Hampshire CYP Eating Disorder Team

Nicky Duncombe Lead Nurse

Dr Becky Neale Lead Psychiatrist

Overview and Aims

Identifying eating disorders in young people
Gathering important information from the family
Supporting young people and their families to
access specialist treatment
Having an overview of what specialist treatment
might involve

Identifying Eating Disorders

ICD-10 Diagnostic Criteria for AN Weight 15% below normal expected (or BMI 17.5)
Weight loss (or lack of gain) self-induced by
avoidance of fattening foods
Self-perception of being too fat and fear of fatness
Amenorrhoea (unless on COCP) in females and loss
of libido/potency in older males

Identifying Eating Disorders

ICD-10 Diagnostic Criteria for BN Recurrent episodes of overeating large volumes of
food in short time
Preoccupation with eating and cravings to eat
Counteractive acts of purging or starving
Self-perception of being too fat and fear of fatness

Identifying Eating Disorders

Symptoms and Signs- Psychological-preoccupation with body image, food, dieting, exercise
-fear of gaining weight
-change in mood (may be happier initially), personality
change, other mental health issues e.g. anxiety/
irritability/obsessional behaviours
-high interest in food preparation, calorific information of
different foods
-poor concentration

Identifying Eating Disorders

Symptoms and Signs- Physical-weight loss or lack of expected weight gain
-fainting or dizziness
-loss of energy, coldness, weakness
-poor sleep
-amenorrhoea
-constipation
-hair thinning, lanugo hair, callouses on hands

Identifying Eating Disorders

Symptoms and Signs- Behavioural-change in eating habits, secretive, hiding food,
avoidance of certain foods
-increased exercise
-vomiting, use of laxatives/appetite
suppressants/diuretics; often going to the toilet
-school and social functioning altered
-wearing baggy clothes
-obsessional behaviours

Identifying Eating Disorders

Top Tips-Always be wary of medically unexplained weight loss
-Young person may minimise or deny symptoms
-Concern may only be raised by parent/carer or school
-Females more affected but males too (10%)
-Beware of rapid weight loss (even if actual weight ok)

Gathering Information - What to Ask

Are you concerned about your weight? Have you lost weight?
Are you trying to lose weight? What is your ideal weight?
Have you cut down on the amount you are eating? What is your
typical days food and fluid intake?
Are there any foods you avoid?
How much exercise do you do?
Have you tried anything else to lose weight? (laxatives, diuretics,
appetite suppressants, vomiting)
Any physical symptoms? Loss of periods?
Any self harm or thoughts of self harm or suicide?
Avoid appearance-based comments and confrontation

Gathering Information - What to Ask

SCOFF Questionnaire can be used as a screening tool

Do you make yourself Sick because you feel uncomfortably full?

Do you worry that you have lost Control over how much you eat?
Have you recently lost more than One stone in a 3 month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

Score 1 point for every 'yes- score of 2 or more indicates likely

eating disorder and indicates further assessment.

Gathering Information Differential

Diagnosis
Endocrine diabetes mellitus, hyperthyroidism,
glucocorticoid insufficiency
Gastrointestinal coeliac disease, inflammatory
bowel disease, peptic ulcer
Oncological lymphoma, leukaemia, intracerebral
tumour
Chronic Infection tuberculosis, HIV, viral
Psychiatric depression, autistic spectrum condition,
OCD, anxiety

Gathering Information - Investigations

Height, weight and BMI or weight-for-height (BMI centile)

Rate of weight loss (1kg per week is high risk)
Blood pressure sitting and standing
Pulse sitting and standing
Temperature
ECG if underweight, if pulse 50 or any cardiac symptoms
Capillary refill
Squat and Sit Up Tests
Blood tests FBC, U&Es, LFTs, TFTs, ESR, Ca, Mg,
Phos, Zinc, Thiamine, Glucose, Iron, Albumin, Creatine
Kinase, Coeliac screen

Access to Specialist Treatment

Early intervention and immediate access to
specialist treatment leads to better outcomes
Include as much information as you can
All referrals are screened for urgency the day of
receipt
Urgent cases are seen within 7 days, routine within
4 weeks
If in doubt refer or seek consultation promptly!

Access to Specialist Treatment

EDT email SPNT.HantsCamhsEDT@nhs.net
EDT Consultation Number
0300 304 0062
EDT clinician on duty each weekday with
dedicated time slot 12.00-13.30

Access to Specialist Treatment

GP Support whilst awaiting specialist input Regular (weekly) monitoring, as young people can
become physically compromised very quickly
Referral to Paediatrics if one or more red criterion on
Junior MARSIPAN (and simultaneous referral to EDT
if not already done)
Low threshold for prescribing multivitamins and
thiamine
Prescription of the COCP or HRT is not
recommended
Watch and Wait not recommended

Overview of EDT Specialist Service

Mix of disciplines, virtual team covering Hampshire, went live
June 2016
Use family-based treatment which has the best evidence base
Treatment is likely to last 9-12 months, requiring weekly
family-based sessions at the outset, regular physical
monitoring, menu planning
Individual therapy is sometimes offered in addition/at a later
stage, e.g. CBT-E
Medication may be used for comorbidities, e.g. anxiety or
depression
In process of setting up own direct access to Path lab results
systems

Final Reminders
If in doubt refer or seek consultation promptly
Early intervention and immediate access to specialist
treatment leads to better outcomes
EDT email SPNT.HantsCamhsEDT@nhs.net
EDT Consultation Number 0300 304 0062