affect fertility. A recent study found one in five women at an IVF clinic were experiencing problems due to an eating disorder. Another study on infertility and eating disorders found that among infertile women with amenorrhea or oligomenorrhea 58% had eating disorders. The stopping of periods can be permanent if a sufferer has had untreated anorexia for a long time. However, the good news is that, for most in this situation, menstruation will start again once they begin to gain weight. Approximately 80 per cent of such people who recover from anorexia will regain their ability to conceive. If someone with anorexia does conceive, they face a high risk of miscarriage and having a low-birth-weight baby. Anyone who is struggling with an eating disorder should delay pregnancy until a full recovery is made. What are the effects of anorexia on the heart? Anorexia has the highest mortality rate of all forms of mental illness, with rates of between 10 and 15 per cent. A significant proportion of these deaths are due to heart failure as a result of long term, severe anorexia. When anorexia has become this severe, the heart is often damaged. As there is not enough body fat to protect the heart, anaemia can develop. This can weaken the blood and leads to poor circulation. As a result, the heart cannot pump and circulate blood effectively. Severe anorexia also results in the loss of muscle mass, including heart muscle. Consequently, the muscles of the heart can physically weaken, leading to a drop in blood pressure and pulse. This can then contribute to slower breathing rates. Studies have shown that many people with anorexia who are admitted to hospital have low heart rates. Common heart problems include arrhythmias (fast, slow or irregular heartbeat), bradycardia (slow heartbeat) and hypotension (low blood pressure). As such, the effects of anorexia on the heart can be devastating. Do the side effect of anorexia include neurological (brain) problems? People with severe anorexia may suffer from nerve damage that affects the brain and other parts of the body. This can lead to things like: Seizures Confused thinking Extreme irritability Numbness or odd nerve sensations in the hands or feet (peripheral neuropathy) Brain scans show that parts of the brain can undergo structural changes and abnormal activity during anorexic states. Some of these changes return to normal after weight gain, but there is evidence that some damage may be permanent. Is anaemia a side effect of anorexia? Yes, anaemia is a common side effect of anorexia and starvation. In one study, up to 39 per cent of anorexic participants had anaemia. A particularly serious blood problem is pernicious anaemia, which can be caused by severely low levels of vitamin B12. If anorexia becomes extreme, the bone marrow dramatically reduces its production of blood cells − a life-threatening condition called pancytopenia. When to see a doctor? As anorexia is an extremely serious illness with some of the highest mortality rates, it's important to see a doctor as soon as possible. If you think that you might be suffering from an eating disorder, it's important to seek help as soon as possible. The good news is that recovery is possible. Our multidisciplinary team here at the Schoen Clinic are here to help you return to healthier eating habits. In most cases, we can help you make a full recovery from the physical side effects of anorexia. For fast access to specialist treatment, get in touch with our compassionate team today. Anorexia health problems FAQs Anorexia frequently asked questions What is anorexia? Anorexia is an eating disorder that involves unhealthy weight loss. People with anorexia often struggle to maintain a healthy weight due to a difficult relationship with food. Many people suffering from anorexia will excessively restrict their calorie intake, exercise compulsively or use laxatives or make themselves sick to try to keep their weight low. Although anorexia is typically seen in those with low body weights, people of any size can suffer from the condition.People with anorexia will often have a distorted image of their bodies. For example, it's common for those suffering from anorexia to think they are fat, even if they are underweight. What are the causes of anorexia? It is unknown what exactly causes anorexia. However, it is assumed that anorexia is caused by a range of biological, physiological and environmental factors. Although there is no definitive cause of anorexia, you might be more likely to suffer from anorexia if: You or a family member have a history of eating disorders People have commented on your eating habits, weight or body shape You feel under constant pressure to be thin You have low self-esteem or anxiety You are a perfectionist or have an obsessive personality What are the warning signs of anorexia? As is the case with many mental health problems, no two people experience anorexia in the same way. However, some of the warning signs of anorexia include: Losing substantial amounts of weight An obsession with weight, food, calories, fat and/or dieting Viewing themselves as fat, despite losing weight or being underweight A lack of appetite or apparent denial of hunger Missing out on social occasions involving food or refusing to eat in public Excessive exercise or an obsession with burning calories Withdrawal Physical signs of anorexia such as gastrointestinal problems or the loss of menstruation Body dysmorphia If you're worried that you or someone you love might be showing signs of anorexia, it's important to get help as soon as possible. What can I do to prevent anorexia? There's no guaranteed