Eating disorders; - Just One Norfolk (PDF)

Eating disorders: a guide for friends and family  Contents Introduction Pg 03 What is an eating disorder? Pg 04 Why do people get eating disorders? Pg 05 Types of eating disorder Pg 06 Bulimia Pg 07 Anorexia Pg 07 Binge eating disorder Pg 08 OSFED/EDNOS Pg 08 How can I approach someone I think has an eating disorder? Pg 09 Treatment for eating disorders Pg 11 Confidentiality Pg 14 Supporting someone with an eating disorder Pg 15 Looking after a child Pg 17 Looking after a partner Pg 18 Looking after a housemate Pg 19 Looking after a friend Pg 19 Looking after a colleague Pg 20 Looking after yourself Pg 21 Dealing with difficult situations Pg 21 Telling others Pg 22 Help and support groups Pg 23 Taking time out Pg 23 Next steps Pg 24 Eating disorders - know the first signs Pg 26 Looking for support? Pg 27 Pg 02  Introduction This booklet is for anyone supporting someone with an eating disorder. This might be a family member, a friend, a partner, a colleague. It covers types of eating disorder, possible causes, how you can help, and treatment. It also gives guidance on taking care of yourself. This booklet is an overview, but we hope it will help you understand more about eating disorders and provide you with information that will help you care for your loved one. You can find out more on beateatingdisorders.org.uk and through the resources listed in the Next Steps section. Eating disorders can take over not only a sufferer’s life but the lives of those around them. If you’re caring for someone with an eating disorder, whether full-time or through occasional support, it can be difficult to know how to help, or even to persuade them they need and deserve help in the first place. But with the right support and treatment, recovery is possible. Encouraging a person to seek treatment as soon as their symptoms appear is important; finding treatment early will give them the best chance of fully recovering from their eating disorder. Pg 03  What is an eating disorder? Eating disorders are serious mental illnesses that involve disordered eating behaviour. This might mean restricting food intake, eating very large quantities of food at once, countering food eaten through purging, fasting or excessive exercise, or a combination of these behaviours. It is important, though, to remember that eating disorders are not about food. Instead, the eating behaviour might be a coping mechanism or a way for the sufferer to feel in control. I thought, ‘If I can’t control what I eat, how can I control anything else in life?’ " " Pg 04  Why do people get eating disorders? Anyone can develop an eating disorder, regardless of age, gender, or background. Research is still being carried out to learn why people develop eating disorders, but evidence suggests it’s a combination of a biological predisposition towards the illness and a social or environmental “trigger”. This can be something life-changing, or something that to an outsider seems small – this does not invalidate the person’s illness. Stress, bereavement, difficulties in an important relationship and cultural pressures are just some of the things that might play a role in someone developing an eating disorder. People with eating disorders do not choose to have them and can’t help being ill. It’s easy to look for someone to blame, whether it’s the person with the eating disorder, someone else, or even yourself. But this isn’t useful – it’s often impossible to say for sure what caused someone’s eating disorder, but there are things you can do to help them get better. Pg 05  Types of eating disorder It’s common to believe you can “see” an eating disorder. However, they are mental illnesses, and changes in behaviour and mood will probably be noticeable well before changes to appearance. Eating disorders vary from person to person – though there are some signs and traits associated with particular eating disorders, a person does not have to show all of them to be ill. Some general signs that may be associated with all eating disorders include: • Preoccupation with and/or secretive behaviour around food • Self-consciousness when eating in front of others • Low self-esteem • Irritability and mood swings • Tiredness • Social withdrawal • Feelings of shame, guilt, and anxiety Pg 06  Bulimia Bulimia involves cycles of bingeing and purging. This means the person will eat large amounts of food in one go and then engage in behaviour to compensate for the food eaten, such as making themselves sick, fasting, taking laxatives, or excessively exercising. Some other possible signs of bulimia include: • Disappearing after meals • A feeling of being out of control around food • Sore skin on the backs of hands or fingers if used to cause vomiting • Bad breath or tooth decay due to being sick • Weight fluctuations Anorexia Anorexia usually involves severely restricting food intake. Excessive exercise and binge/purge cycles may be factors in someone’s anorexia too. Some other possible signs of anorexia include: • Distorted perception of weight • Preoccupation with and/or fear of gaining weight • Obsessive behaviour such as counting calories • Difficulty focusing • Weight loss • Wearing baggy clothes to hide weight loss Pg 07  Binge eating disorder Binge eating disorder involves bingeing, i.e. eating large amounts of food at once, but not engaging in compensatory behaviour associated with bingeing in bulimia or anorexia. Binges are often planned in advance and carried