1. health and fitness
2. disorders

National Services
CAMHS Eating
Disorders Service
A national and specialist service providing expert assessment
and treatment for young people with eating disorders.
South London and Maudsley NHS Foundation Trust
» What helped me was my determination to succeed
and find the girl I used to be. The intensive treatment
programme took me away from all I knew, but it brought
back the most important part of me that was hiding –
happiness. « Kerry
Cover illustration by a young person from the intensive treatment programme, 2011
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CAMHS National and Specialist Services: Eating Disorders Service
Contents
Service overview
4
Our philosophy
5
Who is our service for?
6
Interventions
8
Our care pathway
12
Outcomes
14
Our facilities
16
Training and consultancy
17
Our team
18
Case studies
22
Referring to our service
26
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South London and Maudsley NHS Foundation Trust
Service overview
We provide assessment and treatment for young people with eating disorders and their
families, using a number of innovative and empirically sound methods. We have specialist
knowledge of eating disorders, with expertise in both individual and family therapy.
Our service is nationally and internationally renowned for
clinical and research evaluation of psychological
treatments for eating disorders. Findings from our studies
are frequently quoted as providing the principal evidence
for the effectiveness of family therapy for adolescent
anorexia nervosa.
Our treatment is provided on an outpatient basis and
includes a range of therapies. We have developed an
intensive multi-family therapy (MFT), for which we received
the 2004 Positive Practice Award from the National Institute
for Mental Health in England. We recently developed a new
intensive treatment programme (ITP) which offers a timelimited day service for young people with anorexia nervosa.
King’s Health Partners
Our service is part of the Child and Adolescent Mental
Health Clinical Academic Group. SLaM has joined with
King’s College London, Guy’s and St Thomas’ NHS
Foundation Trust, and King’s College NHS Foundation Trust
to establish King’s Health Partners, an Academic Health
Sciences Centre. King’s Health Partners involves bringing
clinical care, research and education much more closely
together. Our aim is to reduce the time it takes for research
discoveries and medical breakthroughs to become routine
clinical practice. This will lead to better care and treatment
for patients.
Visit www.kingshealthpartners.org for more information.
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CAMHS National and Specialist Services: Eating Disorders Service
Our philosophy
We help young people and their families explore the nature of the eating disorder and its
impact on their lives.
Our goal is to work collaboratively with young people and
their families, to empower them to reclaim their lives from
the eating disorder. Our clinical experience is supported by
research findings that show a full recovery is possible.
» Anorexia is a demon but now I feel
I have control over it, not it over me. «
Amanda
5
South London and Maudsley NHS Foundation Trust
Who is our service for?
We offer services to young people and their families where it is suspected that the young person
has an eating disorder. Our service is able to respond rapidly to new referrals, usually within two
weeks, or faster in very urgent cases.
Eligibility
›› Up to 18 years
›› Male or female
›› Suspected diagnosis of anorexia nervosa, bulimia nervosa,
food refusal, extreme faddism, atypical conditions, or an
eating disorder not otherwise specified (EDNOS), including
patients on paediatric, medical or adolescent mental health
wards, as long as they are medically stable to commence
outpatient treatment
Exclusion
›› 98th centile, equivalent to BMI >30 in adults
» With your encouragement I have been able
to challenge myself further and do things
I previously wouldn’t have done. « Sam
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CAMHS National and Specialist Services: Eating Disorders Service
7
South London and Maudsley NHS Foundation Trust
Interventions
Our interventions are designed to address a broad range of difficulties faced by the young people
admitted to our service and their families.
Our approach includes psychological interventions using
systemic ideas with both the young person and their family.
Systemic therapy draws on and integrates a range of
approaches, paying explicit attention to issues of individual
and family development, culture, ethnicity, gender and wider
familial and societal contexts.
We also offer information about the physical effects of the
eating disorder (psychoeducation), advice on behavioural
management, as well as the use of meal planning and
dietetic support.
