Child and Adolescent Psychiatrist, Dr Nitisha Patel in this article looks at young persons eating disorders and advises on how to get help and what help looks like.
There are a number of eating disorders that many people have heard of such as anorexia nervosa and bulimia nervosa, but there are less common presentations such as avoidant/restrictive feeding intake disorder (ARFID) and binge eating disorder.
Often, parents will notice that something is not quite right with their child in terms of their eating and want to seek help. As an eating disorders consultant psychiatrist for children and adolescents, as always, I would recommend that your GP is your first port of call. It can be hard bringing up your concerns with your child, and then getting them to agree to going to see a healthcare professional, but often these children will have something that will motivate them – ‘you’ll perform better at school if you get help’ or ‘we cannot safely let you do X unless you see someone who you can talk to’.
If necessary, the GP may advise that you need specialist services; in this case an eating disorder team within CAMHS (children and adolescent mental health services). It can be confusing, as there are different ‘Tiers’ in mental health services and outpatient CAMHS’ services are Tier 3. (Tier 1 is early intervention e.g. school and health visitors, Tier 2 is more specialised, so care that may be delivered by counsellors. Tier 3 is then even more specialised care, delivered by highly trained professionals e.g. CAMHS, and finally Tier 4 is highly specialised services that are either preventing young people from admission or services that can provide admission to a mental health unit).
CAMHS would then be able to assess your child and see how the family unit functions – this is very important in eating disorders as the treatment is often for the whole family. Parents need to be on board as they are going to be the key people who will help the young person regain the ability to eat regular, nutritionally appropriate meals. The CAMHS team is typically made up of psychiatrists (medically qualified doctors), clinical psychologists, nurses and family therapists.
Sadly, there is often a wait to be seen, and families may opt to see a professional privately instead to be seen quicker. A private psychiatrist will not only be able to assess and diagnose but be able to provide a treatment plan and prescribe any necessary medication. Medication often is not the first line of treatment – there are no medications specifically for eating disorders – but sometimes there are medications that can be used in conjunction with other therapeutic interventions.
Rarely, a young person may need hospitalisation for their eating disorder. This can be due to physical complications – those that suffer with low weight may have problems with their electrolytes (which in term can cause serious brain and cardiac complications), their blood pressure (presenting as dizziness or even collapsing) – and these can be life-threatening. Some young people may require hospitalisation to a physical health hospital, but others may require specialist mental health support in a SEDU (specialist eating disorder unit).
As part of my NHS job, I am the lead clinician for a SEDU in London. We treat young people with eating disorders who need more intensive care and support than can be provided by our community services. As the ward’s consultant psychiatrist, it is my role to lead and support the team in making decisions about a young person’s illness and the care and treatment they need. Typically, a young person stays for 12 weeks, whilst we work with the young person themselves, the family, social care (if involved) and the young person’s school. We also have a school on site which is often a great motivator for our patients. The aim of inpatient treatment is allowing the young person to be safe enough to go back to where they belong –home – through an improvement of eating behaviours and empowering parents to be able to feed their child.
The young person is treated as a whole by a variety of professionals including other doctors, psychologists, nurses, family therapists, a social worker, an occupational therapist and art therapist. We often have young people on the ward who having eating disorders as well as another diagnosis, such as ADHD or autism, and our highly specialised team are able to manage a variety of presentations.
So, now we have covered how to get help and what help is out there, it is really important to remember that there is an abundance of mixed information about weight, food and diets which can be confusing to navigate and understand, which is why it is vital to seek professional help. The causes of eating disorders are multifactorial – it can be to do with genetics, personality, family discord, previous trauma or none of these aspects! What is important is to ensure healthy eating as the priority, whilst also identifying triggers. If a young person is not meeting their nutritional requirements their brains will not be able to function well enough to benefit from psychological input.
The nature of eating disorders and disordered eating, along with the societal and cultural factors that can contribute to their development, make them very relatable experiences. Many of us will have experienced the feelings of guilt that can come with eating something we think we shouldn’t have. It is when those feelings get out of control that they can start to impact a person’s life. I enjoy working with families who typically have so many strengths that they have forgotten they have during times of crisis. Eating disorders can be scary, but with the right treatment and approach, young people can do extremely well and get back on a safe and healthy path towards adulthood.