Eating Difficulties and Disorders

Eating Difficulties and Disorders,
Developmental or Emotional based eating difficulties (including ARFID presentations),
Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED).

Anorexia nervosa is characterised by intentional weight loss where body weight is maintained at least 15% below the expected (either lost or never achieved) or a trend of rapid weight loss with intent to continue.  The weight loss is self-induced by avoidance of adequate food, self-induced vomiting, self-induced purging, excessive exercise, use of appetite suppressants and/or diuretics.  There is body image distortion and in post pubertal females an abnormal absence of menstruation.

Bulimia nervosa is characterised by a persistent pre-occupation with eating and periods of over-eating in which unusually large amounts of food are consumed in a short period of time.  Associated symptoms include – self-induced vomiting, purgative abuse, alternating periods of starvation, and use of drugs such as appetite suppressants.

People with binge eating disorder eat large quantities of food over a short period of time with the absence of purging behaviour. BED differs from “overindulging” – where binges are very distressing, feel out of control and often feeling disconnected. Characteristics can include eating much faster than normal, eating until feeling uncomfortably full, eating large amounts of food when not physically hungry, eating alone through embarrassment at the amount being eaten, and feelings of disgust, shame or guilt during or after the binge.

Initial intervention from other Tier 1/2 services (Universal and Targeted services) prior to specialist CAMHS involvement

Early intervention is key to the successful treatment of an eating disorder and therefore GPs, schools and parents play an important role in identifying an emerging eating disorder.

If concerned about a possible eating disorder the GP should complete a comprehensive physical health screen including a height, weight, postural assessment of BP and HR, tympanic temperature and full bloods (FBC’s, LFT’s, U’s and E’s). Guidelines for estimating risk from these results can be found in Junior MARSIPAN Guidance.

If there is suspicion of Anorexia Nervosa, Bulimia Nervosa, or BED the young person should be referred straight to specialist CAMHS.

Contact can be made with the CAMHS Eating Disorder Team (CEDS) if there are concerns about whether a referral should be made.

Service leaflet available at:

Service provided by Specialist Child and Adolescent Mental Health Service –   Tier 3

CEDS aim to provide assessment and appropriate NICE-Concordant treatment intervention for AN, BN and BED within 4 weeks.

Possible referral to local paediatric services for medical review, which may result in short term admission on to paediatric ward if required, depending on concerns and severity.

The young person and family will be offered an assessment and from this a care and treatment plan will be developed and implemented.

A Care Co-ordinator will be appointed who will over-see physical health monitoring.

CAMHS Consultant Psychiatrist involved where appropriate/ indicated.

When there is a co-occurring mental health condition requiring Tier 3 treatment Core CAMHS services can provide treatment for young people presenting with ARFID.