1. How to recognise an eating disorder? How to recognise an eating disorder?

2. Eating Disorders “Eating disorders are complex illnesses, rooted in psychological and emotional distress, where people use food and eating as a means of coping with seemingly insurmountable problems. They offer a mechanism for control in a life that seems out of control.” Eating Disorders Association (now b-eat)

3. BMI SCALES 17.5 - 20 Irregular or absent ovulation Osteoporosis risk increased 15 – 17.5 Anorexia nervosa. Amenorrhoea, loss of substance of all organs and structures, Osteoporosis high risk 13.5 - 15 Severe Anorexia nervosa. Compromised bone, heart and brain. Metabolism reduced 50% 12 – 13.5 Organs begin failing muscle, heart, bone marrow. Life threatening < 12 Sudden Death

4. Effects of excessive weight loss or food restriction Decreased heart rate Decreased heart rate Digestive system slows down – gastro intestinal discomfort Digestive system slows down – gastro intestinal discomfort Decreased tolerance for cold temperature – extremities become purple/blue Decreased tolerance for cold temperature – extremities become purple/blue To conserve heat, fine hair may grow on the body To conserve heat, fine hair may grow on the body Decrease in body tempera Decrease in body tempera Decrease in metabolic rate Decrease in metabolic rate

5. Cont’d Reduced strength Reduced strength Dizziness, headaches Dizziness, headaches Decreased need for sleep Decreased need for sleep Skin and hair become dry/hair falls out Skin and hair become dry/hair falls out Females may notice that periods become irregular Females may notice that periods become irregular Hormone imbalance and poor diet can lead to osteoporosis Hormone imbalance and poor diet can lead to osteoporosis Hurts to sit down Hurts to sit down Long-term muscle loss can damage the heart, kidney and other organs Long-term muscle loss can damage the heart, kidney and other organs Collapse and even death Collapse and even death

6. Psychological effects Food becomes the principle topic of conversation Food becomes the principle topic of conversation Pre occupation with reading cook books and collecting recipes Pre occupation with reading cook books and collecting recipes There may be signs of hoarding There may be signs of hoarding Much of day spent planning allotted food Much of day spent planning allotted food Unusual concoctions Unusual concoctions Increased use of salt and spices Increased use of salt and spices Often increased consumption of tea and coffee Often increased consumption of tea and coffee

7. Cont’d Emotionally there may be periods of depression and low mood. Emotionally there may be periods of depression and low mood. Anxiety high with outbursts of anger and irritability Anxiety high with outbursts of anger and irritability Socially withdrawn Socially withdrawn Loss of sexual interest Loss of sexual interest Feeling of social inadequacy Feeling of social inadequacy Humour seems to disappear Humour seems to disappear Concentration becomes increasingly difficult Concentration becomes increasingly difficult Decision making almost impossible Decision making almost impossible Forgetfulness common Forgetfulness common

8. SCOFF questionnaire  Do you ever make yourself sick because you feel uncomfortably full?  Do you worry you have lost control over how much you eat?  Have you recently lost more than one stone in a three month period?  Do you believe yourself to be fat when others say you are too thin?  Would you say that food dominates your life?

9. What to do? Complete referral to CMHT Complete referral to CMHT If monitoring risk, use King’s College Guidelines If monitoring risk, use King’s College Guidelines

10. Case study 1 Patient presents feeling cold all the time, lack of motivation, tired, eating very little, feeling sick Recent weight - 41kg Height – 1.54m What next?

11. Case Study 2 Patient presented with restricted food intake, vomiting, regular alcohol intake and exercising every day but looks normal weight What next? What next?

12. Case Study 3 Patient presents with weight loss, anxiety, insomnia, increased alcohol intake, exercising every day, chest pains – recently moved to the area after brief recent admission to psychiatric unit for suicidal ideation. Weight 43kg, Height - 1.75m, BMI 14 What next? What next?