Supporting a young person with a restricted eating disorder (PDF)

PATIENT INFORMATION Supporting a Young Person with a restricted eating disorder Welcome to Devon Child and Adolescent Mental Health Service (CAMHS) We work closely with our paediatric colleagues in the local general hospitals to keep children and young people safe as they recover from an eating disorder. More about Us This is a specialist service for the physical and psychological assessment and treatment of young people who might have physical and/or emotional difficulties caused by a low body weight or issues with food or eating. Our service treats all of these difficulties very seriously as the severe weight loss associated with anorexia nervosa, for example, starvation, leads to serious complications. These can include:  Lower body temperature  Decreased blood pressure  Decreased heart rate  Rough and dry skin  Loss of hair  Loss of menstruation in young women  Osteoporosis (brittle bones) Because the body isn’t being fed, it turns to muscle for fuel. This causes weakness, fatigue and in particular, decreased cardiac mass (the heart being a large muscle), which can prompt dangerous changes in heart rhythm and cause cardiac failure, resulting in death. Your child will be monitored whilst receiving treatment, which may include very regular medical and psychological therapies, and advice on how to become healthy again. Helping your child eat more  Why is being underweight a problem? Not eating enough food and being underweight can cause serious health problems. In the short term, you may notice your child:  Feels tired  Has poor concentration, sleep disturbance, tiredness  Feels cold  Has thinning hair  Has dry and discoloured skin and nails  Feels anxious and has low or changeable mood  Becomes withdrawn  Is constipated  Has poor strength  Describes a lack of interest in eating and hunger  Periods have stopped (in girls)  Feels dizzy and faints In the long term, being underweight may also lead to:  Stunted growth (being shorter than we would expect)  Brittle bones (osteoporosis)  Infertility in women (if your child’s periods don’t resume)  Doing poorly in exams or failing to complete education Being very underweight can quickly have very serious consequences. For example, it can stop your child’s heart from working effectively. Whilst it is rare, some young people with very low body weight can die. What you can do You can encourage your child to make some changes to improve their weight and diet:  Eating regularly during the day  Choosing foods and drinks that are higher in energy  Including foods from all different food groups daily Most young people need to eat at least three meals a day to maintain a healthy weight. This means eating breakfast, lunch and dinner (including puddings) every day. If your child is underweight, they will need to take extra energy to help restore a healthy weight. You can help by offering and encouraging snacks between meals, for example, adding in a mid-morning, mid-afternoon and evening snack. When your child is struggling with eating, it is important that the food you offer provides plenty of energy. Low calorie foods that are high in fibre will leave your child feeling too full to eat more. Here are some examples of changes you could make:  Avoid buying ‘diet’, ‘light’, or ‘low fat’ foods  Chose whole milk rather than semi-skimmed or skimmed milk.  Provide milky drinks, smoothies or pure fruit juice rather than sugar free squash, water or black tea or coffee.   Use butter or full fat margarine  Use extra butter, cream, sugar, cheese or mayonnaise to add energy to your child’s foods.  Keep portions of fruit and vegetables small – these are high in fibre but low in energy, and will fill your child up too much  Choose lower fibre starchy foods such as white bread rather than granary bread – this will help your child feel less full. Eating a healthy diet is not just about getting enough energy to grow and develop. We also get other important nutrients from our diet, for instance, calcium for strong bones. The main food groups are: Food Group: Examples: Provides: Starchy foods Bread, potatoes, pasta, rice, cereals Energy, fibre and vitamins Protein foods Meat, fish, egg, nuts, soya, pulses, Quorn, tofu Protein, vitamins and minerals e.g. iron Dairy foods Milk, cheese, yoghurts, custard Energy, protein and calcium Foods containing fat and sugar Spreads, oils, cream, chocolate, sweets, biscuits, crisps, cakes, pastries Energy Fruit and vegetables Fresh, tinned, frozen, dried Vitamins, minerals and fibre Help your child include foods from each of the food groups daily. You can do this by:  Providing some starchy foods, dairy products and a portion of fruit at breakfast  Providing starchy food, protein and a portion of vegetables, followed by a pudding from the fat and sugar group with a dairy portion at main meals.  Snacks are an ideal time to include dairy products or extras from the fat and sugar group. Examples of meals and snacks Here are some good choices for meals and snacks. These can be adapted to include foods your family enjoys. Breakfast:  Toast with butter and a banana milkshake made with whole milk  Muesli topped with pouring yoghurt and chopped fruit  Croissant and a thick and creamy yoghurt and grated apple  Boiled egg and soldiers with a fruit and yoghurt smoothie  Bowl of granola with whole milk, topped with raisins. Main Meals:  Fish fingers, chips and peas, followed by hot cake and custard  Pasta with tomato sauce and grated cheese with salad, followed by syrup sponge and cream.  Sandwich with tuna mayonnaise filling, followed by a thick and creamy yoghurt, a banana and a flapjack.   Jacket potato with butter and baked beans topping with a side salad, followed by a pot of rice pudding and a chocolate bar. Snacks:  Hot chocolate made with whole milk  Fruit smoothie made with whole milk, yoghurt and/or ice cream  Chocolate bar  Flapjacks  Biscuits  Muffins  Thick and creamy yoghurts  Pots of custard or rice pudding  Toast and topping  Cheese and crackers  Mixed dried fruit and nuts Frequently Asked Questions Isn’t eating foods that contain fat and sugar bad for my child? Being underweight is harmful to your child’s body, and the most important thing they can do to be healthier is to regain some weight. Foods that are high in fat and sugar are essential to help your child do this, because they add extra energy without adding too much bulk to the diet. Foods that contain fat and sugar will not harm your child; in fact, even in young people who are a healthier weight, fats and sugars are absolutely essential to keep their bodies running effectively. My child just feels too full to eat, what can they do? If your child has been underweight and eating poorly for a while, their stomach may be smaller and they may not feel hungry. Things can improve, but they will need to work hard at eating more before they notice a difference. Discomfort after eating will soon subside. By spreading food out over the day into three meals and three snacks, you can help your child feel more comfortable. Choosing foods that are higher in fat and lower in fibre will help avoid excessive fullness. Does being vegetarian matter? Being vegetarian won’t prevent your child from regaining a healthy weight and eating a balanced diet. You will need to make sure you offer vegetarian alternatives to meat and fish, such as eggs, Quorn, tofu, nuts, cheese and beans. If your child is vegan (they avoid all animal products including milk and eggs), you will need specialised advice from a dietician. If my child eats less fibre, won’t they be constipated? The main reason for constipation in people who are underweight is simply not eating enough food. The less you put in, the less comes out! Eating regular meals and increasing portion sizes will help improve your child’s constipation. Once they feel comfortable managing this and their weight improves, you can then start adding higher fibre foods back into their diet.  My child is not eating very much at the moment. How quickly should I aim to build up their diet? Gradually increasing the diet is usually helpful, as long as it doesn’t take so long that weight continues to drop rapidly. A useful guide is to aim to include one additional meal, snack or pudding every day. How do I help my child actually eat the food I’m offering? Your CAMHS team will be working with you to help you and your child decide which strategies would be most supportive. Some families have found the following general pointers useful:  Try to eat together with your child so that you can support them if they are finding eating difficult.  Make the decision about what your child will be eating – it will be too difficult for them to decide what food they need to eat.  Serve out an appropriate portion of food for your child  Sometimes the time directly after a meal can be difficult, so a gentle distraction like playing a board game or watching TV together may help.  If one meal or day is very challenging, don’t give up, the next day will be better.  Supporting mealtimes can be stressful, so share mealtime support with your partner or other suitable family members.  If your child has restricted the number of foods they are willing to eat over time, offer suitable foods that your child enjoyed before they lost weight. You will then know if it is the eating difficulties that are causing your child’s struggles, rather than a genuine dislike of the food. If you need more help managing your child’s diet, ask your doctor, school nurse or mental health worker to refer you to a dietitian. What strategies will help achieve change? Changes to these types of eating and other behaviour will take some time to achieve and require a great deal of patience. It will help to remember that your child has an illness and therefore is not always in control of his or her thinking and actions. We have found the following principles helpful and supportive for parents (see J.Lock and D LeGrange ‘Help your teenager beat an eating disorder’ for further detailed information)  Work with experts who know how to help you  Work together as a family and support each other  Don’t blame yourself or your child for the problems you’re having  Don’t debate with your child about eating or weight related concerns  Acknowledge their feelings and emphasise that no matter what, you will be there for them.  It will be tough at time, but do not be tempted to give up too soon or lower expectations.  Remember to take care of yourself Managing Meltdowns  Here are 10 tips for managing meltdowns: 1. Stay Calm  You are your child’s anchor, during the storm  Your child needs to know that he or she has a strong and supportive adult to depend on when the eating disorder becomes too difficult to manage.  Your child needs to know that they are still loved and accepted by you. 2. Stay Positive  Remind yourself and your child that you have the skills to manage stressful situations and have done so before.  If you are feeling overwhelmed and cannot remain calm and positive, give yourself permission to take a short five minute break. Come back to the situation (such as a discussion or meal) when both of you are calm and ready to proceed.  