Family therapy
Our treatment model places a strong emphasis on working
closely with families, helping them to rediscover their strengths
and finding ways to overcome their child’s illness. Therapy
often starts on a weekly basis, although this can be reduced
or increased according to need. Treatment lasts between nine
months and one year, and in most cases young people are
discharged with minimal symptoms.
Cognitive behavioural therapy (CBT)
Young people with bulimia nervosa or binge eating disorders
may be treated with CBT, adapted as needed to suit their age,
circumstances and level of development. The young person is
also encouraged to follow an evidence-based, self-help
programme with the support of staff.
8
Physical health monitoring
We emphasise the importance of close physical monitoring
including weight and height, bloods, hormones, heart
(ECG) and bone density (DEXA bone scans). We continually
assess the physical risk induced by the eating disorder. Our
paediatric consultant provides regular paediatric monitoring
and consultation.
If there is deterioration during treatment, or the treatment
does not lead to any significant improvement or is deemed
to take a long period of time, then more intensive forms of
treatment are implemented.
Multi-family therapy
The intensive MFT for anorexia nervosa is a four-day intensive
programme for a group of up to seven families. This is followed
by six follow-up days, over 12 months and combined with
individual sessions with the family as needed.
Feedback from families has been very positive, with many
emphasising the collaborative nature of the treatment.
The high user satisfaction is reflected in a drop-out rate
of less than three per cent.
Following the success of MFT for anorexia nervosa, we are
piloting an exciting new multi-family programme for young
people with bulimia nervosa or atypical bulimia nervosa and
their families.
CAMHS National and Specialist Services: Eating Disorders Service
» I believe the intensive treatment programme has changed my daughter’s life.
She now has a far better relationship with food. « Father
The bulimia nervosa programme is a 20-week course for a
group of up to eight families. Young people and their families
meet fortnightly for group sessions, and young people meet
fortnightly for individual sessions.
Intensive treatment programme
ITP is a seven-week programme for a small group of people
with a diagnosis of anorexia nervosa or EDNOS. The programme
runs from 8am to 8pm, Monday to Friday, for a period of six
weeks and is followed by, or preceded by MFT.
ITP consists of intensive small group therapy and support at
mealtimes. Education is provided on site by teaching staff. The
programme aims to provide young people with skills that they
can apply in everyday life. The groups include:
Medication
A range of medications may be used in the treatment of
co-morbid conditions like depression, obsessive compulsive
disorder and anxiety. Young people with bulimia nervosa are
sometimes treated with selective serotonin reuptake inhibitors,
which can reduce binge eating, under close medical monitoring.
Assessments and second opinions
We offer multidisciplinary assessments and second opinions.
Where treatment is not appropriate, we provide advice and
recommendations for future interventions, including the need
for specialist interventions and services.
›› Anxiety, perfectionism and self-esteem groups,
using CBT approaches
›› Flexible thinking groups using cognitive remediation
therapy approaches
›› Managing emotions, relationships and distress using
dialectical behaviour therapy approaches
›› Psychoeducation and physical health sessions
›› Relaxation, yoga, art and other creative groups
›› Food group and individual dietetic support
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South London and Maudsley NHS Foundation Trust
Our care model
Medical risk management
›› Medical reviews
›› Monitoring of physical risks
›› Blood investigations
›› ECG and bone density scans
›› Liaison with inpatient and
community teams
Education
›› Education provided within ITP
›› Liaison with schools
›› Support to stay in mainstream education
›› Support to maintain school attendance
PATIENT
Intensive treatment
programme
›› Meals supported by staff
›› Psychoeducation and physical
health sessions
›› CBT for worry, perfectionism
and self-esteem
›› Flexible thinking skills
›› Managing emotions, relationships
and distress
›› Mindfulness, relaxation, yoga
and art groups
10
›› Multidisciplinary assessment and
management plan
›› Intensive support helping families
to take on the management and
preparation of meals
›› Re-feeding and weight restoration
›› Psychoeducation on the medical and
psychological implications of the illness
›› Supporting family and peer
relationships, and education
›› Developing an independent life
Outpatient therapies
›› Eating disorder focused
family therapy
›› Individual systemic CBT
›› Multi-family therapy for
anorexia and bulimia nervosa
Dietetic Support
›› Assessment
›› Provision of meal plans and
individual dietary counselling
›› Dietetic group support
›› Joint consultation with patient,
family, dietitian and therapist
CAMHS National and Specialist Services: Eating Disorders Service
11
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South London and Maudsley NHS Foundation Trust
Our care pathway
1
2
Seven-week programme (8am to 8pm)
Family and individual sessions over nine
to 12 months
3
Four days (10am to 4pm), with six follow-up
days over 12 months
Combination of individual, separated and
multi-family groups
CAMHS National and Specialist Services: Eating Disorders Service
13
South London and Maudsley NHS Foundation Trust
Outcomes
Our team monitors the outcomes of the treatment provided in an effort to continually improve
our quality of care.