out in secret. Some possible signs of binge eating disorder include: • Spending lots of money on food • Feeling out of control around food • Eating more rapidly than usual • Eating when not hungry • Weight gain OSFED Sometimes someone’s symptoms don’t fit all the diagnostic criteria for anorexia, bulimia, or binge eating disorder. In that case, they might be diagnosed with “other specified feeding or eating disorder” (OSFED). Less commonly nowadays, you might hear the term “eating disorder not otherwise specified” (EDNOS). An OSFED or EDNOS diagnosis does not mean that the eating disorder is less serious. Signs of OSFED might include any of those mentioned above. For more information about specific types of eating disorder and what to look for if you're worried about someone, visit beateatingdisorders.org.uk. Pg 08  Pg 09 How can I approach someone I think has an eating disorder? It can be difficult to raise the issue – you may worry you’ll say the wrong thing, that it’s none of your business, or that you’re insulting the person. Remember eating disorders are serious mental illnesses and are not the sufferer’s fault. Often people with eating disorders deny or don’t realise there’s a problem, but that doesn’t mean they’re not ill. Eating disorders thrive on secrecy, and countless people who are in recovery agree that breaking the silence is the right thing to do, even if they didn’t feel that way at the time. The sooner someone can get treatment, the greater their chance of a full and sustained recovery. Here are some things you can do when talking to someone you’re worried about: • Think about what you want to say and make sure you feel informed. Reading this booklet is a good start. You could also look at the information on our website. • Choose a place where you both feel safe and won’t be disturbed. If you’re one of several people who have felt concerned, don’t talk to the person together as they may feel you’re ambushing them. Decide who they are most likely to open up to. • Choose a time when neither of you feels angry or upset. Avoid any time just before or after meals. • Have some information with you that you can refer to if you’re able to. You could share it with them, or leave it with them to look at by themselves. When my mum and partner expressed how worried they were…although part of me was annoyed and in denial, a huge part of me felt relieved. " "  • Try not to centre the conversation around food and/or weight. While it may be necessary to bring this up to explain why you’re worried, these may be things they’re particularly sensitive about. At their roots, eating disorders are about what the person is feeling rather than how they’re treating food. • Mention things that have concerned you, but try to avoid listing too many things as they may feel like they have been “watched”. • Try not to back them into a corner or use language that could feel accusatory. “I wondered if you’d like to talk about how you’re feeling” is a gentler approach than “You need to get help”, for example. • They may be angry and defensive. Try to avoid getting angry in response, and don’t be disheartened or put off. Reassure them that you’ll be there when they’re ready, and that your concern is their wellbeing. • Don’t wait too long before approaching them again. It might feel even harder than the first conversation, especially if they didn’t react well, but if you’re still worried, keeping quiet about it won’t help. Remember, eating disorders thrive on secrecy. • If they acknowledge that they need help, encourage them to seek it as quickly as possible. Offer to go with them to the GP if they would find that helpful. • If they tell you there’s nothing wrong, even if they seem convincing, keep an eye on them and keep in mind that they may be ill even if they don’t realise it. Denial that there’s a problem is common – in the case of anorexia, it’s considered a symptom of the illness. You were worried for a reason, so trust your judgment. If you need some support or have unanswered questions, call Beat's Helpline on 0808 801 0677. Pg 10  Pg 11 Treatment for eating disorders While eating disorders are serious illnesses, full recovery is possible. At Beat, we champion early intervention. Research shows that the sooner an eating disorder is treated, the less chance the behaviour and thoughts that cause it have to become ingrained, and the greater the chance of recovery. When we talk about early intervention, we don’t mean that someone who has had an eating disorder for a long time cannot fully recover. However, as with any illness, we would always encourage someone to seek treatment sooner rather than later. This is also true if a person relapses. There are many different treatment pathways. The right one for the person you support will depend on lots of different things, including level of physical and psychological risk, what eating disorder they are diagnosed with, their age, support network, and other physical or mental illnesses they might have. Treatment for eating disorders should address the underlying psychological causes of the illness. It should of course treat any physical problems too, helping the patient to develop healthy eating behaviours and maintain a healthy weight. But alongside this, they should be learning healthy ways to cope with the thoughts and feelings that cause the behaviour. I agreed to see a GP if one of my parents came with me and, looking back, this was the beginning of the treatment that I so