Share the tasks together and take turns – let one parent deal with the problem so the other can step back, then switch over. 3. Be consistent  Remain consistent with your rules and work together as a team – don’t give into meltdowns  If you remain consistent with your approach, your child will know that you are able to remain firm in the face of strong emotions and meltdowns will soon decrease. 4. Be supportive  Be encouraging to your child and use supportive statements such as ‘I know this is hard for you’, ‘we’ll get through this together’.  Don’t use statements such as ‘Don’t worry you’re not fat’ or ‘You still look skinny’.  Focus on your child, not the eating disorder. 5. Be proactive  Try to foresee stressful situations, for example, if you know your child has difficulty eating in restaurants or at large family gatherings.  Plan the outing together and have a back-up plan ready  Pay close attention and anticipate your child’s anxieties. 6. Use positive coping skills  Just as you are aware of your child’s anxieties, remember that he or she is aware of yours.  It is important to be aware of your own anxiety and to model positive coping strategies.  7. Use relaxation techniques  Practice relaxation or mindfulness techniques at home with your child.  Focusing on something else other than food, such as breathing or relaxing music, can be calming for you and your child – this is most helpful for children who find bedtime or sleeping difficult. 8. Trust your judgement  Do not let the eating disorder take away your normal judgement as parents.  Your child needs natural consequences for unacceptable behaviours, just as he or she did before the eating disorder.  Engage your child in finding a solution – they don’t like feeling out of control any more than you like to see them distressed.  After a difficult time, ask your child what he or she would like from you next time – often it is something simple such as ‘ I want you to listen, not try to solve my problem’.  Don’t forget to use distraction and relaxation strategies – you may need to take the lead in this area. 9. Look for triggers  It is important for your child to recognise the connection between stress and thoughts related to eating disorders.  Ask your child if there is anything that has been upsetting him or her.  Ask questions such as ‘How are things at school?’, ‘…with your friends?’, ‘…with the rest of the family?’ 10. Remember that meltdowns are normal  Most importantly, remember that it is normal for all children to have meltdowns and that this is a part of the recovery process.  Your child needs to be able to express his or her feelings in a safe and comfortable environment.  Acknowledge their feelings and emphasise that no matter what, you will be there for them. Managing meal times together What to manage before mealtimes  Meal and snack times will make young people extremely anxious because their fear of weight gain and eating will be overwhelming. They will be feeling guilty about eating and may have distorted ideas about food, making it hard for them to see the need to eat.  Initially you will need to take back control for all food and meals. This will include shopping, preparing and plating up meals and snacks, as well as deciding on the menu. Your child’s only job is to eat what is on the plate. The dietitian will advise you about portion sizes.   Discourage any weighing or checking of food labels (such as for calories and fat) as this behaviour only worsens the eating disorder. Do not buy or provide low fat or diet versions of food unless previously agreed with the dietitian.  Encourage normal wholesome foods. The ideal goal is to have your child eating the same food as the rest of the family or as they did before they became unwell.  Never leave more than three hours without ensuring your child eats, sometimes less. They should be having three regular meals – breakfast, midday lunch and an evening meal, plus three snacks in between these meals every day.  Plan to include your child in your family mealtimes or sit and join them in theirs. Do not allow eating alone or eating in their rooms as this will maintain negative eating behaviours and patterns. Notice obstructive eating behaviours Young people with eating disorders may display unusual or inappropriate eating behaviours at the dining table. Some of these behaviours may include:  Delaying the start of the meal  Dissecting food into tiny pieces  Tearing food apart – this is particularly applicable to food such as sandwiches or toast.  Picking at parts of all the meal or smearing food around the plate  Playing with and pushing food around the plate  Eating at a very slow pace or bolting the food down without really chewing it  Hiding, dropping or smearing food  Inappropriate mixing of food types or using lots of sauces or salt/pepper In order to minimise these behaviours, it can help to have a realistic time frame for each meal. Suggested time frames are:  Breakfast – 30 minutes  Lunch – 45 minutes  Dinner – 45 minutes  Snacks – 15 minutes In sticking to these guidelines, maintain the expectation that all food should be eaten within the time given and any dropped or hidden food will be replaced or made up at the next meal. What you can do during a meal  Try to keep the atmosphere and meal times as light-hearted and relaxed as possible (even when you don’t feel that way inside). In order to do this, it will help to keep the main focus off the child with the eating disorder and avoid discussing feelings during meals.  