Disordered Eating Guidance

About this work

A mother and daughter are seen seated in a living room, mid conversation. On the left the mother is wearing a white t-shirt and beige open shirt. On the right, her daughter is wearing a pink sweater, her hair is tied up in a low pony tail and her hands are clasped towards her face.

Following a rise in presentations of disordered eating, Healthy London Partnership has worked closely with a group of experienced clinicians and experts by experience to develop a set of guiding principles on how to best support and meet the needs of this group.

Eating disorder focused treatment and admission can often lead to an escalation in the presentation and a worsening clinical picture for those with disordered eating, and additionally this cohort of young people often have underlying emotional dysregulation problems or neurodevelopmental difficulties such as Autistic Spectrum Condition (ASC).

The group developed guidance and a series of resources to raise awareness of disordered eating, and to improve care pathways to better meet the needs of young people with this presentation.

Scroll down for additional resources on disordered eating.

Disordered Eating webinar series – sign up

Following a rise in presentations of disordered eating, Healthy London Partnership has worked closely with a group of experienced clinicians and experts by experience to develop a set of guiding principles on how to best support and meet the needs of this group. We will be running a webinar series on Disordered Eating in February 2023 to help families and professionals working with young people to better their understanding of this condition. The webinars will explore the key principles and learning from our recently published disordered eating guidance in more detail.

Disordered Eating Webinar: Improving referrals and supporting young people

Thursday February 2 2023, 2.30-4pm

Aims:

  • To raise awareness of Disordered Eating
  • Improve understanding of the referral process for Disordered Eating and Eating Disorders
      • Improve support for young people and families before, during and after any treatment

        Audience: This event is suitable for school leaders, teachers, GP’s, youth workers, parents and carers.

        Disordered Eating Webinar: Effective approaches and joint working

        Tuesday February 28 2023, 2-3.30pm

        Aims:

        • To raise awareness of Disordered Eating Guidance
        • Share practice on joint working approaches between teams (mental/physical health teams, inpatient/community/alternatives to admission)
        • Share practice on management approaches from referral, treatment to recovery

        Audience: this event is suitable for health professionals supporting young people with disordered eating including CAMHS, Paediatrics, Community Eating Disorder services, alternatives to admissions, DBT teams, Neurodiversity teams.  

        Guiding Principles

        Assumptions

        Do not assume that all young people who are restricting their eating have an eating disorder. Eating disturbances of all sorts, including restricted eating or acute food refusal, may be features of a range of patterns of difficulties.

        Referral, assessment, and treatment

        Planning should be holistic including an assessment of mental health covering history of other disorders, young person’s developmental history including feeding/eating history, family history and social context, rather than just focusing on eating.

        Joint Working

        For this group, labelling a young person as having an eating disorder before this is clear, and focussing too quickly on a plan of eating disorder-focused treatment and inpatient admission, can be ineffective and may lead to an escalation in the presentation. Instead, joint working approaches are recommended for care and treatment. This includes mental and physical health teams as well as between inpatient, community, and home treatment teams. This approach can help teams to confidently manage both the mental and physical health risks presented by young people with disordered eating.

        Admission

        When possible, support from home treatment teams or community teams and avoidance of psychiatric inpatient admission are recommended. Nasogastric tube (NG tube) feeding can result in increased length of stay. Where inpatient stay and NG tube feeding is needed, it is strongly recommended that there is a clear plan in place to discontinue its use.

        Communication

        Ensure you communicate effectively with the young person and parents/carers throughout the referral, assessment, and treatment process. This can help the young person and parents/carers feel more involved and aware of what is happening and when. Regular communication can make a big difference.

        Expectations

        It is important to manage expectations of young people and parents/carers so that they aren’t expecting a specific diagnosis or treatment pathway. Not being accepted into a service or not getting the diagnosis you were expecting can be very difficult.

        Support

        Getting an unexpected diagnosis or treatment pathway may leave a young person feeling unvalidated or rejected, and that what they are going through is less serious and less deserving of treatment. It is important to support young people through this, but also to emphasise that their needs are as important and they are as deserving of help, and to ensure that they are able to receive the intensity of support they need for any other identified needs.

        Additional Resources

        Double check with young people and parents/carers that they have access to, and can engage with, any additional resources or training. This should include those that are waiting to access treatment and throughout the treatment and recovery process.  Examples of resources could include support from Beat, from VSCE in their local areas, access to crisis support and other wellbeing initiatives.

        Transitions

        Transitions can be difficult, whether it is between inpatient and community settings, from adolescent to adult services, stepping down from treatment, or going back into the care of their GP and school. Joint planning and communication with young person, parents/carer about what to expect at all stages can help them feel more on board with next steps and more confident to move forward.

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