desperately needed. " " I would have probably struggled to make the decision to go [for treatment] on my own. " "  The path to recovery will likely begin with a visit to the GP. If they diagnose an eating disorder, they should refer the person to an eating disorders specialist. Our GP leaflets, available on our website, are designed for people to take along to the GP appointment. Some other things you can do to help get a positive outcome include: • Bring as much information as possible. People in England, Wales, and Northern Ireland should consult the NICE (National Institute of Clinical Excellence) guidelines for treatment at nice.org.uk. These guidelines are based on thorough research into what is effective. “Eating Disorders in Scotland – A Patient’s Guide” is available at healthcareimprovementscotland.org. • Offer to go with the person for support. You could stay in the waiting room, or go in with them so you can prompt them if they need it. • Book a double appointment, as a single appointment may not be enough time to discuss everything. • Talk with the person beforehand about how they’re feeling and what they want to get out of the appointment. Suggest they write down their symptoms, behaviour, and any questions they have for the GP so they don’t forget anything they want to say. • Earlier treatment is always better, so it’s important to support the person in pushing for referral to an eating disorders specialist. • The person you’re supporting can ask to see another doctor if the initial appointment doesn’t get the desired outcome. Pg 12  Pg 13 If the person you’re supporting can’t get a referral from the GP, there are other options for treatment. Search our Helpfinder for independent and private treatment centres and practitioners, or see the Next Steps section at the end of this booklet. Specialist treatment may include appointments with a clinical psychologist, psychiatrist, counsellor, dietician, or a combination. Talking therapies, such as cognitive behavioural therapy, are recommended, as these address the underlying causes. Medication can be effective in treating some symptoms – for example, certain types of antidepressants may be prescribed for bulimia. Most often, appointments will take place in outpatient facilities, and their frequency will depend on individual needs. Where someone needs more supervision with their eating, it may be necessary for their treatment to take place in a day patient unit, meaning they are there during the day and go home for the night. If constant supervision is needed or there is major concern about physical complications, someone may be admitted to an inpatient facility, where they stay overnight as well. For under 18s, these services are likely to be administered by your local Children and Adolescent Mental Health Service (CAMHS). In rare instances, someone might be very ill but not willing to enter treatment. In this case, compulsory treatment under the Mental Health Act may be necessary. You can read more information about the Mental Health Act on the NHS Choices website. The Beat website has more information about different types of treatment.  Confidentiality By law, the healthcare team keeps detailed information confidential. As long as they’re deemed capable of making decisions about their treatment, children under 16 are entitled to decide how information they provide in confidence is used. People of 16 and 17 are entitled to the same confidentiality as adults. The Department of Health requires a breach of confidentiality only if they refuse treatment for a life-threatening illness. However, respect for patient confidentiality shouldn’t mean healthcare providers don’t listen to or communicate with you. You should expect to be given enough information by healthcare providers to be able to provide effective care. Remember, anything you as a carer share with professionals should also be treated confidentially. Pg 14  Supporting someone with an eating disorder It’s important to encourage the person into treatment as quickly as possible to ensure the best chance of recovery. But beyond that, there’s a lot you can do to support someone with an eating disorder, no matter what your relationship with them. Remember that each person is different and will need different things, but this will give you some ideas about what you can do to help. Mealtimes are likely to be very hard for the person you’re supporting. Below are some ways you can help them out: • If you live with them, plan to eat together. Arrange with them and anyone else who will be present what time you’ll be eating, what you’ll be having, and portion sizes. • Meals should be balanced, with a range of foods and sensible portions, taking into consideration the dietary needs of everyone else at the table as well as the person with the eating disorder. • Make sure you have everything necessary for the planned meal. Last-minute changes could cause the person to panic, and in the case of anorexia and other restrictive eating disorders, they might limit their food intake. • Shopping together may allow you to introduce new foods that they’re willing to eat in the case of restrictive eating disorders, and discourage them from buying food to binge on where bingeing is a factor in their eating disorder. • Keep conversation neutral, avoiding discussion of food or weight. • You could have the television or radio on to help distract them and to draw attention away from them. Don’t give up – it’s hard, but keep going. " " Pg 15