Anorexia Nervosa (AN)
AN is when a person regularly and significantly restricts their diet in order to control their weight and/ or shape. This is often accompanied by body image disturbances, over-exercising, and an intense fear of gaining weight. Sometimes, people with AN might also make themselves vomit or take laxatives, again as an attempt to reduce their weight and calorie intake. If AN is detected as the primary problem, a person will be accepted onto this pathway. On this pathway, an individual will be offered a choice of three first-line treatments for AN: CBT-E, MANTRA, or SSCM. For more information on AN, please visit the NHS website.
Bulimia Nervosa (BN)
BN is when a person regularly eats a lot of food in a short amount of time (binging), and uses compensatory methods such as self-induced vomiting, laxatives, excessive exercise or restricting their eating to prevent weight gain. If BN is detected as the primary problem, a person will be accepted on to this pathway. On this pathway, there are three tiers of care that a person could be allocated to: Guided Self Help, CBT-T, or CBT-E. For more information on BN, please visit the NHS website.
Binge Eating Disorder (BED)
BED is when a person regularly eats a lot of food in a short period of time. Binges may be planned and are often done alone. Some people have special ‘binge foods’ that they will only eat during a binge. If BED is detected as the primary problem, a person will be accepted onto this pathway. There are three tiers of care available for people with BED: Guided Self-Help, CBT-T and CBT-E. For more information on BED, please visit the NHS website.
Avoidant Restrictive Food Intake Disorder (ARFID)
ARFID is when a person restricts their eating and nutritional content but is not doing so in terms of body image or desire to lose weight. ARFID tends to present in three different ways:
- Sensory – This is when someone struggles with textures of food. A person who experiences this may have specific types of food they can tolerate and others that they extremely dislike the texture,feel, smell or sound of. This can lead to someone only eating the food they can tolerate and so struggling to get adequate nutrition and possibly experiencing rapid weight loss.
- Negative consequences – This is when someone has experienced adverse consequences or experiences with eating and so restrict their food intake to avoid these consequences. Examples of negative consequences can be vomiting, IBS, allergic reactions, illness amongst other things. A person may restrict their eating as means of protecting themselves from these negative consequences but in doing so can struggle to get the nutrition they need and may lose weight as a result.
- Lack of interest/appetite – This is when someone has a lack of interest in food so find it hard to eat regularly and an adequate amount of food. People with this subtype express not enjoying food and feeling that eating is more of a chore. This can make them less responsive to hunger cues and less likely to eat consistently in turn decreasing their weight and reducing their nutritional intake.
People with ARFID can experience more than one of the above difficulties.
If ARFID is detected as a primary problem, a person may be accepted onto the ARFID pathway. This pathway includes treatment of CBT-AR which is a variation on CBT that is designed to especially for those experiencing ARFID. The person may also be seen by a dietician and support worker to help aid their recovery.
For more information on ARFID, visit the Beat Eating Disorders website.
Other Specified Feeding or Eating Disorder (OSFED)
OSFED is the most common eating disorder and refers to a variety of eating disorders where a person’s symptoms do not exactly fit the expected symptoms of a specific eating disorder. OSFED includes Atypical Anorexia Nervosa, Bulimia Nervosa (low frequency/limited duration), Binge Eating Disorder (low frequency/limited duration), Purging Disorder or Night Eating Syndrome. If OSFED is detected as the primary problem, a person will be accepted onto this pathway and will be offered a treatment option from the pathway most closely resembling the symptoms. For example, if a person meets the criteria for Atypical Anorexia Nervosa, they will receive a treatment available on the Anorexia Nervosa (AN) pathway. For more information on OSFED, please visit the Beat Eating Disorders website.
Co-morbidities
Autism
Research suggests that 35% of people experiencing an eating disorder may also have autism. This is because some characteristics of autism, such as sensory sensitivity and preferring strict rules and routines, can impact a person’s relationship with food and their body. If you are autistic and have been referred to Derbyshire Eating Disorder Service for treatment, you will receive treatment for the eating disorder you have been diagnosed with in the same way a non-autistic person would. However, you may require some adaptations to ensure that the service adequately covers your needs. Your therapist will discuss this with you in sessions to find what works best for you.
For more information about autism and eating disorders, and links to further resources, please see the following websites:
Diabetes
It is estimated that up to 30% of people with type 1 diabetes also have an eating disorder. This is because living with diabetes can mean that day-to-day life has more of a focus on managing diet and weight. The mental and physical challenges that come with diabetes, such as increased hunger and thirst, fluctuations in weight, and anxiety or low mood, can risk this focus becoming unhealthy or for the wrong reasons. People with diabetes can develop any eating disorder, but most commonly seen is bulimia nervosa (see above) with insulin restriction as the compensatory behaviour. If you are diabetic and have been referred to our service for treatment of an eating disorder, your therapist will encompass the needs and behaviours related to your diabetes within sessions.
For more information about diabetes and eating disorders, and links to further resources, please see the following websites:
