Feeding and Eating Disorders

Introduction

Approximately 1.25 million people in the UK have an eating disorder (Beat). Twenty-five percent of those affected are male. Although children as young as six can develop an eating disorder, they usually start in the teenage years.

An eating disorder is a serious mental health condition characterised by disturbances in eating behaviours, appetite or food intake, which negatively impacts on a young person’s health, emotions and ability to function. This disturbance in eating may be caused by several factors and is not solely indicative of a young person’s concerns about their weight or appearance.

Eating disorders can be life-threatening and cause significant physical and emotional harm. However, they are treatable.

Types of eating disorder

The most common eating disorders are:

Anorexia Nervosa: Characterised by individuals limited how much they eat or drink, self-starvation and excessive weight loss.

Bulimia Nervosa: Characterised by a cycle of binge eating (eating large quantities of food) followed by compensatory behaviours for that overeating, such as self-induced vomiting, taking laxatives or diuretics, fasting or exercising excessively.

Binge Eating Disorder (BED): Involves recurrent binge eating (consuming very large quantities of food), without the use of inappropriate compensatory weight control behaviours.

Other Specified Feeding Eating Disorder (OSFED): The majority of those with eating disorders do not fall within the guidelines for anorexia, bulimia, and binge eating disorder and are classified as OSFED.

Avoidant/Restrictive Food Intake Disorder (ARFID): Characterised by avoiding certain foods or types of food, having restricted intake in terms of the overall amount eaten, or both. Beliefs about weight or body shape are not reasons why people develop ARFID. Possible reasons for ARFID include:

Sensory sensitivities – negative feelings over the smell, taste or texture of certain foods.
Fear of adverse consequences – a response to a past experience with food that was upsetting, for example, choking or being sick after eating something.
Lack of interest – not feeling hungry or just a lack of interest in eating.

For more information on the different types of eating disorders, please visit the Beat website.

Warning signs of an eating disorder

It can be very difficult to identify if a young person has an eating disorder. They may not realise they have an eating disorder. They may also deny it or be secretive and defensive about their eating or weight.

Some symptoms of eating disorders a professional may notice include:

Changes in mood – depression/withdrawn.
Dramatic weight loss/fluctuating weight.
Wearing loose or baddy clothes to hide weight changes.
Being preoccupied with food.
Eating a lot of food very fast.
Cutting food into small pieces or eating very slowly.
Going to the bathroom a lot after eating.
Exercising a lot.
Avoiding eating with others.
Menstrual irregularities/anaemia.
Sleep problems.
Fainting/dizziness.
Difficulties concentrating.
Dental problems/discoloration of teeth from vomiting.
Poor wound healing.
Dry skin/brittle nails.

What causes eating disorders?

Anyone can develop an eating disorder, regardless of their age, gender, ethnicity or cultural background.

Eating disorders are complex and there is no single reason why someone develops an eating disorder. A whole range of different factors, including someone’s genetics, biology, psychology and surroundings, can combine to make it more likely any one person develops the condition.

Young people who develop eating difficulties often state that eating or not eating is a way of coping with feelings of sadness, worry and stress. Sometimes life stressors such as exams, bullying, friendship or family relationship difficulties and bereavement or loss may play a part in how someone copes or feels about themselves.

Young people may be more likely to develop an eating disorder if they:

Or a member of their family has a history of eating disorders, depression, or alcohol or drug misuse.
Have been criticised for their eating habits, body shape or weight.
Are very worried about being slim, especially if they feel pressure from society or their job, such as ballet dancers, models, or athletes.
Have anxiety, low self-esteem, an obsessive personality, or are a perfectionist.
Have been sexually abused.
Identify as LGBT+. Research shows that these young people are three times more likely to suffer with an eating disorder compared to their non- LGBT+ peers (Just Like Us, 2021). It is important for professionals to be aware of discrimination and bullying factors. Young people may also face discordance between their body and gender.
Are neurodivergent:
- Studies show that nearly 20 percent of individuals diagnosed with avoidant or restrictive food intake disorder (ARFID) also have autism.
- A third of individuals with ARFID reported avoiding foods due to sensory issues, a trait that is present in many neurodivergent individuals.
- A research analysis showed that individuals with anorexia nervosa report higher rates of autistic traits.
- Female-identifying individuals with attention deficit hyperactivity disorder (ADHD) are nearly four times more likely to develop an eating disorder (Psychology Today, 2022).
Have a chronic illness (a long-term condition where there is currently no cure, and which is managed with medications and treatments), such as gastrointestinal and endocrine diseases (coeliac disease, inflammatory bowel disease, diabetes, and thyroid disorders) (JAMA Pediatrics, 1998).
- Although not listed as a formal medical diagnosis, type 1 diabetes and disordered eating (T1DE) or diabulimia, is becoming increasingly recognised in individuals experiencing an eating disorder while living with type 1 diabetes (Beat).
Have a learning disability. There is little research on the body image of individuals with learning disabilities. However, these young people are often at a greater risk of obesity than their peers and has been linked to increased feelings of body dissatisfaction.

What is the impact on safeguarding adolescents?

Eating disorders have severe psychological, physical, and social consequences for young people, impacting on physical health, education and general daily living, such as spending time with family and friends, going out and taking part in activities.

Left untreated, eating disorders can lead to severe malnutrition, family dysfunction, relationship breakdown, heart and kidney problems and even death. Anorexia is known to have the highest mortality rate of any psychiatric condition (BMC Psychiatry, 2020).

Children and young people with eating disorders often have other mental health problems (for example, anxiety or depression) which also need to be treated to get the best outcomes.

It is vital that children and young people with eating disorders and their families and carers access effective help quickly. Offering evidence-based, high-quality care and support as soon as possible can improve recovery rates, lead to fewer relapses and reduce the need for inpatient admissions. With the right treatment and support, recovery is possible.

Next steps

Many young people go through phases of dieting and not eating enough. Sometimes this can tip into developing an eating disorder. If you are concerned about a young person’s eating difficulties, see the Hampshire CAMHS Guide on Eating Difficulties which provides information on thresholds and referral guidance.

Professionals can also seek advice and consultation from the Specialist Eating Disorders Team in their area:

Hampshire

Hampshire Eating Disorder Service

Telephone: 02382 317903

Email: HantsCAMHSEDT@southernhealth.nhs.uk

North East Hampshire

Children’s Eating Disorders Service

Telephone: 01372 216 633

Isle of Wight

Isle of Wight Eating Disorder Team

Telephone: 01983 523602

Email: iownt.spcamhs@nhs.net

Additional resources and information

Strategy Guide: Mental health, Wellbeing and Self-Harm

Wessex Healthier Together – Aimed at improving the health of children and young people in Dorset, Hampshire and the Isle of Wight.

HIPS Procedures – Self-harm and Suicidal Behaviour – Managing self-harm resource for practitioners.

0-19 Health Visiting and School Nursing: Hampshire and Isle of Wight NHS Foundation Trust – The 0-19 Service provides a range of community-based nursing and mental health services to children aged 0-19-years-old and their families across Hampshire and Isle of Wight. The service offers ChatHealth, a confidential text support service for parents, carers, families and young people in Hampshire to support with a wide range of health and wellbeing issues. As well as giving advice, the team can signpost to appropriate services.

Hampshire

Hampshire Child and Adolescent Mental Health Services (CAMHS) – An NHS service that aims to help young people up to the age of 18 who are finding it hard to manage their emotional and psychological health, and who are suffering with acute, chronic and severe mental health problems. Telephone: 02382 317 912 Email: hantscamhsspa@southernhealth.nhs.uk.

