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Intervention and Treatment

Treatment in NHSGGC is based on the best research evidence.

Eating disorders are serious and potentially life threatening conditions affecting a young person’s physical, emotional and social development. The serious nature of an eating disorder, in childhood or adolescence, makes it very important that assessment and treatment are offered as early as possible. It has been shown that early identification and treatment of eating disorders improves outcomes and promotes full recovery for young people. Connect-ED works to support Child and Adolescent Mental Health teams to ensure that the best possible treatment is offered to young people and their families at the point of need. Tackling an eating disorder can be a long and difficult journey. It is important to have the right kind of help and support.

Treatments available have to be know to be the most effective. Organisations such as The National Institute of Clinical Excellence (NICE) and Quality Improvement Scotland produce guideline on eating disorders based on the best research evidence. Links to these reports below:

NICE 2004 http://guidance.nice.org.uk/CG9/QuickRefGuide/pdf/English

QIS http://www.healthcareimprovementscotland.org/default.aspx?page=12455

These types of guidelines and good quality research are what tell us about the best treatments available for children and young people with eating disorders. It is these treatments that have good research evidence that we aim to provide in Greater Glasgow and Clyde.

TREATMENT PLANNING

The young person’s diagnosis, individual difficulties and situation will be taken into account when treatment options are discussed. The young person and parents/carer then decide, with the case manager, which will be the most effective and most suitable treatment. It is recommended that Family members including siblings should normally be included in the treatment of children and adolescents with eating disorders. See more information about eating disorders

A treatment plan can be drawn up which may involve one or a variety of therapists and treatments.

The main treatment options are explained further below:

Family Based Treatment (FBT)

Family Based Treatment is based on the belief that the family is the most vital resource in a child/young person’s recovery from anorexia nervosa/ atypical anorexia. It is a treatment delivered on an outpatient basis within a clinic based setting. Family Based Treatment has been shown to be most effective where the whole family i.e. / parents, young people and their siblings are involved in the treatment sessions. It is sometimes helpful to include extended family members in the treatment e.g. / involved grandparents. The treatment involves meeting with one, sometimes two clinicians, for around 20 family based sessions over a 6-12 month period of time. These sessions take place in an outpatient clinic and typically last about one hour. To begin with sessions will take place weekly with the gap between sessions increasing over the course of treatment. There are 3 phases of treatment. The first phase focuses on empowering parents to re-feed their child/young person in order to restore weight and physical health. The second phase focuses on handing control of eating back to the child/young person in an age appropriate way and the third phase focuses on childhood/ adolescent developmental issues. Sometimes families will move backwards and forwards between phases until progress can be secured and the child/young person is ready to move through the next phase of treatment.

Family Based Treatment has the strongest research evidence of all therapies for young people with anorexia nervosa, which means this therapy results in the best outcomes for patients. All patients are offered this as a therapy option in NHS GG&C and there has been good investment in support and training to staff in this therapy.

Link to leaflet

Other Family Based Work

It is recommended that Family members including siblings should normally be included in the treatment of children and adolescents with eating disorders. The whole family is affected when a young person in the family has an eating disorder. It can be a very difficult time for all in the family, watching the struggles of the young person and helping them to recover.

Families can attend family therapy to help them to manage the problems they face because of the eating disorder. For anorexia nervosa sufferers the type of family therapy described above called Family Based Treatment is the most effective. However there may be situations which do not make family based treatment possible or once Family Based Treatment is finished, when Family Therapy is helpful.

Family therapy is also helpful for young people who are suffering from bulimia nervosa and atypical eating disorders. The family therapist works in collaboration with the family to help support the young person to over come the eating disordered behaviours and thinking. For bulimia nervosa this may go hand in hand with the individual therapeutic work.

A type of group family therapy called Multi Family Therapy is available for families who have a child with anorexia nervosa/atypical anorexia. It is designed to support families in the early stages of learning to manage anorexia nervosa/atypical anorexia. This therapy brings together 4-5 families so that they can think together and support each other with the challenges that tackling anorexia presents. Anorexia nervosa is recognised as a very stressful and demanding disorder to manage and parents often feel isolated and unsupported. Within the group there is the opportunity to share experiences and to learn from other families while receiving support from experienced facilitators. Meeting with other families in Multi Family Therapy has been shown to reduce feelings of isolation.

See link to more information about eating disorder

See link to family experiences of eating disorders

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) is an individual treatment that can be used in child and adolescent eating disorders. CBT works to help the young person understand how thoughts, feelings and actions link together. This type of work is demanding and requires sufferers to be motivated to change and work hard to understand their thinking and make the necessary behavioural changes.

It is often difficult for a young people with Anorexia Nervosa to make use of individual therapy. Because of this Cognitive Behavioural Therapy is most effective following Family Based Treatment. At this point the young person’s weight has been restored and they are more able to cope with the demands of individual treatment. Research has shown that for anorexia nervosa sufferers Cognitive Behavioural Therapy works best for older adolescents who are a weight that is near to being healthy

Enhanced Cognitive Behavioural Therapy (developed specifically for eating disorders) is a therapy that is effective for bulimia nervosa and atypical bulimia nervosa sufferer’s particularly older teenagers. Enhanced Cognitive behavioural therapy (CBT-E): Is a relatively short-term therapy that works on the eating disordered symptoms, by focusing on the beliefs, values, and cognitive processes that maintain the eating disorder behaviour. It aims to change distorted beliefs and attitudes about the meaning of weight, shape and appearance which have been part of the development and maintenance of the eating disorder.

Overcoming Bulimia Online is a CBT based online treatment that the team offer for young people who have less severe symptoms of bulimia or atypical bulimia or for those who find it difficult to come in to the clinic or would find an online package the most suitable method of undertaking therapy. The young person works through a series of computer based sessions and has telephone and email support from a trained therapist. These sessions are interactive; include audio and video presentation and stories.

Individual Supportive Psychotherapy

This is a talking based therapy which provides the young person with an individual space to think about their difficulties and consider ways to make changes. There is no evidence to suggest that individual therapy is helpful when young people are at a low weight or as part of restoring weight. As such while a young person is underweight the focus remains on family based interventions. Once weight has been restored individual supportive therapy can be offered to young people if they feel they still have issues they would like to discuss on a one to one basis with a therapist.

(Link to experiences of young people)

Nutritional Therapy

Registered Dietitians who are specialists in children and young people with eating disorders are part of the team of therapists available to both the child/young person and to parents/carers in CAMHS in NHS Greater Glasgow and Clyde. Dietitians are often involved in the assessment and early medical monitoring stages for all patients. Their on going involvement will then depend on what treatment is decided on. There is a lot of misleading information written about nutrition in the media and online. This information can become very confusing and distorted for eating disorders sufferers. Specialist Dietitians translate the true science of nutrition into practical information about food.

See nutritional information pages

Medical and Psychiatric Treatment

These are the elements of treatment that are managed by the Doctors in the team.

Physical Health Care

Eating disorder behaviours often result in physical symptoms, which can be severe. Careful monitoring of these physical symptoms is an important part of treatment of eating disorders. Common tests include; pulse and blood pressure, blood tests for biochemistry, physical examinations and bone scans. As eating disordered symptoms improve the physical risks reduce and less and less testing is required. However early in treatment physical health monitoring is a frequent aspect of treatment.

Medication in Eating Disorders

There is little research evidence for the use of medication in children and young people with anorexia nervosa; therefore it is not often used. However if the child or young person with an eating disorder has another psychiatric condition such as depression, then medication can be helpful. In Bulimia Nervosa there is more evidence for the benefit of medication and this is a good option to consider.

Psychiatric care

Psychiatrists are likely to be involved in eating disorder cases where the patient is at higher risk. It is the Psychiatrist who refers children or young people to hospital, if required. They are also able to use the mental health act to insist on an admission and treatment against the will of the child or young person. This rarely happens but is essential in making sure that children and young people do not die from their eating disorder.

Inpatient Treatment

Inpatient treatment is only required for a few children and young people with anorexia nervosa. There is no research evidence for other suffers with other diagnosis to be treated as an inpatient. Young people who are discharged are rarely fully recovered and a lot of work is required after discharge to continue to treat and support them to recovery.

The types of reasons for admissions are:

  • Medical stabilisation is required
  • Lack of progress in the community leading to increase risk to the young person
  • Other risk factors that make treatment in the community unsafe

In Glasgow and Clyde there are 2 general psychiatric wards, one at Yorkhill Hospital for under 12 year olds and one at Stobill hospital for 12-18 year olds. Both these wards are experienced in treating eating disorder patients. Admissions to these psychiatric wards can vary in length, 2 - 12 months.

Sometimes children and young people with eating disorders are admitted to medical or paediatric wards because of physical risk, these tend to be short admissions that do not interrupt the care given by the CAMHS team

Home Intensive Treatment Team

There is a home intensive treatment team (HITT) that supports children and young people with psychiatric illness across Greater Glasgow and Clyde Health board. Nurses in this team work with patients of all diagnosis and the aim of their interventions is prevention of admission to psychiatric hospital. They are able to work with young people for an 8 week period. The HITT team can be used to provide additional support to young people whose eating disorder behaviours are putting them at risk of needing an admission. This may include; support at meal times, distraction after meals, medical checks, help with medication etc