Parent and carers can be good role models. By modelling normal eating behaviour, you will encourage your child to do the same. Gently challenge any abnormal eating behaviour as this helps the eating disorder to persist.  It is helpful to avoid discussing food or calories during meals. This is because your child has distorted views and beliefs about food, and being drawn into long arguments about portion size or food content and arguing at meal times  will not change their views or persuade them to eat. Try to change the subject or distract them from the topic.  Try to have everyone arrive at the table together and remain until the whole meal is finished. Ensure that the child with the difficulty does not have to wait for the food to be served in order to minimise their distress and anxiety.  Privately ask siblings and other family members not to make comments about food, weight, appearance or eating habits. Avoid overly focusing attention just on the child with the eating disorder and enjoy the meal.  Discuss interesting or funny things that happened during your day, or hobbies, movies, friends or places to visit. If lots of people are eating, think of some distracting activities to do at the table such as trivia questions, puzzles or quizzes.  Try to stay positive and calm throughout the meal. Remember that your child’s eating difficulties are no one’s fault. It can be hard not to blame your child or yourself. Many families find it helps if they can find a way to manage the stress and frustration, such as silently counting to 10, focusing on a soothing image, and remembering to breathe. You will need to find a balance between being understanding and remaining firm. This will help your child to feel understood whilst at the same time challenge their thinking and behaviour. This is very difficult and takes time and practice to manage. Example Young Person: “I can’t eat that! It will make me fat & disgusting.” Parent/Carer “It must be very hard for you; you have not eaten cheese for so long.” (Understanding) “But you need to sit down and take the first mouthful. I know you can do it and you will be okay, come on…” (Be firm) Continue to reassure and distract your child, change the subject, but continue to be firmly encouraging. Helpful things to say during a meal To help you reduce your child’s anxiety and to distract them from repetitive negative thoughts, chat together about everyday things which will also help to lower the intensity during the meal. Be encouraging but avoid over praising and over focusing on eating. Try to keep all your comments positive, e.g. “I know you can do it”, or “you are nearly there” rather than, “why haven’t you eaten any more” or “you haven’t eaten everything yet”. Examples of positive statements:  “I am here for you, I know you can do it”  “ You will be okay”  “Nothing awful or terrible is going to happen”  “Concentrate only on here and now and eating this meal/snack”  “Getting you healthy and well is the most important thing to me”  Emphasise that no matter what, you love them and will always be there for them. Talk to your child about what they would find most helpful for you to say. How do I help my child actually eat the food I am offering? If your child has not started their meal within five minutes, offering gentle, reassuring and clear prompting can help. Using statements such as “I appreciate that this is really difficult for you, but you need to make a start on your meal now” can be helpful. Try to provide motivation and encouragement to work towards their goals for recovery and change, providing firm but tireless prompts to help them remain focused. Remaining positive and empathic rather than overly sympathetic can help reduce hostility. We would recommend using patience and perseverance to support and reinforce your child’s own goals and commitment towards recovery and change. Eating Disordered Behaviour We Would Recommend To maintain control of meals, portion or calories, your child may attempt or demand to get too involved in cooking the meal or dishing it up. Provide positive feedback but be firm in keeping the boundary, gently asking them to set the table or wash up instead. Delaying starting or finishing meals by constant visits to the bathroom or getting rid of food during the meal in the bathroom. Ask your child to use the bathroom before their meals and provide distraction and close supervision for up to an hour following the meal. During this time there should be no visits to the bathroom. Demanding special cutlery, e.g. using teaspoons for main meals or forks for yoghurts. These strategies slow down eating and are not helpful in re-establishing good eating habits. Firmly discourage and establish normal eating routines and standards. Contesting portion sizes or constantly asking, “how many calories has…. Got in it” or complaints such as “there is too much on my plate”, “it hurts my stomach” or “it is making me feel ill” Spread oils, cream, chocolate, sweets, biscuits, crisps, cakes, pastries. Making constant complaints about imagined discrepancies between meal sizes or calorific value Help your child remain mindful of their task and own meal. Provide distraction from others and re-focus on their own personal goals. Avoid eating low-calorie or diet foods in the front of your child or even having them in the house. Using water and liquids to fill themselves up in order to avoid eating a complete meal. Aim for one standard cup of fluid with each meal or snack. Limit the amount of liquid available to drink at the table. Hiding or dropping food during a meal – this can include:  Food hidden in serviette or tissue  Thrown in the fire or bin  Hidden in socks or