Dumfries & Galloway Health & Social Care

CAMHS Specialist Eating Disorder Service

Who are we?

Our Aims

Our aim is to provide assessment and treatment at the earliest opportunity to children, young people and their families. We know from research that the quicker children and young people receive treatment for Eating Disorders, the better the outcome is likely to be for them.

  • Assessment and treatment aim to focus on both the physical and psychological aspects of eating difficulties.
  • Primarily we work with young people under 18 with a diagnosis, or suspected diagnosis of Anorexia Nervosa or Bulimia Nervosa, but occasionally other types of eating disorders.
  • The service generally is not able to see young people with obesity or those who have feeding/eating problems not related to mental health difficulties.
  • To provide consultation and advice to other services and colleagues as required. 
  • To further develop and improve the Eating Disorder service in line with any new evidence based research. 

What are Eating Disorders?

Eating Disorders include:

  • Anorexia Nervosa: In this condition there is significantly low weight and/or weight loss and a fear of eating along with anxiety about weight, shape and possible hormonal disturbance (loss of menstruation).  People with Anorexia may also use other methods to achieve weight loss such as over exercising.
  • Bulimia Nervosa: In this condition there is recurrent binge eating as well as purging the body by vomiting or other means, along with over concern about weight and shape.
  • Atypical Eating Disorder: In this condition there are serious signs of an eating disorder but it does not fulfil all the criteria for anorexia nervosa or bulimia nervosa. In all of these conditions the young person will have significant concerns about their weight and shape.

Not all eating problems are eating disorders; sometimes we see reduced appetite / weight loss secondary to low mood or anxiety. Concerns around body image are also very common within adolescence. Eating disorders affect both boys and girls, and across age ranges, but we most commonly see them in girls during adolescence.

Often young people with an eating disorder are secretive about it, and hide their behaviours. It is important to note not everyone with an eating disorder is underweight.

Spotting the Signs Of An Eating Disorder

Eating Disorders are very complex, not every sufferer experiences identical symptoms. Often, eating disorder sufferers experience other physical or mental health problems simultaneously with their eating disorder. These may have developed because of or alongside the eating disorder, or may have actually played a role in the development of the eating disorder in the first place. 

There are a number of behavioural, psychological and physical signs which signal the presence or onset of an eating disorder. Those who suffer from an eating disorder or an emerging eating disorder, may display a range of symptoms or very few.  It is very common for someone with an eating disorder to try hard to hide their behaviours. This makes it very challenging to recognize the symptoms of their condition, particularly during the early stages.

There are, however, a few things to look out for which could be a tell-tale sign of an eating disorder or of an emerging eating disorder. Of course, not every sufferer will show all of these symptoms or signs, and, indeed, people who display some of these symptoms may not have an eating disorder at all. However, this list is a good place to start if you’re worried someone.

Physical Signs

  • Frequent dieting or very fast weight loss
  • Disturbed or lost menstruation
  • Decreased libido 
  • Dizziness or fainting
  • Fatigue and insomnia
  • Low energy and lethargy
  • Swelling around the jaw or cheeks, damaged teeth, bad breath or calluses on their knuckles – these could all be due to induced vomiting
  • Feeling cold even during warm weather
  • Stomach cramps, acid reflux and constipation 
  • Difficulty in focusing or concentrating
  • Abnormal  blood results 
  • Slow heart rate or low blood pressure / abnormal ECG
  • Dry skin and nails
  • Thinning hair
  • Development of fine hair all over the body
  • Muscle weakness
  • Mottled and cold feet and hands
  • Swollen feet
  • Impaired immune system
  • Slow wound healing
  • Slowing of 'normal' growth 

Psychological Signs

  • It is especially difficult to spot the psychological signs of an eating disorder. Often, these only become apparent through behavioural changes or through conversation.
  • An obsession with weight, body shape, food and eating
  • Feeling as if they can’t control themselves around food
  • Feeling irritable or anxious at mealtimes
  • Rigid thought patterns about food being “bad” or “good”
  • Using food to comfort themselves
  • Distorted body image
  • Using food to punish themselves
  • Feelings of ineffectiveness 
  • Having a strong need to be in control
  • Displaying patterns of inflexible thinking
  • Having extremely restrained emotional expression
  • Signs of anxiety and low mood