way to prevent a person from developing anorexia. Primary care doctors (paediatricians, family GPs, and internists) may be well-positioned to spot anorexia's early warning signs and stop the condition from progressing to a more serious stage. For instance, at normal medical check-ups, they might inquire about dietary habits and contentment with looks. Consider talking to a family member or acquaintance about these concerns if you see that they have poor self-esteem, strict eating habits or dissatisfaction with their looks. Even though you might not be able to stop an eating issue from forming, you can discuss better habits or available treatments. How much do anorexic people weigh? An adult's normal BMI ranges from 18.5 to 25. Anorexic adults have a BMI of less than 17.5 pounds. Using specific age-related BMI tables, your normal weight is determined if you are under the age of 18. Can I have anorexia and be normal weight? Researchers from Stanford University School of Medicine and the University of California-San Francisco have published a new study which demonstrates that teens and young adults with atypical anorexia nervosa can have normal body weights while yet being severely unwell. As a result, these patients can be under-recognised and under-treated. As these people can be suffering from anorexia health problems just as much as underweight sufferers, it's important to seek treatment − even if your body weight is considered 'normal'. How skinny is too skinny? An individual is termed "too thin" from a clinical standpoint if they are underweight. A person is considered underweight if their Body Mass Index (BMI) is lower than 18.5. What are the different treatment options for anorexia? If you're suffering from the effects of anorexia, we're here to help. Here at Schoen Clinic, our multidisciplinary team has extensive experience in helping people who are suffering from eating disorders to make full a recovery. Our highly successful anorexia treatment method is tailored to each individual − as everyone will experience an eating disorder differently. Although everyone is different, our specialised treatment programme includes: Psychotherapy, occupational therapy and psychology Specialist mealtime support and dietetics One-to-one therapy Group therapy Family therapy Get in touch with our caring team at Schoen Clinic today if you need anorexia support for yourself or a loved one. Our anorexia specialists in London, Birmingham and York offer highly specialised treatments and welcome children, teens and adults.

What is bulimia nervosa? If you need support for bulimia, please reach out to our team for help. Bulimia nervosa, often known as bulimia, is a severe eating disorder that can result in very serious complications if not treated early. People experiencing bulimia may covertly binge and purge, seeking to burn off the additional calories in an undesirable way. Binging is defined as consuming excessive amounts of food without self-control. Individuals with bulimia may also employ a range of techniques to burn calories and avoid gaining weight. For instance, following bingeing, the individual might attempt self-induced vomiting or abuse laxatives, diet pills, diuretics, or enemas. Others may try other strategies to burn calories and avoid gaining weight, such as fasting, tight dieting, or excessive overexercising. Our specialists at Schoen Clinic have been treating eating disorders for over 35 years and are highly regarded as leaders in the field of clinical research and optimised patient outcomes. If you need support with bulimia or any other eating disorder, we're here to help. Bulimia risk factors Like other eating disorders, bulimia nervosa is complex, which means that it can have a variety of underlying causes, such as genetics, neurochemical imbalances, and environmental stressors like abuse or trauma exposure. A person who is inclined to having an eating disorder is also often affected by other psychological and emotional problems, such as an anxiety condition, depression, and poor self-esteem. Understanding the underlying causes of bulimia nervosa and recognising its warning signs can help people seek out early treatment that can greatly enhance the outcomes for those who are suffering from the disorder. Since there are several contributing factors to bulimia, there are many different therapy options accessible in order to get the best possible outcome. The physical effects of bulimia nervosa Bulimia Nervosa is an eating disorder with physical effects on the body which are serious, harmful and if left untreated, can result in long-term problems. Although the physical effects of Anorexia Nervosa, including the condition’s mortality rate, are perhaps better recognised, the physical effects of Bulimia are multiple and should not be under-estimated. Bulimia effects can, for some, become life-threatening and certainly for many, bulimia can have a long-term health impact. The frequent, recurrent pattern of bingeing and purging that characterises bulimia can have detrimental repercussions on a person's physical health. Bulimia treatment is essential: the longer the condition persists without effective treatment, physical effects become increasingly serious and lasting. Here, we will break down the; Immediate physical signs of Bulimia Long-term physical effects of Bulimia Treatment and support Physical signs of bulimia There are a range of immediate physical effects of Bulimia. The effect on each individual will vary according to the pattern of their eating disorder and individual physiology. Physical signs can include: Russell’s sign Swollen face Tooth decay Sore throat Dehydration One of the most well-known Bulimia effects is ‘Russell’s sign’: calluses on the knuckles and hands caused when inducing vomiting as in doing so, this part of the hand scrapes against the teeth. Russell’s sign, however, is not present in all people with Bulimia; many will purge without causing this Bulimia effect and may depend on other types of purging (laxatives, over-exercising). When someone has bulimia, their outward look frequently conceals the reality that they have a harmful eating condition. Along with a host of other grave bodily symptoms, a person's oral health may deteriorate as the condition worsens. Tooth decay is closely linked to the binge-vomit cycle because the contents of the stomach are highly acidic and repeated cycles of vomiting cause tooth enamel to break down through this acidic content. Bad breath is another bulimia effect. These effects of an eating disorder vary depending on its degree and duration, but the longer an individual is affected by it, the more serious the condition becomes. People can recover and heal, as well as have the majority, but not all, of the physical effects reversed, with prompt and appropriate treatment. Often, the first person to spot bulimia symptoms is a dentist. Teeth are permanently degraded by vomiting, and they may start to darken or vary in size, shape, or length. They frequently weaken, grow more transparent, and become fragile. Gums and soft tissues in the mouth are also harmed in addition to the teeth being damaged. By inducing vomiting with fingers or any another object, those who purge may develop sores on the inside of their cheeks, on the back of their throat, or on the roof of their mouth. Face swelling is one of the bulimia effects sufferers find most distressing: At Schoen Clinic we don't use these terms but this symptom is often referred to as ‘bulimia cheeks’, ‘bulimia face’ or 'chipmunk cheeks', this swelling can make people feel their face ‘looks fat’. What is taking place is the body’s reaction to self-induced vomiting and the dehydration it causes. The body reacts by trying to hold on to as much water as possible and this is most evident in the parotid glands (around the jawline and side of the face). Warning signs of bulimia If you're worried that a friend or loved one may be bulimic it's important to know what to look out for. If you do believe they have bulimia, reach out to them in a safe, non-judgmental way to let them know you care for them, or seek advice from a specialist. It's important they get professional help as early as possible to provide them with the best chance of overcoming the condition. Characteristics to be aware of: Social exclusion Bathroom use immediately after eating Mood or personality change Avoiding eating in front of others Dental decay, receding gum lines, and yellow, painful teeth Talking about food or weight all the time Acting impulsively Excessive or recent drinking or drug usage A strong dread of gaining weight Obsession with appearance Keeping or concealing food Obsession with plain, loose-fitting apparel Calorie counting and weight tracking Body image distortion Withdrawing from the outside world Frequently weighing themself Long-term physical effects of bulimia Bulimia has a devastating impact upon the whole body in the long term, causing multiple serious effects: Electrolyte imbalance, particularly potassium Chronic fatigue Loss or disruption of menstrual cycle Bone weakness Electrolytes are electrically charged salts, or ions, used by the body to regulate hydration, together with nerve and muscle function. They are determined by hydration: how much water is present in the body. A long-term pattern of purging leaves the body’s electrolytes in a persistent imbalance, with the risk of effects on heart and kidney function. Potassium is an electrolyte (and also classified as a mineral) which is often depleted by the binge-purge cycle and is particularly important for heart function. People with bulimia should have a test of potassium levels and receive a supplement, if required because very low potassium levels can cause irregular heart rhythms and the breakdown of heart tissue fibres. Other long-term physical effects of bulimia nervosa and potential risks include menstrual cycle disruption and associated fertility problems. Chronic fatigue caused by the constant depletion of nutrients during purges is also a risk, together with future problems with bone health, due to loss of calcium. Tooth decay caused by bulimia may be permanent and difficult to treat. Gastrointestinal effects of bulimia Due to frequent vomiting, laxative usage, and/or diuretic use, those with bulimia may have a range of gastrointestinal symptoms. Gastrointestinal bleeding and reflux can be brought on by vomiting and abusing laxatives excessively. The oesophagus relaxes as a result of frequent vomiting, making it simple for the contents of the stomach to ascend up into the throat and mouth. An individual with bulimia may also involuntarily vomit if they lean over after eating or when they burp, for instance. Although rare, if the vomiting behavior isn't addressed and irritation of the esophagus becomes severe, it may result in a ruptured esophagus. Electrolyte abnormalities and dependence on laxatives are common in those who overuse laxatives. In some cases, the colon may extend and weaken as a result of binge eating and laxative usage, leading to chronic constipation. In extreme cases, some people with bulimia have permanently lost their bowel function and must use a colostomy bag for the rest of their lives. Bulimia treatment & support Fortunately, there is good, established