Recognising an eating disordered client/student

1. Recognising an eating disordered client/student W: www.firststepsderby.co.ukF: facebook.com/firststepsderbyshire.co.ukT: @firststepsD First Steps Derbyshire - Do not replicate without explicit permission

2. Welcome and Introductions • Ground Rules, Facilitator introduction First Steps Derbyshire - Do not replicate without explicit permission

3. Structure of the session Afternoon session Eating Disorders (ED) types, signs and symptoms ED causes/vulnerabilities First Steps Derbyshire - Do not replicate without explicit permission

4. Aims • To enable front line staff to recognise a client/student who is struggling with disordered eating. First Steps Derbyshire - Do not replicate without explicit permission

5. Please Remember… Each client you encounter is unique and may have a variety of underlying issues and influences in their life.. Therefore, there is no ‘magic cure.’ In our experience there are no set answers or ways to work with an individual who has such a complex psychological problem First Steps Derbyshire - Do not replicate without explicit permission

6. Activity – ‘Bad Day’ • As a whole group, discuss what would happen in a bad day. • Individually, how would you cope with having a bad day? • What would you do if you didn’t have these coping strategies? First Steps Derbyshire - Do not replicate without explicit permission

7. No Coping Strategies? • Eating Disorders are often a way of ‘coping’ with problems and stress  • To overcome an Eating Disorder, the person will need to learn new and positive ways of dealing with difficult issues in their life First Steps Derbyshire - Do not replicate without explicit permission

8. A Continuum First Steps Derbyshire - Do not replicate without explicit permission Body Acceptance Normal and healthy eating habits Healthy weight for age, height and body type Restricting ‘Allergies’ Yo-yo dieting Celebrity diets Weight and body shape preoccupations Comfort eating Over exercise Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder OFSED

9. Discussion - Eating Disorder Types • Anorexia Nervosa • Bulimia Nervosa • EDNOS (Eating Disorders Not Otherwise Specified- incorporating Binge Eating Disorder) - EDNOS is now recognized as OSFED, ‘other specified feeding or eating disorder’ First Steps Derbyshire - Do not replicate without explicit permission

10. Activity – Eating Disorder Types • Consider all eating disorder types, signs and symptoms in groups First Steps Derbyshire - Do not replicate without explicit permission

11. Vulnerabilities • There are stations placed around the room with potential ‘vulnerabilities’ that may cause an eating disorder • Explore the stations individually and put your named post it notes in the vulnerability box you rank as the most common • You only have 3 notes, therefore you can only choose 3 vulnerabilities First Steps Derbyshire - Do not replicate without explicit permission

12. Vulnerabilities Group discussion What was your rationale? First Steps Derbyshire - Do not replicate without explicit permission

13. Co-morbidity of Psychiatric Illnesses with Eating Disorders. • Approximately 45% to 86% of people with eating disorders have depression • Approximately 64% of people with eating disorders have an anxiety disorder • Approximately 58% of people with eating disorders have a personality disorder • The standardized mortality rate for suicide among people with eating disorders is 23.14 – the highest of any psychiatric illnessNational Eating Disorders Collaboration, 2013 First Steps Derbyshire - Do not replicate without explicit permission

14. A report commissioned by Beat in 2015 estimated that more than 725,000 individuals in the UK are affected by an eating disorder (NHS, 2016). First Steps Derbyshire - Do not replicate without explicit permission

15. Commonalities • Intense negative thoughts about self & world • Hidden emotion behind ED • Low self worth • Starved/unbalanced brain • High /low emotional state • Fear about change/leaving safety of ED behaviour First Steps Derbyshire - Do not replicate without explicit permission

16. Closing the session… • Any questions? • Complete evaluation sheetsPlease could you fill in the evaluation sheets found within your folders First Steps Derbyshire - Do not replicate without explicit permission

17. Anorexia - Inpatient treatment is required if physical health is very poor or the individual is at risk • Bulimia - Self-help may be recommended by your GP In the majority of cases all treatment for bulimia will be as an outpatient • Binge eating disorder - Self-help is often suggested initially Psychological treatment might be recommended plus medication Someone with binge eating disorder is generally unlikely to be admitted as an inpatient BEAT, 2016 First Steps Derbyshire - Do not replicate without explicit permission

18. Signposting and Information Sources Organisations that may be useful: • First Steps - http://firststepsderbyshire.co.uk/ • BEAT - https://www.b-eat.co.uk/ • Mind - http://www.mind.org.uk/information-support/types-of-mental-health-problems/eating-problems/#.V_-greArLcs • Derbyshire Healthcare - http://www.derbyshirehealthcareft.nhs.uk/services/mental-health/eating-disorders/ • National Centre for Eating Disorders - http://eating-disorders.org.uk/ First Steps Derbyshire - Do not replicate without explicit permission