We actively involve young people and families in gathering
data on symptoms at a number of stages throughout
treatment. The measures we use include the Child Global
Assessment Scale, the online Development and Well-being
Assessment, eating disorders scales, quality of life and
obsessive compulsive disorder scales, amongst others.
The outcomes that the young person and their family can
expect are:
›› Recovery or significant improvement in illness
›› Improved psychological and psychosocial functioning
›› Improved well-being
Graph 1 shows the changes in weight during the course of
outpatient family therapy and long-term follow-up for
adolescent anorexia nervosa.
Graph 2 shows the percentage of patients reaching a normal
weight at the end of treatment in single family and multifamily therapy, for adolescent anorexia nervosa.
100
90
80
70
TREATMENT
FOLLOW-UP
5 YEARS
1 YEAR
14
PERCENTAGE WEIGHT, ADJUSTED FOR HEIGHT,
AGE AND SEX
6 MONTHS
3 MONTHS
ASSESSMENT
Graph 3 shows the changes in bingeing and vomiting during
treatment and follow-up for adolescent bulimia nervosa.
1.Adolescent anorexia nervosa: changes
in weight during family therapy
CAMHS National and Specialist Services: Eating Disorders Service
» We were so relieved when the service got involved. We thought we were going
to lose our daughter. « Mother
2. Adolescent anorexia nervosa: percentage of
patients reaching a normal weight after single
family and multi-family therapy
3. Adolescent bulimia nervosa: changes
in bingeing and vomiting
NUMBER OF EPISODES PER WEEK OVER THE
PREVIOUS 28 DAYS
PERCENTAGE
100
6
5
4
TREATMENT
FOLLOW-UP
3
2
1
BINGE-EATING
10
9
8
7
80
60
40
20
6
5
4
3
2
1
0
0
SINGLE FAMILY
THERAPY
MULTI-FAMILY
THERAPY
VOMITING
0
2
4
6
8
10
Family therapy (N=41)
Guided self-care (N=44)
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South London and Maudsley NHS Foundation Trust
Our facilities
Our service is based in the Michael Rutter Centre at the Maudsley Hospital and is designed
around the needs of young people and their families or carers.
Our clinic has both individual and group therapy rooms that
are equipped with observational and audiovisual equipment
to help with treatment, enable training and learning
opportunities, and to ensure good clinical outcomes by
allowing close supervision of therapists. This also enables
team consultation and input with minimal intrusion for
young people and their families.
» There were times when each of us
found it hard, but the staff and other
girls worked together. This bond
and trust made you feel safe and
helped to break the shield anorexia
strongly holds. « Tanya
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CAMHS National and Specialist Services: Eating Disorders Service
Training and consultancy
We provide training in single and multiple family therapy approaches, as well as in the treatment
of eating disorders, for individuals or small groups of professionals. We also provide team
outreach training for larger groups and consultations on specialist service development.
Our multi-family therapy training is relevant to both clinicians
working with eating disorders and those working with other
mental health problems like obsessive compulsive disorder,
substance misuse, depression, school refusal and psychosis.
We offer follow-up consultation and ongoing supervision
on multi-family therapy and single family-based treatments.
We also provide consultations to clinicians, managers and
commissioners wishing to develop specialist child and
adolescent eating disorders services.
