Eating Difficulties

eating difficulties .png

When eating is used to manage difficult situations, thoughts and feelings it can sometimes develop into an eating disorder. The most common types of eating disorder are bulimia nervosa and anorexia nervosa. Anyone can have an eating disorder regardless of their age, sex, ethnicity, or background. 

Eating disorders are not all about the food itself. Setting strict ‘rules’ around food and eating, being pre-occupied with weight, shape, food and developing rituals around food and eating are way of coping with difficult situations, thoughts and feelings.   The way the person treats food may make them feel more able to cope, or feel more in control, but they might not be aware of the purpose this behaviour is serving.

There is no one cause of an eating disorder. Young people who develop eating difficulties and disorders often tell us that eating or not eating can be 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. There are also some personal factors such as having low self-esteem, experiencing anxiety or depression, setting high standards and being perfectionistic and identifying as LGBT (Lesbian, Gay, Bisexual or Transsexual) are sometimes associated with people who develop eating disorders. However, experiencing any one of these things does not necessarily mean that someone will develop an eating disorder or difficulty.

Most young people worry at some time about how they look and can become unhappy with their weight or shape. Some will ‘diet’ and / or exercise as a way of losing weight. This is different from an eating disorder, which is an extreme and unhelpful focus on eating, weight and shape.

An eating disorder can quicky take over a person’s life and make them very unwell. Eating disorders can involve eating too much or far too little. Worries about things like their weight and shape get tied up with feelings of self-worth and can become extreme. People with eating disorders also experience a deep fear of gaining weight, and will usually challenge the idea that they should. People with eating disorders can develop a distorted body image that does not fit with how others see them. Eating disorder behaviour can impact on physical health, education and general daily living, such as hanging out with friends, spending time with family, going out and taking part in activities.

There are many different types of eating disorders, with bulimia and anorexia nervosa being the most common, and all of them are serious. All eating disorders are treatable and a full recovery is possible. Getting help and advice as soon as possible improves the chances of a full recovery.

Here are some signs that there might be a problem and it’s time to get help;

  • Constantly thinking or worrying about food, calories, weight gain or your shape. You might notice that it is hard to concentrate on other things such as conversations or school work.cartoon of girl overthinking regarding eating.png
  • Reducing your food in order to lose weight and setting yourself strict rules about what you can or cannot eat.
  • Trying to do other things to lose weight, such as lots of exercise, vomiting, taking laxatives (medication to help you go to the toilet) or slimming pills.
  • You might become tired and more emotional (tearful, irritable).
  • If you are female, your periods might stop.
  • Other people might start noticing and commenting that they are worried about you

Not everyone who has an eating disorder will experience all the signs and symptoms. Also, if you are experiencing some of these signs and symptoms this does not necessarily mean that you have an eating disorder, but it is important to get help and advice​​​​​​​

Top Tips:

  1. It is common for people with eating difficulties to not see that there is a real problem. You may not understand why others are concerned or you might disagree that there is a problem altogether. This may make you feel angry and frustrated.
     
    Calmly support them to open up about how they are feeling and what they are struggling with.  The quicker they can get help for your difficulties, the better the outcome.
  2. Take things one day at a time, each meal at a time. If they have a difficult meal or snack, start the next one afresh.
  3. Find things that will motivate them to maintain healthy eating when things are hard; such as being able to go out with friends, do sports and activities and achieve goals that they have set.
  4. Have a look at these helpful, downloadable workbooks and self-help materials:
  • What’s eating you? A Workbook for Teens with Anorexia, Bulimia, and Other Eating Disorders by Tammy Nelson
  • Getting Over Overeating for Teens: A Workbook to Transform Your Relationship with Food Using CBT, Mindfulness, and Intuitive Eating by Andrea Watcher
  • Body Image Workbook for Teens: Activities to Help Girls Develop a Healthy Body Image in an Image-Obsessed World by Julia Taylor
  • Self-Esteem Workbook for Teens: Activities to Help You Build Confidence and Achieve Your Goals by Lisa Scab
  • Skills Based Learning for Caring for a loved one with an eating disorder; The New Maudsley Method by Janet Treasure, Grainne Smith and Anna Crane
  • Anorexia and other eating disorders; how to help your child eat well and be well by Eva Musby
  • Food Refusal and Avoidant Eating in Children (including those with Autism Spectrum Conditions); A practical guide for parents and professionals
  • Self-Harm and Eating Disorders in Schools; A guide to whole school strategies and practical support by Pooky Knightsmit
  1. . If you live in Hampshire and you are concerned that your child may have an eating disorder and you’d like help or                 advice, please contact the Hampshire CAMHS Specialist Eating Disorder Team on 0300 304 0062 Monday-Friday, 9am-5pm or if you live in Dorset you can call Young People’s Eating Disorder Service (YPEDS) on 01202 492415. For those living on the Isle of Wight you can call IOW CAMHS on 01983 523602 between Monday-Friday 8:30am-5pm (answerphone out of hours).