bulimia treatment, with strong evidence for its effectiveness. Bulimia treatment is based on a CBT (Cognitive Behavioural Therapy) based approach, supporting individuals to consider the links between their thoughts, feelings and behaviour. It is a practical, problem-solving approach and in bulimia treatment, the triggers for a binge are considered and how this could be overcome by changing the pattern of thoughts, feelings and behaviour. Treatment is almost always provided in an outpatient setting (seeing a CBT therapist once a week), unless there are other problems which necessitate an inpatient admission. Group support may also be helpful. Seeking treatment for Bulimia as early as possible is very important, both in terms of reducing your risk of long-term, enduring physical side-effects and because it is recognised with Bulimia and other eating disorders, early treatment is linked to better outcomes. This is because the longer eating disorders persist, the more entrenched and difficult to treat they become. Get in touch with our caring team at Schoen Clinic today if you need bulimia support for yourself or a loved one. Our bulimia specialists in London, Birmingham and York offer highly specialised treatments and welcome children, teens and adults.

In a world where appearance often seems to hold paramount importance, the line between self-perception and reality can blur, leading to a condition known as body dysmorphia. This psychological disorder, characterised by an obsessive focus on perceived flaws in physical appearance, affects individuals across diverse backgrounds. Understanding body dysmorphia entails delving into its intricate manifestations, exploring effective treatments, and addressing questions surrounding the condition. In this blog article, we shed light on its symptoms, causes, diagnosis and available treatments and answer commonly asked questions to raise awareness and support for those grappling with this challenging disorder. Please don't hesitate to contact our team if you need support. Body dysmorphia is the term for a condition that causes an individual to be overwhelmingly focused on perceived flaws in their appearance. This is a distorted perception – evident to the affected individual in a very different way than everyone else. There is compulsive checking of the imperfections or flaws which causes high levels of distress and disruption to the individual’s life. For example, the person may become socially isolated because they fear responses to their perceived flaws or become overwhelmed by repeated actions to hide perceived flaws. Body dysmorphia may be expressed as mirror checking repeated so often as to disrupt normal life and negative comparison with others, often on social media. Is body dysmorphia an eating disorder? Body dysmorphia is not about overall weight, shape and body image. A person with body dysmorphia may be highly distressed about perceived flaws in their face or skin, for example, but eat normally, without concerns about weight, shape or body image. As such, body dysmorphia is not in itself, an eating disorder. However, some forms of body dysmorphia can be a trigger for the development of an eating disorder. How is body dysmorphia diagnosed? Body Dysmorphia, also known as Body Dysmorphic disorder, is a recognised mental health condition described in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). According to these key guidelines, these are the features of body dysmorphia used to make a diagnosis: The individual is highly preoccupied with perceived flaws which are not apparent to others There is a repetitive behaviour component associated with the perceived flaws, for example, very excessive mirror checking Diagnosis will consider the individual’s insight and response to reassurance: people with a mild disorder can be distracted and reassured to some extent. Those with more severe body dysmorphia will be wholly convinced of the imperfection and overwhelmed by it. How common is body dysmorphia? Body dysmorphia can occur at any age, but most commonly develops during adolescence. According to the DMS-5 data, the average age when body dysmorphia developed is 16 to 17. The condition affects males and females roughly equally, at around 2.5 per cent and 2.2 per cent respectively (American Psychiatric Association, 2013). What causes body dysmorphia? The causes of body dysmorphia are not fully understood. There is likely to be a range of possible factors and higher-risk groups. These include: There is a link between Obsessive Compulsive Disorder (OCD) and body dysmorphia. Some clinicians believe body dysmorphia is a form of OCD. Studies have shown people with OCD themselves, or with OCD within their close family are more likely to develop body dysmorphia There is a theory that body dysmorphia is linked to chemical imbalances in the brain, particularly in low levels of serotonin Trauma and distressing experiences, such as bullying, can be a trigger for the development of body dysmorphia There is a link between perfectionism and body dysmorphia How is body dysmorphia treated? There is a good evidence base for the use of Cognitive Behavioural Therapy (CBT) as a way of treating body dysmorphia by challenging the distorted perceptions underpinning the disorder. If there are impacts such as depression, this may need to be treated with medication. For some people, body dysmorphia will be interlinked with an eating disorder and in this situation, a full assessment is required and treatment programme that addresses all aspects of the eating disorder, including body dysmorphia. 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.