We offer training for service managers and clinicians on the
setting up and delivery of intensive day treatment programmes.
For more information about training, telephone Louise Proust
on 020 3228 2545 or email [email protected]
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South London and Maudsley NHS Foundation Trust
Our team
Our team includes psychiatrists, psychologists, systemic family psychotherapists,
nurse therapists, psychology assistants and administrators as well as medical staff,
including a paediatrician and dietician.
Dr Mima Simic MSc, MD, MRCPsych
Joint Head of the Child and Adolescent Eating Disorders
Service | Consultant Child and Adolescent Psychiatrist
Dr Mima Simic is joint head of our service at the Trust, as well as
a consultant psychiatrist with the Dialectical Behaviour Therapy
Service.
Other roles
Dr Simic has been active in teaching, training and research
in the United Kingdom and abroad and has been involved
in multi-centric research studies on anorexia nervosa and
self-harm.
Background
She completed her Doctor of Medicine (MD) qualifications at
the University of Belgrade in the former Yugoslavia, followed
by specialist training in child and adolescent psychiatry.
Dr Simic retrained as a consultant psychiatrist at the Maudsley
Hospital and St George’s Hospital. From 2000 to 2009,
she was a consultant child and adolescent psychiatrist for
the community adolescent mental health service in Croydon
and our service.
Research
Dr Simic is collaborating with Professor Ivan Eisler, Professor
Ulrike Schmidt and Professor David Cottrell on research testing
the outcomes and cost-effectiveness of CBT and family therapy
in treating eating disorders and self-harm in adolescents.
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CAMHS National and Specialist Services: Eating Disorders Service
Professor Ivan Eisler MA, PhD, CPsychol, AcSS
Joint Head of the Child and Adolescent Eating
Disorders Service | Professor of Family Psychology
and Family Therapy
Professor Ivan Eisler is joint head of our service, as well as a
professor of family psychology and family therapy at the
Institute of Psychiatry, Kings College London. He is also head
of the section of family therapy at the Institute.
Other roles
Professor Eisler is a family therapy trainer and has played
a key role in developing training courses in family therapy at
the Institute of Psychiatry and the Institute of Family Therapy.
Background
Professor Eisler gained his BA and MA in philosophy and
psychology at New College, Oxford in 1971, continuing
on to a Diploma of Psychology at Charles University, Prague.
He worked as a clinical psychologist in Prague in the school’s
psychological service and in fostering and adoption up until
1982, when he moved to London and joined the clinical
research team at the Institute of Psychiatry. He completed a
PhD at the University of London in 1993.
Professor Eisler won the Outstanding Clinician Award from
the Academy for Eating Disorders in 2009 and was also the
recipient of the 2011 Rosenberry Award for contributions
to the fields of psychology and behavioural sciences.
Research
Professor Eisler has a longstanding interest in the
development and evaluation of psychological treatments and
a special interest in family therapy and its integration with
other psychotherapies.
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South London and Maudsley NHS Foundation Trust
Our team continued
Eoin Power RMN, MSc
Clinical Nurse Specialist | Family Therapist
Eoin is the clinical nurse specialist for our service and is
responsible for the running of the intensive treatment
programme (ITP) for young people with anorexia nervosa.
Other roles
›› Representing child and adolescent mental health services
(CAMHS) on the Trust’s nutrition steering group. The group
meets quarterly to monitor policy, practice and procedures
on all issues associated with improving the nutritional
status of Trust patients
›› Involvement in the development of QED, a quality network
for UK eating disorder services
›› Involvement in the quality network for inpatient child
and adolescent mental health services (QNIC)
Background
Eoin qualified as a registered mental nurse at King’s College
London in 1998. He then completed a masters in family
therapy at the Institute of Psychiatry, qualifying in 2009.
For two years, he worked on the Jim Birley Unit, an adult
general ward at the Maudsley Hospital. He then moved to
national and specialist CAMHS. During eight years on the
Bethlem Adolescent Unit he worked as a staff nurse, charge
nurse, deputy unit manager and family worker.