Downloads

CAMHS Eating Difficulties and Disorders Referral Guidance

What we do, what we don’t do and what you can do if you are worried about your child

Many young people go through phases of dieting and not eating enough. Sometimes this can tip into developing an eating disorder. Here’s a guide to help you know how best to support your young person if they are experiencing eating difficulties. This is not an exhaustive list; young people may experience symptoms which may not be included on this guide:

Green:

Coping / needs support; These are experiences that most young people will have from time to time

Type and nature of distress

It is common for children and young people to experience eating difficulties during childhood and adolescence. These tend to be short term, have no impact on physical health or daily functioning (e.g., going to school, seeing friends, taking part in hobbies or activities) and can be managed with clear boundaries combined with the love and support of parents/ carers.

What you might see or what a young person might report

  • Faddy or fussy eating; only eating a limited repertoire of foods (certain colours, textures, temperatures)
  • Wanting to or trying to diet by ‘eating healthily’ or following eating regimes, such as ‘clean eating’, ‘raw food’, ‘vegan’
  • Taking a more active interest in food, meal preparation, e.g. checking food labels or packaging
  • Taking a more active interest in fitness/ health or wellbeing
  • Increase in activity/ exercise
  • Talk about body dissatisfaction/ worrying about appearance
  • Comparing themselves to other people
  • Feeling anxious about eating in public/ in front of others
  • Young people with Type 1 diabetes may become more inconsistent with insulin and diabetes is less well managed (this should be checked with a medical team as a matter of priority)
  • No longer eating foods they previously enjoyed

Things to try, support and next steps

  • Be aware of any changes in eating behaviour as this is often seen before any physical signs.
  • This may include:

If someone is developing an eating disorder, often changes in behaviour are noticeable before changes to physical appearance. Signs include:

  • Saying they have eaten earlier or will eat later, or that they have eaten more than they have
  • Not being truthful about how much weight they have lost
  • Strict dieting and avoiding food they think is fattening
  • Counting the calories in food excessively
  • Eating only low-calorie food, or otherwise limiting the type of food they will eat
  • Missing meals (fasting)
  • Avoiding eating with other people
  • Hiding food
  • Binge eating
  • Cutting food into tiny pieces to make it less obvious they have eaten little or to make food easier to swallow
  • Eating very slowly
  • Taking appetite suppressants, such as slimming or diet pills
  • Obsessive and/or rigid behaviour, particularly around food
  • Irritability
  • Excessive exercising – this might involve exercising when not physically well enough to do so, or feeling guilty or anxious about not exercising
  • Vomiting or misusing laxatives (purging)
  • Social withdrawal and isolation 
  • Wearing baggy clothing to hide their body, due to self-consciousness or to make weight loss less noticeable
  • It is important that young people eat regularly so insist upon breakfast, lunch and dinner plus snacks
  • Encourage a balanced diet; with all food groups included (carbohydrates, protein, fats, vegetables and fruits, dairy/ dairy alternatives ). It’s ok to have snacks and treats
  • Ensure young people drink plenty throughout the day; aim for 6-8 glasses per day (water, milk). Avoid sugary drinks.
  • Be active with your young person so that you can monitor and ensure they are exercising in a way that is appropriate
  • If you are concerned about your child’s eating:

See your GP (ask for physical health observations to be done- height, weight, blood pressure, pulse)

Inform your child’s school to share concerns and ask if they have noticed any other concerns

  • Monitor and restrict the use of apps/ gadgets that track exercise and food e.g., My Fitness Pal and Fitbit watches
  • Encourage team sports and activities rather than solitary sporting or fitness activities. Ensure food and fluids are had before and after exercise.
  • Monitor use of social media and ensure only positive accounts are being followed/ accessed
  • Discourage talking about body concerns, weight or food/ eating habits with others

Useful resources:

  • For fussy/ faddy eating : Food Refusal and Avoidant Eating in Children; A Practical Guide for Parents and Professionals
  • The Self-Esteem Workbook by Lisa Schab
  • Banish Your Self-Esteem Thief by Kate Collins-Donnelly
  • Banish Your Body-Image Thief by Kate Collins- Donnelly
  • Beat (eating disorder charity): https://www.beateatingdisorders.org.uk/

Amber

Needs help; These are challenges that some young people experience and may need some support with

Type and nature of distress

The degree to which a young person experiences eating difficulties may cause the young person distress or might have some mild impact on their ability to cope with everyday life such as going to or coping at school, seeing friends, or taking part in leisure activities. The family may also be experiencing a degree of stress characterised by more arguments or disagreements around food/ mealtimes, exercise levels/known or suspected vomiting. Other people may be commenting or noticing there is a difficulty or noticing change in weight. These difficulties may have been going on for a few weeks.

