What is an eating disorder?
We all have different eating habits. There are a large number of 'eating styles' which can allow us to stay healthy. However, there are some which are driven by an intense fear of becoming fat and which actually damage our health. These are called 'eating disorders' and involve:
- eating too much
- eating too little
- using harmful ways to get rid of calories
‘Eating disorders' usually involve a lot more than eating behaviour, so you might constantly worry about how to avoid calories or how to 'burn off' calories you’ve eaten. You might also find yourself checking your weight and appearance all the time or avoiding seeing yourself in mirrors or photographs.
Eating disorders usually begin in the teenage years, although they can develop in adult life or in childhood. Eating disorders are more common among girls and women, but are also experienced by boys and men. Eating disorders among boys and men are more likely to involve over-exercise to develop a muscular build rather than a motivation to be thin.
Anorexia nervosa and bulimia nervosa are the two most common eating disorders. However, you might experience an eating disorder that includes a mix of symptoms related to both anorexia and bulimia. Some people also move between symptoms of bulimia and anorexia, so you might start with symptoms of anorexia and later develop symptoms of bulimia (or vice versa).
Binge eating disorder is different to anorexia and bulimia because you wouldn’t usually have symptoms such as purging (e.g., deliberate vomiting or misuse of laxatives), restricted eating over a long time or fearing weight gain. Binge eating disorder usually involves repeated episodes of binge eating and feeling that your eating is out of control.
People who have anorexia nervosa typically try to keep their weight as low as possible by restricting how much they eat, avoiding foods that are seen as high calorie or exercising too much. This can have very serious consequences for your health.
Often young people with anorexia have a fear of gaining weight. This can be driven by a distorted body image, so you might see yourself as overweight even when you are very underweight.
For children and young people, not eating enough will affect your growth and development. If you have started puberty, anorexia could mean that you stop growing and going through the normal changes that puberty brings. Unless you manage to maintain a healthy diet (that gives your body the energy it needs), this can be irreversible.
A key goal of treatment for anorexia is to help you to restore your physical health. This means reaching a healthy body weight and helping you with any worries you might have. If you live with your parents or carers then another aim of treatment will be to help your parents or carers to support you.
- Getting help
Sometimes it is someone’s family, friends or school who first raise concerns, and sometimes people try to hide their eating disorder from their family. People can also avoid treatment because of worries that they will be asked to eat more and start restoring their weight. Often children and young people experience anorexia as a way of coping and some children and young people talk about it as similar to a friend (although one who bosses them around), so letting go can be hard.
Anorexia is a serious illness and it is important that you start treatment as soon as possible. This can make recovery easier and could help you to avoid becoming seriously ill.
Your GP will be able to give you advice and can refer you to a Community Eating Disorders Team specifically for children and young people, which are usually part of Child and Adolescent Mental Health Services (CAMHS). Your school might also be able to refer you to these services and in some areas you or your parents or carers might be able to make a ‘self-referral’.
Even if you are referred in another way, your GP might still get in touch with you if they need to arrange an appointment with you to check your physical health. If you’re referred to a Community Eating Disorders Team then they should see you within two weeks, or within five days if your eating disorder is more severe.
You can find more information about mental health referrals here and more information about local mental health services here.
- Treatment planning
Treatment for anorexia usually involves a combination of supervised weight restoration and psychological therapy. It's important that you start treatment as early as possible. This can help you to avoid serious physical health problems, especially if you are very underweight.
The psychological therapies that you might be offered are:
- anorexia focused family therapy (FT-AN) which is usually the first treatment you’ll be offered
- eating disorder focused cognitive behaviour therapy (ED-CBT), which you may be offered if FT-AN has not helped, or you can’t have FT-AN for some reason
- adolescent-focused psychotherapy for anorexia nervosa (AFP-AN), which is another option if FT-AN has not helped, or you can’t have FT-AN for some reason
Your professional might recommend combining one of the individual therapy options (ED-CBT or AFP-AN) with the family therapy option (FT-AN) if they feel that would be more helpful for you. Your professional will also usually arrange for you to have a physical health check, which could include blood tests and an electrocardiogram (ECG).
At your first appointment with the eating disorder team, your professional will talk with you about:
- your eating disorder symptoms and how long you’ve had them
- things in your life that could be keeping the eating disorder going and things that might be helpful during treatment (e.g., if you have a good relationship with your parents or carers)
- how your eating disorder is affecting your physical health, social life, education and family life
- whether you have any other physical or mental health conditions
- whether you might need to stay in hospital to manage risks to your physical health or risks related to self-harm or suicide
- any treatments for eating disorders that you’ve already tried
- how you and your family are coping and any support you might need to take part in treatment while you’re living at home
Based on your first appointment, your professional could suggest that you have one of the following types of support:
- Care from your GP, who will be supervised by the eating disorders team. This would only be suggested if you have a mild eating problem that hasn’t developed into an eating disorder and if you don’t need supervised weight restoration or other treatments.
- Treatment in the community, which means living at home with support from your parents or carers while you have treatment. Your professional will suggest this option unless there’s a good reason not to because it’s generally more helpful for people to have treatment at home than in hospital.
- Intensive community treatment where your eating disorder team visit you at home to support you and your parents or carers to start treatment. In some areas you might be referred to a day programme which you go to during the day. Day programmes can also offer more intensive support to you and your family.
- A stay in hospital, which your professional might suggest if they have concerns about your physical or mental health, or if it isn’t possible for you to have treatment while you live at home. Your professional would only suggest this if they are worried about your safety or if you need treatment in hospital for another mental health condition. This could involve staying at a children and young people’s medical ward or a CAMHS inpatient unit. If you stay at a CAMHS inpatient unit then you might stay at a unit that specialises in treating young people with eating disorders or a unit that treats young people with eating disorders alongside young people with other mental health problems. Your eating disorders team will keep supporting you while you are in hospital and make a plan for your treatment once you are back at home.
You can find more information about how treatment decisions are made here and more information about inpatient care here.
You might have heard of some other types of help for anorexia which currently don’t have much evidence to show that they are effective for children and adolescents with an eating disorder. These types of help include:
- video feedback therapy
- Chinese chiropractic therapy
- transcranial magnetic stimulation
- weight training
- warming therapies
- aerobic exercise
- relaxation training
- graded body image therapy
- acceptance-based mirror exposure therapy
- psychomotor therapy
Just because there isn’t much evidence doesn’t mean that you won’t find these things helpful, but your professional will be unlikely to recommend these options when there are other types of support that have more evidence behind them.
- What about my parents or carers?
The most helpful treatments for anorexia often involve parents and carers. Professionals usually also offer parents or carers information to help them support you during treatment. This doesn’t mean that your professional will share everything you tell them privately and your professional should talk with you about what you are happy for your parents or carers to know. You can find more information about confidentiality and privacy here.
If you’re able to make treatment decisions for yourself, then you will be able to decide how much you would like your parents or carers to be involved in your treatment. Even if you are not able to make these decisions for yourself, your professional should talk to you about this and listen to your preferences.
The wellbeing of your parents or carers is important, and they might be distressed themselves about your eating disorder and might feel guilty or responsible. Your professional should help them to access any support they need, including an assessment of their needs that addresses the impact the eating disorder has had on them and their mental health, and what support they need (e.g. practical support, emergency plans or emotional support).
- Transitions between services
Transitioning from CAMHS to adult services can be a worrying time. To help it go smoothly, your professional should leave plenty of time to work with you on planning the change. You should be given clear information about what to expect from adult services and during your transition, a professional from the adult service should join your CAMHS meetings to get to know you and your family. You should be able to talk to them about any concerns you have.
You may also transition to another CAMHS service (e.g. if you move house). If this happens, your professional should work with you to make sure that your care can continue smoothly, and that your new service has all the information they need.
For more information about transitions between services, please see Moving on.
- Additional support
The below organisations offer anorexia nervosa support for children, young people and their families:
- AFC Crisis Messenger: a free, confidential, 24/7 text message support service for anyone who is feeling overwhelmed or is struggling to cope. If you need support, you text AFC to 85258.
- Beat: UK charity which offers support including free helpline to those affected by eating disorders
- Childline: Childline is there to help anyone under 19 in the UK with any issue they’re going through. Whether it’s something big or small, their trained counsellors are there to support you
- eating disorders support: charity offering free eating disorders support by phone or email
- Supportline: charity offering helpline for people of all ages on a wide range of issues including anger, eating disorders, self-harm, depression, anxiety, panic attacks, and addictions
- The Mix: support and advice for children and young people under 25
- TalkED: UK charity offering emotional support and practical advice for those affected by an eating disorder
Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.