sleeves  Butter smeared in hair  Food given to dog or cat  Food replaced into serving dishes  Hidden in plant pots or ornaments  Pushed onto others plates This urge is driven by fear of food or weight gain. It is easier if the supporting adult at a meal sits next to their child rather than opposite or across the table. This is less confrontational and also minimises opportunities to get rid of food. If noticed, calmly ask them to replace the food, or make up the value at the next opportunity. Becoming aggressive during mealtimes, throwing plates or food, kicking, punching or other violent behaviour, and Remember this behaviour is because your child feels terrified of food, weight gain, losing control or due to distorted  screaming or shouting abuse. thinking patterns. Do not put up with violence; if you allow yourself to be bullied, everyone will become controlled by the eating disorder. Be firm and clear, calmly set acceptable standards of behaviour and use short brief interventions such as a time out. Be consistent and set appropriate consequences. Try to focus on completing the meal rather than placing too much emphasis on every single behaviour to avoid getting caught up or distracted with behaviours rather than eating. Don’t despair if a meal goes badly, just move on and try and again next time. Other helpful strategies It might be helpful to encourage your child to use some simple mindfulness techniques. These are designed to help them be present in the moment. Let go of distressing thought and reduce stress. http://www.actonpurpose.com.au/Mindfulness-activities-for-young-children.pdf Alternatively, look at this short video together on easy mindfulness techniques: http://youtu.be/L-IZArfQHOo Other helpful ideas might be to make a table card with a personal statement, goal or inspirational quote to have beside them or even a favourite picture to provide on- going motivation or encouragement. What to manage after meal times After any meal, it can be helpful for your child to receive some support after they have eaten. They may have intractable feelings of guilt, shame and anger and need help to process their feelings positively. This will be especially true in the early stages of getting use to the changes in food intake. A family activity after the meal, such as a board game or watching TV, can help to distract your child from negative thoughts or potentially harmful behaviour’s such as purging or over exercising. This will give your child’s body time to rest and begin digesting their food. Try to use this time as an opportunity to spend some positive time together to praise and validate your child and support their achievements. We recommend a 30 minute rest period following a meal. During this time, your child’s anxiety or distress may significantly increase, triggered by feeling disgust at having eaten a meal or fears of weight gain. They may need intensive support at this time to avoid vomiting or over exercising. What if your child wants to talk to you directly about their eating disorder?  Prepare what to say in advance  Don’t be critical, blame or judge  Concentrate on how they’re feeling  Be prepared for a negative response  Stay calm  Try to give them a chance to express themselves  Resist the urge to argue or make judgements   Try to identify their emotions, even if they can’t at the moment, e.g. say something like, “You look/sound as if you are feeling very angry/sad”, rather than focusing on the contradictory messages or content being expressed.  Summarise what is being said from time to time and try not to disagree.  Try to separate the eating disorder from your child, remembering and holding on to how they were before the difficulties began.  Remember, one of the effects of starvation is that it causes changes in the brain, which make it very difficult for the sufferer to think in complex ways and ‘all or nothing’ thoughts can dominate. It then becomes impossible for them to negotiate or make compromises of any kind. This is why they may feel the day is ruined if they have eaten 50 more calories than they had planned to or if they thought they would be walking somewhere and then got a ride. In general terms, all eating disorders make it hard to think in normalised ways. It can also help to:  Be confident and relaxed, even if this is not what you are feeling yourself  Learn as much as possible about eating disorders and have resources to hand – it helps you to understand what you’re dealing with.  Avoid talking about your child’s appearance, even if it is meant as a compliment.  Try to build their confidence in other ways, e.g. by praising them for being thoughtful or congratulating them on an achievement at school.  Avoid talking about other people’s diets, looks or weight problems.  Talk to your child about the range of professional help available, and say that you’ll support them through everything.  Talk positively about activities they could be involved in that don’t involve food, e.g. hobbies or days out or activities with friends  Try not to feel hurt if your child doesn’t open up to you straight away, and try not to resent them for being secretive – this is due to their illness, not their relationship with you.  Ask your child what you can do to help them  Try to be honest about your own feelings – this will encourage them to do the same  Remember that the feeling behind the eating disorder may be really difficult for them to express  Try to be patient and listen to what they’re trying to say.  