Useful resources related to feeding and eating disorders:

Hampshire Youth Access (HYA) – A partnership of 11 leading agencies providing counselling, information, advice, and support to children and young people aged 5 to 17 across Hampshire. They also offer advice and information to anyone concerned about a child or young person’s emotional wellbeing. Telephone: 02382 147 755 Email: enquiries@hampshireyouthaccess.org.uk

Safe Haven – Provide out-of-hours support to young people experiencing, or on the verge of, mental health crisis. Anyone aged between 10 and 17 who needs support for a mental health crisis can drop in to receive help.

Isle of Wight

IOW Child and Adolescent Mental Health Service (CAMHS) – Provide a service to children and young people aged 0–18-year-olds, and their families, who are experiencing emotional health and wellbeing difficulties, including eating disorders. Telephone: 01983 523602 (answer phone out of hours) Email: iownt.spcamhs@nhs.net

Children in Care & Care Leavers Nurse Team – Delivers direct clinical contact, advice and support to Children in Care/Care Leavers, their carers and social workers to address health issues unique to this group of children and young people. This includes emotional well-being. Telephone: 01983 822099 extension 4512. Email: iownt.childrenincare@nhs.net

Isle of Wight Youth Trust – Offers a range of support for children, young people and their families, providing a professional one-to-one counselling service. They also offer group work, training and other early-intervention opportunities. Telephone: 01983 529569 Email: info@iowyouthtrust.co.uk

Safe Haven – Provides a safe space for people experiencing a mental health crisis. Support from staff can be accessed by telephone, email or face to face during evenings, weekends and bank holidays. Email: safehaven@twosaints.org.uk. Telephone: 01983 520168.

National

National Centre for Eating Disorders – A comprehensive resource on eating disorders, including support, training and information.

Mind – Details of Mind’s services and other organisations who can support anyone experience eating problems.

NSPCC – Young people and self-harm advice.

NHS England – Children and young people’s eating disorders programme.

NHS – Eating disorders – Provides an overview of eating disorders.

NHS Choices – NHS advice about healthy living, including eating a balanced diet and healthy weight.

Resources and training

BEAT – Training and events.

FREED – Free training and resources for healthcare professionals.

MindEd Hub – Free educational resources and training for professionals and volunteers.

Young Minds – A suite of courses to support professionals.

Mental Health Fist Aid (Youth) – resources and training.

We Can Talk – Free training and fee training available for healthcare professionals.

Eating Disorders Awareness: Guidelines for referring CYP with eating disorders – Transformation Partners in Health and Care Partnership guide.

Disordered Eating in Children and Young People – Guidance for Health and Care Professionals – Transformation Partners in Health and Care Partnership guide.

Anna Freud National Centre for Children and Families – Free resources on eating disorders.

BEAT Schools resources ‘Spot the signs’ – Free resource on spotting the signs.

ARFID – National Centre for Eating Disorders – Free resources on ARFID and what to do about it. Includes information on ARFID and autism.

ARFID Awareness UK – Provide individuals, parents, carers and medical professionals with up-to-date relevant information, research and support.

NICE Guidelines – Eating disorders: recognition and treatment – Covers assessment, treatment, monitoring and inpatient care for children, young people and adults with eating disorders. It aims to improve the care people receive by detailing the most effective treatments for anorexia nervosa, binge eating disorder and bulimia nervosa.

Body image

National Centre for Eating Disorders – Information on body image.

Taking action on body image – An active citizenship toolkit for those working with young people. It aims to engage young people with the issues around body image and inspire and guide them to utilise their understanding to promote positive body image in themselves and others through social action.

Body Confidence Campaign Toolkit for Schools – Created by the Be Real Campaign, this toolkit for schools helps develop body confidence in students in and outside of the classroom.

Further studies

Somebody like me – A report investigating the impact of body image and anxiety in the UK. YMCA (2017)

Body Image: How We Think And Feel About Our Bodies – Mental Health Foundation (2019)