What you might see or what a young person might report

  • A committed and persistent effort to lose weight or control weight or shape through:
  • Dieting/ restricting food intake
  • Exercising/ increased activity
  • Purging (self-induced vomiting)
  • Taking laxatives
  • Eating excessive amounts/ bingeing/ constantly seeking food; gaining weight

Behavioural signs can include:

  • Saying they have eaten earlier or will eat later, or that they have eaten more than they have
  • Not being truthful about how much weight they have lost
  • Strict dieting and avoiding food they think is fattening
  • Counting the calories in food excessively
  • Eating only low-calorie food, or otherwise limiting the type of food they will eat
  • Missing meals (fasting)
  • Avoiding eating with other people
  • Hiding food
  • Binge eating
  • Cutting food into tiny pieces to make it less obvious they have eaten little or to make food easier to swallow
  • Eating very slowly
  • Taking appetite suppressants, such as slimming or diet pills
  • Obsessive and/or rigid behaviour, particularly around food
  • Irritability
  • Excessive exercising – this might involve exercising when not physically well enough to do so, or feeling guilty or anxious about not exercising
  • Vomiting or misusing laxatives (purging)
  • Social withdrawal and isolation 
  • Wearing baggy clothing to hide their body, due to self-consciousness or to make weight loss less noticeable
  • Experiencing upset or distress/ feeling of guilt or shame after eating
  • Dissatisfaction about body image
  • More emotionally labile/ more sensitive (upset, irritable, withdrawn) especially when boundaries are put in around food or exercise
  • More argumentative (especially around food or mealtimes)
  • More controlling or rigid around food/ mealtimes and other areas of life
  • Preoccupied/ overly concerned/ interested by food (e.g., counting calories)
  • May show some signs of physical compromise e.g., gradual weight loss, tired/ lethargic, difficulties concentrating, not seeming usual self, feeling cold
  • Other areas of life might be a struggle e.g., academic work, friendships, engaging in family life

Things to try, support and next steps

  • Ensure that the young person eats regularly. Eat together as much as possible. Make sure that 3 meals plus snacks are provided and eaten.
  • Make sure that all food groups (carbohydrates, protein, vegetables and fruits, dairy/ dairy alternatives ) are in the general diet, plus it’s ok to have snacks
  • Ensure young people drink plenty; aim for 6-8 glasses per day (water, milk, avoid sugary drinks)
  • Calm support during mealtimes.
  • Support your young person to access self-help resources including:

YP section- eating difficulties, anxiety, depression (see downloads)

Podcasts and Videos Section on www.hampshirecamhs.nhs.uk

  • Watch our parent/ carer workshop on:

How to support a young person with an eating difficulty here: https://youtu.be/-ApfAzKOy60

How to support a young person with anxiety: https://youtu.be/LMFQHABnH1M

How to support a young person with depression/ in crisis/ who engages in self-harm: https://youtu.be/qBAZQVjSmQU

  • Share concerns with your child’s school/ college
  • See your child’s GP; ask for physical observations to be taken (including; height, weight, temperature, blood pressure, pulse and request a blood test)
  • Inform and access pastoral support from school
  • Monitor and restrict use of apps or gadgets that track exercise and food e.g., My Fitness Pal and Fitbit watches
  • Monitor use of social media and ensure only positive accounts are being followed/ accessed

Other Useful resources:

  • For fussy/ faddy eating : Food Refusal and Avoidant Eating in Children; A Practical Guide for Parents and Professionals
  • What’s Eating you? A Workbook for Teens with Eating Disorders by Tammy Nelson
  • The Self-Esteem Workbook by Lisa Schab
  • Banish Your Self-Esteem Thief by Kate Collins-Donnelly
  • Banish Your Body-Image Thief by Kate Collins- Donnelly
  • Beat (eating disorder charity): https://www.beateatingdisorders.org.uk/

Red

Needs Specialist Treatment or a Crisis Response; These are difficulties that cause a significant impact and a young person may need specialist support.