Research
Over the past 10 years, Eoin has championed the idea that
families be closely involved in the care of their young person if
he or she is a resident on an inpatient unit. He has promoted
skills and confidence development among staff working with
the families of young people and has conducted research that
explores the experiences and strengths of young people and
their parents or carers.
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CAMHS National and Specialist Services: Eating Disorders Service
Gladys Ellis RMN, MSc in Systemic Family Psychotherapy
Senior Systematic Family Psychotherapist |
Team Co-ordinator
Gladys is a senior systemic family psychotherapist and team
co-ordinator for our service.
As well as working directly with children and adolescents
with eating disorders, she is involved in family and multifamily therapy.
Other roles
She is a placement supervisor for the masters in family therapy
course at the Institute of Psychiatry, King’s College London.
Background
Gladys started her career as a mental health nurse, working
with inpatient and outpatient services in West London
(Paddington and Notting Hill), North London (Central
Middlesex and Shenely) and East London (Newham). She
also worked in day hospitals and the voluntary sector with
the post-adoption service in Kentish Town.
Gladys qualified as a systemic family psychotherapist in 1998
and worked for six years in Greenwich child and adolescent
mental health services, before joining the Trust to specialise in
eating disorders.
She was a guest speaker at ANASA, the first national Greek
conference on eating disorders in September 2009.
Research
Gladys’ current research interests relate to working in a
multi-family therapeutic way with families affected by bulimia.
Previously, Gladys was involved with a five-year randomisedcontrolled trial, the multi-centre treatment of anorexia
nervosa in adolescents.
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South London and Maudsley NHS Foundation Trust
Leanne (mother of Christina)
“The anorexia hit suddenly...wham!”
Christina seemed well over Christmas 2008, but by
Easter she’d become noticeably thinner. In the two to
three months afterwards she stopped eating almost
completely, eating only small amounts of fruit and veg.
Two months after Easter, when out shopping for a dress,
I saw her in the changing rooms and she was so much
thinner, shockingly so, that I burst into tears. Her bones
stuck out so much.
Soon after that, a friend, teacher and her boyfriend spoke
to her and she agreed to see our GP, who was great. She
saw our GP a few times in a few weeks and then was
referred to the Eating Disorders Service. By this time
I knew something was seriously wrong.
“It was shocking, shocking, shocking.”
In a matter of six weeks, there we were at the Michael
Rutter Centre. I remember Christina cuddling up to me
saying ‘could I really have an eating disorder’? We were
both in tears. When Christina was told she had anorexia,
she was absolutely horrified. As well as the diagnosis,
she had holidays booked – a few days at Glastonbury,
Spain and a family holiday – and the service told her
she was too ill to go. She was extremely distressed
and angry.
We were given a meal plan at our first trip to the service,
and came home reeling. It felt awful for professionals
to tell us our darling daughter was anorexic, even
though we sort of already knew. Things were pretty
stark at that moment.
22
“There’s no greater pain than seeing your
child in pain.”
When we got home, she started on the meal plan
straight away – it didn’t really occur to her not to.
She didn’t go to Spain, but she did go to Glastonbury
for a day. We also went on the family holiday, but that
was a disaster.
Extremely slow eating was the form the anorexia took
for Christina. She would spend literally 13 hours each
day eating. She needed so much support to eat. Either I,
her dad, brother, or one of two close family friends, sat
with her and encouraged her through those very long
hours. It was an endurance feat for us all, physically,
mentally and emotionally. Christina became extremely
depressed too. At times she was really out of reach and
I’d often find her curled up silently in a ball.
Of course, it’s extremely distressing seeing your daughter
like that. One of our aims was to keep her at home
rather than on an inpatient ward, and we managed that,
but by the end of November we were all desperate.
“Multi-family therapy was where things
changed.”
Christina started antidepressants, which definitely helped
a bit, but she didn’t really have anything else to her life
except the long hours spent eating. How she ate had
become more ritualised. One day, she said she couldn’t
eat the cheese in front of her, as it would make her fat,
and her brother said to her ‘it won’t make you fat, it’ll
CAMHS National and Specialist Services: Eating Disorders Service
make you better’. Christina burst into tears and took
what he said to heart.
We started multi-family group therapy, which was four
or five intensive days in one week, with six other families
plus some additional days that would be spread over the
next year. To be honest, I didn’t want to start this type
of therapy because I felt like I could barely stand our
own pain, never mind anyone else’s. But I also knew
we really couldn’t carry on the way we were going.
The activities at the multi-family therapy were hard
at times, but very interesting.
“Christina had to show how she wanted
things to be in a year’s time.”
Two activities, in particular, were really good. First, she
had to choose people from the group and arrange them
to represent members of our family, including one person
as anorexia. She then had to rearrange everyone to show
how she wanted things to be in a year’s time. It was very
emotional, but helpful because it somehow brought into
contrast how she might get better. The enactments for
other people were intense too. I remember one girl
didn’t survive in her imagined future – anorexia won
– and that was really tough to watch.
The second exercise was a timeline Christina had to
create, drawing a line from the current time up until
a year ahead. We were filling gaps between where we
were right then and her starting university, and I think
that’s when she realised if she really wanted to get better
in time to go to university nine months later, she had
to start straight away.
“Her meal times reduced from 13 hours
to half an hour.”
At the end of the multi-family therapy week, Christina
said she was going to try and eat normally straight away,
that evening, even though she would need lots of help.
And she did it. I had to feed her at first. It was so hard,
she’d get clammy and have panic attacks, but straight
away her meals reduced from 13 hours to half an hour.
Since then, things have been steadily progressing, and
are now, a year later, really good. She got up to a healthy
weight in about five months and, wonderfully, she was
able to take a three-month gap year trip, something
unthinkable before multi-family therapy. She is still
recovering emotionally and still has to fight anorexic
thinking sometimes, but physically she’s well.
“I’m thrilled she’s got her life back now.”
Anorexia was extremely distressing for us because it
pervaded everything. It was really isolating, like we were
in a bubble of pain. It’s hell, as a mother, to see something
like this happening to your daughter. But I’m thrilled
Christina’s got her life back now. She has just started
university and is well and happy. I’m so thankful to
be largely free of the anorexia.
The clinicians at the Maudsley were superb all along.
For us, anorexia hit hard and fast but we got help fast
too. I’m sure that’s contributed to Christina getting
better relatively quickly. I’m immensely thankful for that.
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South London and Maudsley NHS Foundation Trust
Christina
“I don’t know when I started losing weight.”
I remember my best friend and one of my teachers
telling me I had lost weight a couple of weeks after
Easter. Then when I went shopping with my mum,
she just burst into tears when she saw me in a bikini.
Other friends said things, but I ignored them.
My friend and teacher mentioned it again on the last day
of school, but it wasn’t until my boyfriend said that I’d
lost a lot of weight that I agreed to go and see a doctor.
I could see I’d lost a bit because my clothes were baggier
on me. I realised I’d been cutting back.
“I was surprised when she said I should
go to the eating disorders clinic.”
The first time I went to the doctor I told her I thought
I was ‘getting a bit funny about food’, but only because
that’s what other people were telling me. I saw her three
times and on every visit I’d lost weight – one or two
kilogrammes a week. Looking back, I was eating next
to nothing, but at the time I didn’t know how I could
still be losing weight because I’d been really really trying
to eat more. I was surprised when she said I should go
to the Eating Disorders Service. I don’t think I knew what
it meant because it’s nearly impossible to imagine a clinic
when you haven’t been to one before. I think I thought
they’d just weigh me, like at some kind of drop-in place.
Still, I didn’t think it was a big deal.
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“I was so angry when they told me
I had anorexia.”
I went to the Michael Rutter Centre at the Maudsley
Hospital with my parents for some tests. My heart rate
was low, and I was unhealthy in other ways too; my
blood pressure, and stuff. Apart from the diagnosis,
they told me I couldn’t go on holiday or to Glastonbury.
I was so angry. When they handed over my meal plan,
I couldn’t even look at them.
It’s a shock when someone tells you you’re ill, obviously,
but this was surreal. In a way, I didn’t really know what
they were talking about. I was someone who loved
chocolate and fry ups.