Behaviour Signs

  • Dieting behaviour such as counting calories, fasting, avoiding carbohydrates or fats
  • Frequently going to the bathroom during meals or just after eating
  • Evidence of overeating such as hoarding food or finding empty wrappers hidden away
  • Using laxatives, appetite suppressants, diuretics or enemas
  • Vomiting
  • Wearing large and oversized clothing
  • Excessive or compulsive exercising, such as working out even when injured or unwell or in bad weather and becoming very distressed if exercise isn’t possible
  • Changed food preferences – no longer eating foods they used to enjoy, replacing normal meals with fluids or suddenly becoming obsessed with healthy eating
  • Developing obsessive rituals surrounding eating and food preparation such as eating extremely slowly, cutting up food into tiny pieces or eating at precisely the same hour every day
  • Becoming extremely over-sensitive to comments about exercise habits, eating, weight and body shape
  • Becoming secretive around food such as saying they’ve already eaten if they haven’t or hiding food which hasn’t been eaten
  • Frequently avoiding meals including arranging other activities as a valid reason to avoid the meal (eg. staying behind at school to study, seeing friends)
  • Young people keen to cook meals but not eat them. 
  • Reluctant to have other people to cook their meals.  
  • Starting to become more isolated and withdrawn from usual activities and friends
  • Starting to be worried about eating food in front of other people
  • Unable to stay at a bodyweight which is suitable for their build, height and age
  • Having a terror of gaining weight or becoming fat, possibly even though they are underweight
  • They might be visiting websites that promote eating disorders

When to make a referral?

If the case is urgent, e.g. very low weight, rapid weight loss or serious psychiatric comorbidity such as suicidal risk, we advise ringing the CAMHS team direct, backed up by a written referral (marked urgent) – duty details

In the case of a physical health emergency the young person should be referred immediately to Paediatrics (Under 16) or General Medicine (16/17 years).

A useful guideline for assessment and management of physical risk is the Junior Marsipan Guideline MEED

If it is unclear whether an eating disorder referral is indicated or if the symptoms are less severe but there is concern of an emerging eating disorder please discuss with FBT clinicians for advice re early intervention.

You can contact us for consultation on Tel: (01387) 244662 or by email to: dg.CAMHS-mail@nhs.scot However we may not be able to respond the same day; but will do as soon as possible.

Referral should include:

  • Summary of the current concerns.
  • Current weight and height
  • History of weight and height over time
  • Changes in eating behaviour and food preferences
  • Exercise levels
  • Any other behaviours intended to control weight or body shape
  • Distorted self-perception or body-image difficulties
  • How the young person and their family are managing
  • Any recent blood chemistry results, blood pressure and pulse, ECG if appropriate
  • Contact details of the referred young person and their family
  • Whether you have consent from the young person and their family to refer to CAMHS ED service.

Please Note:

We accept referrals from anyone involved with the young person who has concerns.  

We also accept self referrals. 

Referrals should be made for young people who have had a recent and significant weight loss which is continuing and problematic, irrespective of their BMI or weight category.

Weight should not be the single indicator of risk, and a young person may have a relatively healthy weight but may still be very unwell.

The service aims to carry out urgent assessments within one week of referral and routine assessments within four weeks. Specialist treatment, if appropriate, is normally started on the day of assessment.

Treatment For Eating Disorders

For children and young people the evidence shows that a family based approach is most effective, we call this FBT (Family Based Treatment). This involves the family coming together, in clinic, this can include siblings where appropriate, and the aim is to identify how the family can support their child’s recovery.

Throughout treatment we will also carry out physical monitoring – this includes checking weight, blood pressure, blood tests as required.

The specialist eating disorder service aims to provide treatment consistent with ‘The National Institute for Health and Care Excellence (NICE) guidelines for eating disorders (2004)’and SIGN guidelines . Both of which advise that FBT should be offered as the first line evidence based treatment of choice, for Anorexia and Bulimia, with CBT-ED to be considered if FBT is not successful or the family are unable to engage in this treatment.

The length of treatment will usually depend on the severity and history of the eating disorder. Normally we would expect treatment to last nine months to a year (this may be around 20 sessions, spaced out over the last few months), but it may take longer to achieve a full recovery, although some people complete treatment more quickly. Generally treatment will be more intensive at the start and appointments will become further apart as recovery progresses.

Eating Disorders can be life threatening, and in some occasions we may have to consider inpatient treatment if a young person’s physical or mental health is at significant risk. In this case it is sometimes necessary to refer a young person to the local paediatric ward (DGRI) or the inpatient adolescent unit (Skye House Glasgow) for a short period of inpatient care.

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