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Care Forum South Glo s -Eating Disorders

Care Forum South Glo s -Eating Disorders. Introduction to STEPs Motivational Work Eating Disorders Questions Lydia Pym - Occupational Therapist Alysun Jones – Clinical Psychologist STEPs Eating Disorder Service. STEPs Eating Disorder Service

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Care Forum South Glo s -Eating Disorders

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  1. Care Forum South Glos-Eating Disorders Introduction to STEPs Motivational Work Eating Disorders Questions Lydia Pym - Occupational Therapist Alysun Jones – Clinical Psychologist STEPs Eating Disorder Service

  2. 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* Out-patient and Community services • Primary Care Service- First Step • Multidisciplinary Team • Variety of treatments • Supporting Carers

  3. Treatments Offered • Compassion Focused Therapy – Dr Paul Gilbert 2006 • Cognitive Behavioural Therapy – Dr Christopher Fairburn • Motivational work – Dr Josie Geller • LEAP group, Cooking sessions, Dietitian, Physio community group • Other specialist therapy (EMDR, CAT)

  4. Cognitive Behavioural Therapy • CBT-E • 20 Sessions for BN • 40 for AN • Developing regular eating plan, diary, weight charts, body image work, understanding and challenging beliefs about food and weight.

  5. Prochaska & DiClemente’s Six Stages of Change • How and why did we develop our current model of working?

  6. Motivational Work • Listen • Step back • Learn • Be curious • Invest less Is it any good? • Benefits Staff, team and Clients

  7. Non-Negotiable

  8. 1. Clearly defined from the outset – no surprises2. Agreed by staff & clients if possible 3. Not arbitrary, but with good justification4. Consistently applied by all staff

  9. Diagnostic Criteria - Anorexia nervosa A. Restriction of energy intake relative to requirements leading to a significant low body weight in the context of age, sex, developmental trajectory and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or for children and adolescents, less than minimally expected. B. intense fear of gaining weight, or becoming fat, even though underweight C. disturbance in the way in which body weight or shape is experienced with undue influence of body weight on self-evaluation, or denial of seriousness of current low body weight Restricting type - no bingeing or purging during last 3 months Binge - eating / purging type - regular bingeing or purging during last 3 months

  10. Bulimia Nervosa A. Recurrent episodes of binge eating 1. Eating in a discrete period of time an amount of food that is definitely larger than most people would eat in similar time and under similar circumstances 2. Sense of lack of control over eating B. Recurrent inappropriate compensatory behaviour to prevent weight gain - vomiting, laxatives, diuretics, enemas, fasting, exercise, other medications C. Bingeing and compensatory behaviour more than twice per week for three months D. Self-evaluation unduly influenced by body shape and weight E. Disturbance not occurring exclusively during episodes of anorexia nervosa

  11. Other specified feeding or eating disorder 1 Atypical Anorexia nervosa as AN but in or above normal range 2 Sub-threshold BN as BN but binge eating less than once a week and/or less than 3 months 3 Sub-threshold BED As BED except bingeing less than once a week and/or less than 3 months 4 Purging disorder Recurrent purging, no binge eating, intense fear of weight gain 5 Night eating syndrome 6 Other feeding or Eating condition not elsewhere classified

  12. 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%)

  13. 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, long-distance runners, skaters, models, actors, wrestlers, gymnasts

  14. Symptoms - AN

  15. Symptoms - BN

  16. 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.

  17. 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.

  18. Thank you for listeningAny questions? Please contact us at: STEPs Eating Disorder Service Clifton Building Southmead Hospital Westbury-on-Trym Bristol BS10 5NB Tel: 0117 3236113

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