1. EATING DISORDERS NH Explore 7/8/15 Ken Yeow

2. Overview WHAT are they? WHY do they happen? HOW can people be helped?

3. WHAT

4. Main types ANOREXIA NERVOSA (AN) BULIMIA NERVOSA (BN) AN with BN symptoms Atypical AN/BN

5. Core features Weight – BMI; trend Eating – Under; over Behaviours – Vomiting; laxatives; exercise etc. Thinking/feeling – Fear; self-evaluation; distortion; preoccupation etc. Complications – Acute; chronic (periods, bones etc.)

6. Estimated frequency Inc. /10 5 pop./yr Prev. /10 5 pop. NI New cases/yr NI Existing cases AN 4-1010-3068-170170-510 BN 10-3050-150170-510850-2550 Atypical ‘Atleastasmany’ TOTAL 28-80120-360476-13602040-6120

7. WHY

8. Quote ‘It’s not about food, it’s about feelings’ (and much more... self-esteem, identity, control etc.)

9. One Model For Understanding Early experience  Emotional problems  Attempted solution  Solution becomes a problem

10. It serves a purpose What is being AVOIDED? – Negative emotions; frightening change; family disruption etc. What is being GAINED? – Control, safety/security; attention, regard; self-esteem, value; achievement, specialness; anxiety relief, mood lift etc. What is being EXPRESSED? – Anger/frustration, guilt, self-hatred (self- punishment) etc.

11. HOW

12. Principles of helping 1)Engagement/motivation 2)Risk assessment/management 3)Nutritional restoration 4)Psychological therapy 5)Medication sometimes 6)Functional/occupational recovery 7)Support for/from family/friends

13. 1) Engagement/motivation Curious Compassionate Containing

14. 2) Risk assessment/management Physical, psychiatric, social Point in time and trends Multidisciplinary team (including patient and family/friends)

15. 3) Nutritional restoration Essential priority Individualised approach ‘Food as medicine’

16. 4) Psychological therapy Symptoms/causes Structure, focus, timing Supervision, reflection

17. 5) Medication sometimes Helpful in BN Symptomatic treatment in AN For co-occurring psychiatric conditions

18. 6) Functional/occupational recovery ‘Getting a life’ Basic living needs/skills Structured, purposeful activity

19. 7) Support for/from family/friends Young person vs. adult Working together against the illness Communication, communication, communication

20. How you can help Mild-moderate BN – ‘Guided self-help’ (‘Overcoming’ books) – Encourage to see GP for physical monitoring and ?medication Severe BN and AN – Usually referred, via GP (collaboration, advocacy) General support – Friendship, ‘normality’, distraction, spiritual help, encourage treatment engagement etc.

21. From a Christian perspective Christians not immune! Avoid superficial/overly spiritual answers Real answers to deeper questions – Self-esteem, identity, control etc.

22. We have good news! Personal Freedom: How The Gospel Can Be Good For Your Mental Health (www.amazon.co.uk)

23. Divine resources The Word of God (truth) The Spirit of God (power) The people of God (community)

24. Other resources See handout