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

Across our leading eating disorder clinics and hospitals in the UK, Schoen Clinic provides an integrated, multi-disciplinary approach to eating disorder treatment and Occupational Therapy is a key part of this approach. In this way, we can respond to and meet the physical, psychological and social needs of each individual patient. Read on to find out how Occupational Therapy plays an integral part in the recovery process. Please feel free to contact our team today if you need support. What is occupational therapy? Occupational therapy is concerned with the activities, or occupations which we engage in during everyday life. Our occupations are divided into three groups: Self-care Productivity Leisure activities. Occupational therapists look at how people manage in these three areas of occupation. They support people to explore how their motivation, habits and skills have an impact on their day-to-day activities within their home and social life. The occupational therapist will support an individual in identifying the barriers to a healthy and balanced lifestyle to identify and work on positive changes. The occupational therapist will educate individuals on the importance of the balance between self-care, productivity and leisure activities, which is important for our overall wellbeing. Why is occupational therapy helpful in the treatment of eating disorders? Occupational therapy is a well-established, practical approach to helping people with a wide range of difficulties, including those with learning disabilities and physical and mental health challenges. Occupational therapy is considered to be very valuable as part of an integrated eating disorders treatment programme. People with an eating disorder are likely to have a marked imbalance in their daily activities. To take leisure activities as an example, a young person who has anorexia may over-exercise very excessively, rather than take part in exercise as an enjoyable leisure activity. The young person will not engage in regular, enjoyable leisure activities, such as going out for a meal with friends, because of the impact of their eating disorder. Occupational therapy, in combination with other therapeutic approaches, provides a way of helping the individual to rebalance their activities into a more healthy and balanced pattern. It harnesses the motivation of each individual and helps them to develop the skills needed to live a more balanced life. Occupational therapy at Schoen Clinic “Group activities within the community help young people to build their social skills and confidence in a safe and supportive environment. These activities are designed to help in their transition back to their local community and social life.” - Janet Tighe, senior occupational therapist, Schoen Clinic Newbridge. When an individual arrives at Schoen Clinic for eating disorder treatment, they will meet the Occupational Therapist and discuss their daily routine and interests with them. The aim is to integrate each person’s interests and daily routine into their activities throughout treatment. The Occupational Therapist will build up an understanding of what they enjoy and their motivation. For example, they may enjoy spending time with their friends but regret not being able to join them when social activities involve food. Occupational Therapy provides a way of building on motivation and providing the individual with new skills to help achieve a better balance of activities. Occupational Therapists run and contribute to a range of groups, covering lifestyle rebalance, social skills and art-based groups. What do occupational therapy groups involve? The leisure group provides an opportunity for each patient to return to physical activity gently, whilst building confidence in accessing the local community. They are encouraged to consider the difference between appropriate and excessive exercise and enable a balanced range of activity. Activities vary regularly but include badminton, table tennis, rounders, swimming and tennis within the local community. The social eating group is used to facilitate a graded approach to eating snacks, progressing to meals out in the community. The group uses the experience of outings into the community, for example visiting cafes, parks and shopping centres, to enable each individual to adjust and adapt to eating away from Schoen Clinic. Progress is made incrementally, reflecting the needs of each individual and the stage they have reached. A meal out is a goal which will be achieved very gradually, taking account of the individual’s progress in the treatment programme and individual needs. An older individual, or someone who will go on to independent living at university, for example, will progress to focus on life skills training around meal planning, shopping and cooking skills, in preparation for life after discharge. A younger person, who may be returning home to live with their parents and will not be responsible for day-to-day cooking, will focus on different life skills. When working with younger people, our Occupational Therapists will work closely with parents to ensure they can provide support to sustain their lifestyle changes after discharge. The creative art groups provides a creative outlet for individuals, an opportunity for distraction and a means to develop interests and hobbies. In addition, it can be used by the therapist as a method of assessment of areas such as motivation, communication and interaction. Our facilities enable Occupational Therapists to work to maximum benefit. Schoen Clinic Newbridge, Schoen Clinic Chelsea and Schoen Clinic York have occupational therapy kitchens, enabling patients to cook and eat meals as they would do at home and a large craft and activity area. How do you qualify as an Occupational Therapist? To qualify as an occupational therapist, it is necessary to study for a three-year degree. During this time, students will undertake a range of placements in healthcare, adding up to 30 weeks of practical experience. Occupational therapists are trained in both physical and mental healthcare. If you're interested in a rewarding career at Schoen Clinic, visit our careers page today to find out more. 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 recent years, there has been a surge in the number of people exploring vegetarian and vegan diets. This is widely evidenced through social media sites and the promotion of campaigns such as ‘meat-free Monday’ and  ‘Vegan-uary’. It also correlates with the increasing demand for meat-free food items within UK supermarkets. In fact, consumer statistics show that in 2017 the market for meat-free items increased by 987 per cent. The shift is evident by looking at the vegetarian and vegan food sections in supermarkets and the growing range of non-meat choices on most menus. Correspondingly, specialists working in eating disorders hospitals are receiving increasing numbers of requests to follow a vegetarian or vegan diet. Does this simply reflect the pattern in wider society, or is something else evident? We dive in and answer these queries in this article. Please don't hesitate to contact our team if you need support. Statistics and figures The statistics suggest there may be a correlation between veganism and eating disorders. At Schoen Clinic Newbridge, for example, 35 per cent of the young people we treat stated they wanted to follow a vegan, vegetarian or pescatarian diet. This compares with just two to three per cent of the UK population as a whole following a completely vegan or vegetarian diet and lifestyle. We considered this difference may reflect the age profile at Schoen Clinic Newbridge, with higher proportions of younger people following a vegan or vegetarian diet, compared with an all-age population sample. To test this, we undertook a survey with female students at a secondary school, asking pupils of a similar age what their dietary choices were. Comparing the same age group samples, we found Schoen Clinic Newbridge had four times as many vegans, five times as many pescatarians and double the number of vegetarians compared with the school group. Why are these statistics so different? We need to think about the motivations for following a vegan or vegetarian diet and how this may interact with the psychological influences of an eating disorder. It is recognised that anorexic thinking and behaviour commonly feature; Avoiding high-fat foods Avoiding processed foods and Choosing the lowest-calorie items. Orthorexic thinking, sometimes known as ‘clean eating’ is also regularly seen in those with a diagnosis of anorexia nervosa. This is the belief that food should only be ‘natural and pure’ and any processed food should be avoided and can result in a highly restrictive diet. In other words, the primary motivation for following a vegan or vegetarian diet may be weight loss, calorie restriction or orthorexic notions of ‘healthy’ food, but this is expressed as an ethical diet preference. Our society promotes that we should support the choice of an individual which can make it uncomfortable for parents and professionals alike to challenge the motivation for this lifestyle choice. Of course, it would be an overstatement to say veganism is a specific trigger for eating disorders, or that going vegan or vegetarian inherently increases eating disorders risk. However, there is a danger that a vegan or vegetarian diet can support restriction and weight loss and thus become a maintaining factor for an eating disorder. At Schoen Clinic Newbridge, we work to return to the dietary norm which was prior to the development of the eating disorder. This allows time to unpick the reasoning for following a vegan or vegetarian diet and addressing this within the treatment plan. Once the young person reaches a healthy weight, further discussions will take place with their treatment team and family around the appropriate diet for the individual as they progress to discharge and the process of recovery. Of course, it is possible to follow a healthy vegan diet if no eating disorder is present. But as the Vegetarian and Vegan societies advises, individuals should not practice restriction unless they are physically and mentally well; a young person who is being treated in an inpatient setting for an eating disorder would not fulfil the criteria of being physically and mentally well until the latter part of their treatment. If you need support for an eating disorder, please don't hesitate to reach out to our teams at Schoen Clinic Newbridge in Birmingham, Schoen Clinic Chelsea in London, or Schoen Clinic York in the North of England. Our caring teams have extensive experience in treating eating disorders and are ready to help you get back to you. Get in touch today.

Compulsive eating is a type of behaviour with food: when a person eats in a way that feels out of control, that has an emotional component and involves eating an uncomfortably large amount. Compulsive eating is not an eating disorder in itself. It can be a recognised feature which is part of known eating disorders such as bulimia nervosa and binge eating disorder. If you need support, please don't hesitate to contact our team at Schoen Clinic. What are the signs of compulsive eating? It may be difficult to identify compulsive eating as a distinct feature compared with the normal parameters of food consumption. We all have favourite foods which we turn to for comfort and food types which we might like to avoid or limit but find it hard to do so. It is normal to feel our eating is not as controlled as we may wish to lose or maintain weight. It is also normal to have certain foods that we turn to for comfort. If you are concerned you may have a problem, consider these signs which indicate compulsive overeating may be present: Eating rapidly and in secret. You may dislike eating in public or socially. Eating beyond the feeling of comfortable fullness; feeling completely unable to stop. Turning to food whenever you experience difficult feelings, moods or situations The urge to eat large amounts of food and/or forbidden food is experienced as utterly overwhelming Looking at feelings and well-being as a whole, these are indications you may be experiencing compulsive overeating: Always trying to diet but unable to lose weight Immense feelings of self-dislike/disgust at eating habits and inability to lose weight Depression and low self-esteem are often present A sense that life would improve if weight could be lost but feeling powerless to achieve this Is compulsive eating the same as binge eating? Binge eating is part of the diagnostic criteria for bulimia nervosa and binge eating disorder and as such, clear measures have been developed to define a binge: Quantity of food consumed in a binge is described as: “an amount of food that is definitely larger than most people would eat” (American Psychiatric Association, 2013) Feeling out of control during the binge Binge behaviour occurs at least once a week for a period of three months It could be argued that binge eating, particularly as part of a diagnosis of bulimia or binge eating disorder, is a more specific classification than compulsive eating. A binge requires the food consumption to be large (although what is large for one person may be normal for another), as well as the accompanying feelings of loss of control, shame and secrecy. Compulsive overeating is more focused on the feelings around the eating behaviour, rather than the amount consumed in a single episode. Compulsive overeating could be present in an overall pattern without the presence of single, large binges. In practice, many clinicians suggest the difference between definitions is slight: individuals present and talk about experiencing binges, compulsion and food addiction. The key, common characteristic is the underlying feelings of loss of control, disgust and secrecy and the link between food consumption and difficult emotions. How is compulsive eating treated? If you feel you may be suffering from compulsive overeating, an assessment may be very important, particularly if you have accompanying, harmful purging behaviours of bulimia nervosa. At Schoen Clinic, we offer private assessments for individuals of all ages and run one-to-one Cognitive Behavioural Therapy programmes for people with bulimia. There is a strong evidence base for the effectiveness of this approach. 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 will always be a number of factors in the development of an eating disorder and each individual will be affected by a unique combination. There is never one simple, single cause, although sometimes there may be one factor in a person’s life which plays a particularly prominent role in his or her eating disorder. If you need specialised support, please don't hesitate to contact our team. An eating disorder, at its root, is the expression of emotional distress and means of managing difficult and painful feelings. Anorexia is an eating disorder which typically occurs during adolescence, so emotional difficulties are likely to encompass issues at school, trouble with friendships, parental conflict and struggles coping with puberty. Of course, many young people face these sorts of challenges without developing eating disorders; there must be other factors involved which trigger disordered eating. Do personality types play a part in developing an eating disorder? There are currently a number of studies exploring whether certain personality types may be more predisposed to an eating disorder. The theory is that young people with more rigid thinking styles and perfectionist traits may be more at risk of responding to difficulties through their eating. Young people who develop anorexia frequently express how losing weight provided the sense of control they felt was lacking in every other area of their lives. Other research about anorexia questions whether we should look more closely within the brain physiologically to understand the cause of anorexia and the factors which lead to its persistence for some people. This theory suggests there is a dysfunction within the part of the brain involved with taste, emotion, appetite and pain which explains why someone with anorexia has such extreme and intransigent behaviour. Can social media influence eating disorders? There are often questions about the role of the media, both mainstream and social, as a factor in the development of eating disorders. At Schoen Clinic, we do see some young people who have used pro-anorexia websites which have served to sustain and normalise their eating disorder. Certainly, the idealised images which bombard young people every day do play a role in anxiety around body image, but it would be too simple to suggest that the media causes eating disorders. It may, in some cases, be a factor in creating a disposition to the eating disorder and or perpetuating it after onset. Family therapy is a cornerstone of the work we do with young people and their families. It is never about pin-pointing blame