Mental Health Network -Eating Disorders • Introduction to STEPs • Motivational Work • Eating Disorders • Questions Lydia Pym - Occupational Therapist Nadia Freyther – Community Nurse STEPs Eating Disorder Service STEPs Eating Disorder Service • Adult Service offering specialist service interventions and consulting to a wide geographical area • Commissioned to work with people with a diagnosis of Anorexia, Bulimia and EDNOS, excluding Binge Eating Disorder • 10 Bed In-patient unit, 8 place Day Therapy programme* Outpatient and Community services • Multidisciplinary Team • Variety of treatments • Supporting Carers Prochaska & DiClemente’s Six Stages of Change • How and why did we develop our current model of working? Motivational Work • Listen • Step back • Learn • Be curious • Invest less Is it any good? • Benefits Staff, team and Clients Non-Negotiable 1. Clearly defined from the outset – no surprises 2. Agreed by staff & clients if possible 3. Not arbitrary, but with good justification 4. Consistently applied by all staff Anorexia nervosa (F50) • Weight loss leading to body weight at least 15% below normal weight for age & height (BMI below 17.5) • Weight-loss is self-induced by avoidance of ‘fattening foods’ • Self-perception of being too fat & intrusive dread of fatness • Widespread endocrine disorder involving hypothalamicpituitary-gonadal axis - amenorrhea in female - loss of sexual interest in males • Restricting type & Purging type (DSMIV) Bulimia Nervosa (F50.2) • Recurrent episodes of overeating (at least twice a week over a period of 3 months) in which large amounts of food are consumed in short periods of time • Persistent preoccupation with eating, & strong compulsion to eat • Self-perception of being too fat with an intrusive dread of fatness • Attempts to counteract the fattening effects of food by one or more of: – Self-induced vomiting – Self-induced purging – Alternating periods of starvation – Use of drugs (appetite suppressants, thyroid preparations or diuretics, failure to take insulin) Atypical eating disorder • Do not meet criteria for AN or BN but are clinically severe (atypical anorexia nervosa (F50.1) & atypical bulimia nervosa (F50.3)) • Sub-group – binge-eating disorder (DSM IV) Recurrent bulimic episodes in absence of other diagnostic features of BN, particularly counterregulatory features such as vomiting May be evidence of depression, unhappiness with weight but less significant vs BN Higher spontaneous remission rate, txt CBT Epidemiology • • • • • Prevalence – 0.7% (school & college girls) Incidence range from 0.37 – 4.06 per 100 000 Female-to-male ratio of 10:1 Primarily white (>95%) & adolescent (>75%) High concordance rates for monozygotic twins (55%) Causes Complex condition - biological, psychological, and social factors – Developmental condition • Predisposing - Female sex, family history of eating disorders, character (low self-esteem & perfectionism) & family dynamics • Precipitating – cultural & peer group group pressure, peer acceptance for dieting & weight loss, autonomy conflicts • Perpetuating – secondary gain (attention), biological factors (starvation) – Certain groups increased at risk - dancers, longdistance runners, skaters, models, actors, wrestlers, gymnasts Symptoms - AN Symptoms - BN Prognosis • • • • • • Full recovery more common in those with a short history Some may be left with atypical ED or BN 20% make a full recovery 60% fluctuating course 20% remain severely ill Most severe cases – 15% mortality (suicide & cardiac complications) • BN – COMORBIDITY WITH DEPRESSION AND ALCOHOL USE • Assessing and Managing risks – bloods, weight, Squat tests, driving, cognitive function, mood, DSH, suicidal ideation. Referring to STEPs • BANES • If already in secondary mental health services the referral is direct to STEPs. • GP refers to PCLS. • PCLS and STEPs offer a joint assessment. • Decision about treatment is usually made at assessment. • What we can offer, treatment, joint working, supervision, teaching. Thank you for listening Any questions? Please contact us at: STEPs Eating Disorder Service Clifton Building Southmead Hospital Westbury-on-Trym Bristol BS10 5NB Tel: 0117 3236113