For the first week they gave me a milk-based eating plan.
That wasn’t much fun, but I did it…I ate everything.
I wanted to go to Glastonbury and I wanted to prove
that I didn’t have a problem. I did go to Glastonbury for
one night, but I was so run down and tired that I didn’t
enjoy it much.
“I would eat really slowly. One meal
would spread over 12 hours, which
was pretty rubbish.”
I was on a meal plan where I’d weigh out my food and
eat things like flax. I was also seeing someone at the
service to talk about food, but things started getting
worse. My 18th birthday was a good day, but things
went downhill after that. I was eating lots of vegetables
and drinking lots of water and meals just got slower and
CAMHS National and Specialist Services: Eating Disorders Service
slower. We had a rubbish holiday in Turkey. My weight
wasn’t going up – it was probably going down actually
– I was depressed, and I just didn’t want to see anyone
or do anything. My life got taken over with eating all
day, every day. There were a lot of tears, and my family
helped me a lot. I refused to eat if someone wasn’t with
me, so I guess they had no choice.
Antidepressants helped a bit because they gave me
energy to eat a little more, but things didn’t really
change until the multi-family therapy.
“I knew that my family wouldn’t be able
to live like this forever.”
At first I didn’t want to do it because it sounded kind of
horrific, talking about our problems with others. Something
had to give though, and I felt things couldn’t get worse. It
was four or five intensive days of therapy in a row.
On the last day we had to make a timeline of the next 12
months. The first thing I put on was going to university,
in just under a year. I realised that if I didn’t do something
about my eating straight away I wouldn’t be able to go.
Also, I could see that the other people in the group were
really ill…and it made me realise how ill I was. The
multi-family therapy was the real turning point.
“Eating faster was so hard. The hardest
thing I’ve ever had to do.”
I decided at the multi-family therapy to start eating
at a normal pace, from that night. It was difficult and
I was terrified. Eating slowly was my life…that’s what
I did. Mum had to feed me at first, but after two weeks
it was a bit easier. At Christmas, I still weighed my food,
but I ate it myself at the same speed as the others.
After New Year, we all sat down together to work out
what I had to do to make sure I would get well enough
to go to university. We looked at all the rules I had in my
head when I was eating and each week I’d pick things to
challenge myself so I could keep up the momentum. I was
eating faster and the sky hadn’t fallen in, so I knew a pie
or a cheese sandwich wouldn’t be the end of the world.
“I’m excited about university. It’s a
fresh start.”
Since then, I’ve started seeing a CBT therapist, who’s
been great. I’ve also seen a dietician to help me re-learn
what you’re meant to eat and how – my view of food
was so screwed up. It’s been hard but definitely worth it.
I’m a lot happier now.
Recently I went travelling for three months and that was
amazing! I mean, how could I have gone to a place like
China before? It would have been impossible. After all
that’s happened, I feel like I’ve got my life back. Eating
is still hard sometimes, and sitting at the dinner table
at home can remind me of those difficult times, but I’d
rather be who I am now than someone who doesn’t eat.
I even enjoy food sometimes. Chocolate, peas and cereal,
they’re my favourites!!
25
South London and Maudsley NHS Foundation Trust
Referring to our service
Referrals are accepted from consultant psychiatrists, GPs and GP consortia.
A2
02
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Tel: 020 3228 2545
Fax: 020 3228 5011
[email protected]
2 Ca
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A215 D e n m a r k H i l l
Eating Disorders Service
Michael Rutter Centre
Maudsley Hospital
Denmark Hill
London SE5 8AZ
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Printed on Soporset by Crucial Colour
Photography: davidhares.com
Design: piersanddominic.com
Published: October 2011
Eating Disorders Service
Michael Rutter Centre
Maudsley Hospital
Denmark Hill
London SE5 8AZ
www.national.slam.nhs.uk/camhs-eatingdisorders
» Here at the Maudsley Hospital, we are
at the forefront of developing family-based
treatments for children and young people
with eating disorders. « Dr Mima Simic