on families, although very often parents come into the process with great fear that the eating disorder reflects their failure in some regard. Although there may be some cases where, for example, a mother has food and body image anxieties which are transmitted to their daughter, we see many families where this is not the case in any way. Family therapy and supporting family work seek to understand the dynamics within each family and find ways of harnessing the support within each family in a positive way to overcome the eating disorder. Some people go through the whole process of having an eating disorder, having treatment and on to recovery without ever fully understanding the original cause. For some, through psychoanalytic psychotherapy, it is very important to illuminate the cause and use this understanding to move forward to change. For others, often the younger children we treat, therapy is more focused on developing different strategies for dealing with difficult and painful emotions, so there is an alternative to disordered eating as a response. Sometimes families leave Schoen Clinic with an understanding that the cause was a general inability to cope with the pressures that adolescence presented, and that recovery is based on utilising new strategies. One mother, who felt she would never fully understand the root cause of her daughter’s eating disorder, reflected during her daughter’s recovery: “Our daughter now has new and more positive ways of interpreting the world.” Specialised eating disorder treatment is available The cause of an eating disorder such as bulimia may be a little easier to understand than some examples of anorexia. Treatment is based on a Cognitive Behavioural Therapy approach, encouraging the sufferer to understand what feelings trigger the thoughts and behaviour leading to binge eating. Through understanding this trigger point, the individual is better able to develop other ways of thinking and behaving at the stage when disordered eating occurs. In conclusion, the causes of an eating disorder are likely to be complex, not always apparent and will involve an interaction of several factors. It is essential that parents do not blame themselves and that if symptoms of an eating disorder are a concern, medical help is quickly sought because the longer an eating disorder persists, the more difficult it will be to treat. 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.

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

It has been commonly stated that one in ten men have anorexia, bulimia or another type of eating disorder. Recent figures from the NHS Information Centre suggested the real figure is actually much higher, with 700,000 men being registered as having an eating disorder, a quarter of the total number of people affected. While it is difficult to be exact in terms of numbers, it is clear that there are many men who hide their eating disorder and do not seek help. Many men feel anorexia or bulimia are a ‘female’ condition and this shame is combined with the guilt and secrecy common to all eating disorders. Eating disorders in men typically develop between the age of 14 and 25 but people can also be affected at other ages. If you need support, please don't hesitate to contact our caring team. How do eating disorders develop in men? Eating disorders in men have many of the same causes as eating disorders in women. There will certainly be a number of different causes and these may include childhood trauma, family difficulties, stressful life events, low self-esteem, personality factors and genetic predisposition. Eating disorders in men can be expressed in a different way to eating disorders in women – men and boys may be more preoccupied with having a muscular physique than losing weight. Male eating disorders are often closely linked with exercise and initially appear to be healthy, masking the underlying problem. For example, sudden weight loss may seem the result of a training programme for a sporting goal. There is also evidence that men are facing similar pressures to women in terms of conforming to an unrealistic body shape and increasing numbers of men and boys feel dissatisfied with their own bodies. Risk factors Some of the same risk factors known to apply to women seem to also apply to men and there are others which are more specific to men. In common with women, the most important factor is unresolved distress and trauma, which is expressed in an eating disorder. But some groups seem to be at a greater risk: Men who have been overweight, bullied or teased about their weight. Taking part in a sport which demands a specific body shape, for example athletes and jockeys are at a higher risk. A study carried out by the national charity Beat found 20 per cent of men with eating disorders are gay, making up twice the proportion of gay men in the population as a whole. Men working in a job or profession in which an idealised body image is very dominant. Male models, actors, and general entertainers seem to be at higher risk than the general population. Male eating disorders Eating disorders don't discriminate. Everyone who is affected by an eating disorder like anorexia, bulimia or OSFED deserves support and specialised treatment. At Schoen Clinic, we don't discriminate. We welcome men at our leading eating disorder clinics and hospitals across the UK, where we provide comprehensive treatment programmes to meet individual needs. If patients require an individual programme of outpatient treatment, we can structure treatment around individual needs and commitments, offering evening appointments, for example. At Schoen Clinic Newbridge, young men aged 14 to 17 may be assessed for our inpatient programme for adolescents, tailored to the needs of young people with eating disorders. At Schoen Clinic Chelsea, our leading London mental health clinic, we welcome individuals of all ages for highly specialised eating disorder treatment. At Schoen Clinic York, our highly specialised eating disorder hospital for adults provides comprehensive inpatient and daycare treatment, as well as short-stay support to help those experiencing eating disorders. 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.

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.