1. B ULIMIA N ERVOSA R ECOGNISING THE W ARNING S IGNS Dr Pooky Knightsmith

2. W HAT IS AN EATING DISORDER ? Food and weight used as a way of coping Serious mental health issue ANYONE can be affected Not all about appearances Low self-esteem

3. B ULIMIA N ERVOSA I spent longer throwing up than eating. Every time I’d promise myself I’d stick to my diet this time, but I just couldn’t do it. Roughly normal weight Frequent fluctuation in weight Influence of shape and weight Binge purge cycle Most common forms of purging are laxative abuse and vomiting

4. Strict dieting Diet slips or difficult situation arises Binge eating triggered Purging to avoid weight gain Feelings of shame and self- hatred T HE B INGE P URGE C YCLE

5. T RIGGERS Family relationship difficultiesPeer relationship break upBullyingTraumaExposure via friends, family, mediaDifficult times of year e.g. anniversariesExam pressureTimes of change (new school, parents split etc)

6. B ULIMIA IS A SECRETIVE DISEASE People with bulimia are often very ashamed of their illness and will work hard to conceal signs and symptoms making it very difficult to spot. An awareness of the warning signs on the next few slides may help you pick up a case early – which will maximise the chances of effective support and complete recovery.

7. Bulimia Warning Signs Weight Fluctuation Due to the binge purge cycle However, weight change is often not noticeable making this a hard illness to spot.

8. Bulimia Warning Signs Callused Knuckles Due to repeated vomiting. This sign is not always present but is often the most clear indicator of bulimia.

9. Bulimia Warning Signs Chewing Gum Drinking Water As a food replacement when trying to restrict food intake To mask the smell of vomit after purging

10. Bulimia Warning Signs Wearing Scarves Scarves will sometimes be warn to hide swollen glands / puffy face caused by vomiting

11. Bulimia Warning Signs Toilet after Meals Could be a sign of purging – either laxative abuse of vomiting

12. Bulimia Warning Signs Tooth Decay & Sore Throat Acid in vomit wears away teeth. Dentists often note erosion of enamel on the inside of teeth of someone who vomits regularly.

13. Bulimia Warning Signs Can’t focus on School Work Too consumed with eating disordered thoughts

14. Bulimia Warning Signs Isolation People suffering with eating disorders will often push away their friends and find they have less in common with them than they used to.

15. Bulimia Warning Signs Summary Weight Fluctuation Chewing Gum/ Drinking Water Toilet after meals Secretive behaviour Puffy Face Calussed Knuckles Sore ThroatTooth Decay Can’t Focus on School Work Isolation / loss of friends

16. How to be helpful ListenBe honest Try to understand Persevere & offer support Voice the difficulties Remember the ‘real’ child

17. T REATMENT O PTIONS Family supported in playing an active, positive role Family Therapy Alters behaviour by altering way we think about food / weight Cognitive Behavioural Therapy (CBT) Talking therapy with the aim of developing a healthy diet Dietary Counselling Explores life experiences and their impact on behaviour Psychodynamic Therapy Antidepressants Medication

18. Need more support? Dr Pooky Knightsmith specialises in mental health and emotional well-being in the school setting. She can provide training sessions or workshops for school staff, parents or students on a variety of topics, including self-harm and eating disorders. For further information and free resources visit www.inourhands.com Email: pooky@inourhands.com Twitter: @PookyH