 

The degree to which a young person experiences eating difficulties may cause the young person distress or might have an impact on their ability to cope with everyday life such as going to or coping at school, seeing friends or taking part in leisure activities. The family may also be experiencing a degree of stress characterised by; more arguments or disagreements around food/ mealtimes or exercise levels/known or suspected vomiting. Other people may be commenting or noticing there is a difficulty or noticing change in weight.

The difficulties may have had a sudden onset at a significant level of concern or may have been deteriorating gradually over a long period of time.

What you might see, or what a young person might report

Emergency symptoms – seek immediate medical advice

  • Sudden or rapid weight loss
  • Fainting/ collapse
  • Drowsiness
  • Refusing food or drink for more than 24 hours
  • Chest pains
  • Concerns about daily vomiting
  • Significant restriction of food (and fluid) leading to rapid weight loss. This is a concern for both young people that lose weight and become underweight as well as young people who perhaps are overweight then lose weight and appear a healthy weight. It is the speed of weight loss not necessarily just their weight that is a concern.
  • Young person may avoid eating; excuses such as ‘have already eaten’, ‘not hungry’, ‘don’t feel well’
  • Distress prior to, during or after meals. You might notice your young person may want to prepare their own food or eat alone
  • Preoccupation with food/ eating/ weight or shape or having rituals around eating/ preparing food such as weighing food, eating with certain crockery/ cutlery
  • Unusual eating behaviour such as unusual combinations of food or cutting up food into very small pieces/ eating very slowly
  • Hiding or throwing food away
  • Weight control behaviour including; exercise/ increased activity, laxative/ diuretic misuse, self-induced vomiting
  • Young people with Type 1 diabetes may become more inconsistent with insulin and diabetes less well managed
  • Reluctance, avoidance or secrecy of the young person to talk about eating; lack of recognition of concern that others may have or minimising the extent of difficulties
  • More withdrawn/ lethargic or tired
  • Feeling physical unwell; dizzy, light-headed, chest pains, fainting, stomach pains, constipation, coldness
  • Symptoms of vomiting including bad breath and swollen or puffy face; poor dental health
  • More emotionally labile/ more sensitive (upset, irritable, withdrawn) especially when boundaries are put in around food or exercise
  • More argumentative (especially around food or mealtimes), may become aggressive and violent#
  • May hide body under baggy clothing
  • Either becomes preoccupied by checking themselves in the mirror and weighing or avoids mirrors altogether
  • Frequent trips to the bathroom especially after meals
  • For girls: periods stop (they make stop asking for feminine hygiene products)

Things to try, support and next steps

  • Share concerns with your child’s school/ college
  • See your child’s GP; ask for physical observations to be taken (including; height, weight, temperature, blood pressure, pulse and request a blood test)
  • Important that all young people eat regularly so insisting upon breakfast, lunch and dinner plus snacks. Support and supervise meals and snacks. If a young person has severely restricted their food and fluid, you must seek advice from a medical professional about restarting eating and drinking as this needs to be done with careful monitoring of physical health.
  • Ensure diet is balanced with all food groups (carbohydrates, protein, vegetables and fruits, dairy/ dairy alternatives ) plus it’s ok to have snacks
  • Ensure young people are well hydrated; aim for 6-8 glasses per day (water, milk, avoid sugary drinks)
  • Support your young person to access self-help resources including:

YP section- eating difficulties, anxiety, depression (see downloads)

Podcasts and Videos Section on www.hampshirecamhs.nhs.uk

  • Inform and access pastoral support from school
  • Monitor and restrict use of apps/ gadgets that track exercise and food e.g., My Fitness Pal or Fitbit watches
  • Monitor use of social media and ensure only positive accounts are being followed/ accessed

Other Useful resources:

  • For fussy/ faddy eating : Food Refusal and Avoidant Eating in Children; A Practical Guide for Parents and Professionals
  • Skills based Learning for caring for a Loved One with an Eating Disorder by Janet Treasure, Grainne Smith and Anna Crane
  • Anorexia and Other Eating Disorders; How to help Your Child Eat Well and Be Well by Eva Musby
  • When your teen has an eating disorder by Lauren Muheim
  • The Self-Esteem Workbook by Lisa Schab
  • Banish Your Self-Esteem Thief by Kate Collins-Donnelly
  • Banish Your Body-Image Thief by Kate Collins- Donnelly
  • Beat (eating disorder charity): https://www.beateatingdisorders.org.uk/

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