Try to remember to tell them you love them as often as possible Looking after yourself Having support for you is important. Prolonged time together with anyone who has a specific eating disorder is likely to provoke difficult thought and feelings in you. Examples include:  Finding yourself wishing that they would “just eat it”  Having the urge to shout “Stop playing around with your food”  Finding it hard to let go of these thoughts at the next meal with your child  Having intrusive thoughts that you might similar behaviours during meals  Feeling the need to eat lots after time spent with your child  Feeling controlled by the child with an eating disorder, whatever their age   Feeling under huge pressure not to do or say the wrong thing leading to strong feelings of guilt or frustration, and then shame for having these feelings. Strategies families find helpful Making time to talk together to reduce the stress and psychological impact that any eating disorder can have on families is a priority. The examples above are normal responses and it may help to talk about them so that you can work out strategies to dealing with them. If you are able to be open about how it is affecting you, it will enable you to share the burden together. As parents, you might have different styles of dealing with difficulties or talking to your children. However, it will help you to challenge the eating disorder more effectively if you can both reach a compromise on the approach you take, Do your best to keep each other up to date with everything that is happening and do not agree to keep secrets for the child with the eating disorder. It can be difficult to maintain your child’s recovery as your top priority when there are many competing demands such as work, school and the needs of other family members. Work together as a family and maintain a strong alliance with your partner or other supportive adults in your family in order to manage the frustrations and reduce stress. There is always the potential that your child will blame you for what they have to do, and they may try to make you feel guilty that they have to work against the one thing that is important to them. Try and be aware of the thoughts and feelings that this may generate in you, be mindful that they are just statements made to you at the height of your child’s distress, and accept that they are not personal, have no truth or validity, and let them go. The words spoken may feel very harsh and critical and will possibly make you think twice about what you are doing. Support each other to keep to the recovery plan. The eating disorder will want you to collude with it to save your child from having to challenge it; you need to remain strong in the fight against it and remind yourself that what you are doing is for your child’s recovery to full health. The most challenging times will be at the start and near the end of their recovery. This is when the internal thoughts will be at their strongest for your child, which will encourage them to hold onto their eating disorder even more. Challenge them and try to say strong, as this will get better over time. It’s possible that you yourself will have judgements about your child’s presentation and way of managing his or her diet. Try to observe these as being frustrations at the nature of the illness and not at your child. Making use of the supports around you will help to diffuse and accept their source, whilst remaining mindful of why you are doing this, to help your child in their recovery. When you feel supported, you can be stronger for the person you want to help. It is important to be realistic and accept that even with the best support it is very likely you will have days when the situation makes you feel completely hopeless. In these circumstances, you can’t expect to be strong all the time.  Keep up interests and hobbies   Maintain some of your social life  Use forms of relaxation such as massage, swimming, complimentary therapies.  Take a day off and entrust your child to a responsible friend or family member An eating disorder dominates not only the person experiencing it but also all the people who love them. Although your instinct will be to focus on their needs, it is crucial to continue your own life as well. Try to keep doing the things you enjoy and take pleasure in them, even if it is just meeting a friend for a coffee and cake! Further Information Help your Teenager Beat an Eating Disorder by J.Lock and D.LeGrange (ISBN 1- 57230-908-3; 2005: Guildford Press, New York) This book is highly recommended reading and will help families to take an active role in their child’s treatment. Ed says U said: Eating Disorder Translator by June Alexander and Cate Sangster (Jessica Kingsley Publishers 15 Dec 2012) This book helps to improve communication between someone with an eating disorder and their friends and family by revealing the eating disorder mind set. www.b-eat.co.uk The B-EAT website also offers excellent information and support as well as details for local support groups for carers. http://www.getselfhelp.co.uk/anorexia.htm Cognitive Behaviour Therapy (CBT) has been proven to help mental health problems. This website offers CBT self-help information, resources and self-help therapy worksheets on the free download/print pages. www.maudsleyparents.org A non-profit, volunteer organisation of parents who have used a family-based treatment called the Maudsley Approach to help their children heal from eating disorders. www.childrenandfamilyhealthdevon.nhs.uk For further assistance or to receive this information in a different format, please contact the department which created this leaflet. 25532 V1/Child Health/TSDFT/05.19/Review Date 05.21