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EG is a 16-year-old female who had been told by family, friends and coaches throughout her sporting life that she is destined for the Olympics if she keeps training hard. She has had many successes to date. She trained with a swimming club since she was aged four. E is a top-three short distance national swimmer for her age group. Her most recent success was coming 2nd in the under-15 age category at last summer’s British championships.
This chapter introduces the reader to current treatments for Anorexia Nervosa and Bulimia Nervosa. Much of the evidence is summarised within NICE guidelines (and APA and Australian and New Zealand guidelines) but in this chapter, treatment is also linked to the age of the patient and stage of the illness. Although this chapter is lengthy it is one of the three core chapters.
Dieticians play an important role in managing eating disorders – not just looking at nutrition but providing psychoeducation around nutrition, helping patients begin to normalise eating and making sure nutrition is adequate for growth, development and life-style. The reader is introduced to the depth and range of work that a dietician is able to provide.
Transitions in patients with an eating disorder are a high-risk time for relapse, with increased risks of relapse and hospitalisation – and risks due to being lost between services. A variety of different types of transitions are discussed and considered within this chapter.
This chapter looks at ethical and medico-legal aspects of eating disorder treatment. Legal frameworks for involuntary treatment of this illness may be needed when risks are high and capacity is lacking. The reader is also introduced briefly to some of the different legal frameworks present in England, Northern Ireland, and Scotland. We mention eating disorder legislation in the United States. Ethical aspects of care are also discussed and should provoke thoughtfulness no matter what part of the world the clinician is working in.
This chapter focusses on presentations in children and adolescents. Although ARFID (avoidant restrictive food intake disorder) is not covered in many guidelines yet, it is discussed here – due to being both a risk factor for anorexia nervosa and important to clinically distinguish from anorexia nervosa.
Risk assessment is a key area within looking after a patient with an eating disorder and this chapter is one of the key chapters for any trainee. Eating disorders carry high levels of physical health risk which need monitoring and managing but additionally the behavioural and psychosocial risks must not be neglected. This is one of the three core chapters identified within the book.
Carers are a valuable resource for a patient who is suffering from a severe eating disorder. The treating team does need to respect confidentiality but also acknowledge the risks that a carer may need to be aware of when looking after a relative with an eating disorder.
This chapter briefly summarises some of the causes of eating disorders and introduces the reader to the concept of bio-psycho-social formulation and how to develop a formulation with the patient, looking at predisposing factors, precipitation (trigger) factors, and maintaining factors within an eating disorder.
The reader is introduced to the contentious concept of severe and enduring eating disorders which may not have responded to traditional treatments. It suggests a potential staging model and encourages the reader to make links with patients they might be seeing in order to understand this further.
The focus of this chapter is on body image and how poor body image contributes to the development and maintenance of an eating disorder. The reader is introduced to formulation around this and some of the current evidence base.
We can think of transitions as ‘life events’ or ‘life-cycle changes’. In addition, there can be specific challenges for those with eating disorders due to the specific cognitive difficulties they present. These include a lack of flexibility and difficulty in terms of seeing the ‘bigger picture’ when faced with a particular issue. Those patients with anorexia and strongly obsessional disorders can find ‘set shifting’ particularly difficult – that is, when the ‘rules’ change, they struggle to shift to the new rules instead of the old ones. It is hard for them to learn new adaptive skills or mobilise and generalise learned adaptive skills to a new situation. Their capacity to adapt is further impaired by starvation and low weight, which exacerbates rigidity of thinking.