19. Recommended Reading • Shelley, R. 1997. Anorexics on Anorexia. London: Jessica Kingsley Publishers • Stavrou, M. 2008. Bulimics on Bulimia. London: Jessica Kingsley Publishers • Treasure, J. and Schmidt, U. 1993. Clinician's Guide: Getting Better Bit(e) by Bit(e). Clinician's Guide: Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders. London: Routledge. • Fairburn, C. (2013) Overcoming Binge Eating, Second Edition, London: Guildford Press. • Fairburn, C. 2008. Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press. • Treasure. J. 2007. Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method. London: Routledge. • Treasure, J. 1997.Anorexia Nervosa: A Survival Guide for Families, Friends and Sufferers. East Sussex: Psychology Press First Steps Derbyshire - Do not replicate without explicit permission

20. Johnston, A. 2000. Eating in the Light of the Moon: How Women Can Transform Their Relationship with Food Through Myths, Metaphors and Storytelling. CA: Gurze Books • Leach, K (2006) The Overweight Patient: A psychological Approach to Understanding and Working with Obesity.  Publishers, London and Philadelphia: Jessica Kingsley. • Brooke, S. 2008. The Creative Therapies and Eating Disorders. Illinois: Charles C Thomas Publisher. First Steps Derbyshire - Do not replicate without explicit permission

21. References Adult Psychiatric Morbidity Survey. 2007. Accessed online: http://www.ic.nhs.uk/pubs/psychiatricmorbidity07 Barker, P. 2008. Psychiatric and mental health nursing: the craft of caring. USA: Taylor and Francis BEAT. 2016. Help and treatment. Accessed online at: https://www.b-eat.co.uk/about-eating-disorders/help-and-treatmentDosil, J. 2008. Eating Disorders in Athletes . West Sussex: John Wiley and Sons. Goodheart, K.l., Clopton, J.R. & Robert-McComb, J.J. 2012. Eating Disorders in Women and Children: Prevention, Stress Management, and Treatment. USA: Taylor and Francis Grilo, C. & Mitchel, J.E. 2012.Treatment of Eating Disorders: A Clinical Handbook. New York: Guilford Press.Hamilton, K. and Waller, G. 1993. Media influences on body size estimation in anorexia and bulimia. British Journal of Psychiatry. Vol 162, p. 837-840. Markowitz, J. .1998. Interpersonal psychotherapy Washington: American Psychiatric Press Maine Mellace, J. 2010. Eating Disorders Not Otherwise Specified — Real Disorders, Real Risks. Social Work Today10 (4).MIND.2016. Accessed online at: http://www.mind.org.uk/National Eating Disorders. Get The Facts On Eating Disorders. Accessed online at: https://www.nationaleatingdisorders.org/get-facts-eating-disordersNHS. 2015. Eating disorders. Accessed online at: http://www.nhs.uk/conditions/Eating-disorders/Pages/Introduction.aspx National Institute of Health and Clinical Excellence (NICE) guidelines. 2016. Accessed online at: http://www.nice.org.uk/guidance/cg9/chapter/1-recommendations.National Services – South London and Maudsley. 2016. Accessed online at: http://www.national.slam.nhs.uk/services/adult-services/eatingdisorders/faq/Posluszny, D. and Arnold, R. 2008. Facts and Concepts # 203. Available: http://www.eperc.mcw.edu/FileLibrary/User/jrehm/fastfactpdfs/Concept203.pdf. First Steps Derbyshire - Do not replicate without explicit permission

22. RECOVERY: South London and Maudsley NHS Foundation Trust (2010) Recovery is for All: Hope, Agency, and Opportunity in Psychiatry. Accessed online at: http://www.rcpsych.ac.uk/pdf/Recovery%20is%20for%20all.pdfReel, J.J. 2013. Eating Disorders: An Encyclopedia of Causes, Treatment, and Prevention. California: ABC CLIO STATISITICS: Maria Makino, MD, PhD, Koji Tsuboi, MD, PhD, and Lorraine Dennerstein, AO, MBBS, PhD, DPM, FRANZCP (2004) Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries. MedGenMed. 2004; 6(3): 49. Published online 2004 September 27.  Watts, L.M. 2001. Countertransference: A Psychological Aspect of Nutritional Counselling. Eating Disorders Review. 12 (3)  Wessler, R.L., Hankin, S. & Stern, J. 2001). Succeeding with Difficult Clients: Applications of Cognitive Appraisal Therapy. California: Academic Press. Health and Social Care Information Centre (HSCIC). ‘Eating disorders: Hospital admissions up by 8 per cent in a year.’Accessed online at: http://www.hscic.gov.uk/article/3880/Eating-disorders-Hospital-admissions-up-by-8-per-cent-in-a-year First Steps Derbyshire - Do not replicate without explicit permission