Dragon Parade Clinic
2 Dragon Parade
Harrogate
Phone: 01423 726900
Orca House
Osbaldwick Link Road
York, YO10 3JB
Phone: 01904 615300
North Moor House
North Moor Road
Northallerton, DL6 2FG
Phone: 01609 718810
Lake House
20 Manor Court
Scarborough Business Park
Eastfield
Scarborough
YO11 3TU
Phone: 01723 346000
Children and young people’s mental health services
Children and young people’s mental health services (CYPMHS) support young people with their mental and emotional wellbeing. This often also includes supporting families.
Within CYPMHS, the community eating disorders team are specialists who can help young people with eating disorders.
What is an eating disorder?
Eating disorders are complex mental illnesses. Anyone, no matter what their age, gender, or background, can develop one.
Some examples of eating disorders include bulimia, binge eating disorder and anorexia. It is important to recognise that there is no single cause and it is nobody’s fault if it happens.
What to expect from the community eating disorders service
The eating disorders team includes a variety of different professionals, including CAMHS practitioners, nurses, dietitians, psychologists, family therapists and doctors. This is called a multi-disciplinary team who work together to support young people and their family.
Eating disorder clinicians within our team will meet with you and your family member(s) to discuss what you have been going through and how this has impacted on you and your family.
Following your initial assessment, we will meet with our wider team to consider together whether our service is needed and, if so, which is the best way we can support you. In the feedback session, we will share our thoughts with you and together agree and develop an initial plan of care.
Treatments offered
Within our service, we would normally consider a family-based treatment approach for all types of eating disorders, as there is evidence to suggest that this is most successful.
The family-based approach to treatment is there to help families develop new skills in supporting a young person to recover from an eating disorder as we recognize that families are a valuable resource.
In the initial stages of treatment, the focus is usually on families working together. This may include appointments when the whole family is seen together, sessions for parents, peer support groups and group work with other families. As you recover, the treatment may change to more individual work.
As an eating disorders service, we will always consider the physical effects an eating disorder is having on a young person as well as the psychological effects. In the early stages, it is very important that physical health needs are addressed as it is a very important part of the recovery process.
Useful resources
As a parent/carer of a child/young adult struggling with eating difficulties, it can be overwhelming and difficult to know how to manage.
As well as seeking support from CYPMHS, it can be helpful to do some reading around the subject.
The following are resources that parents and carers of young people with eating disorders have found useful.
Websites
- Eva Musby
www.anorexiafamily.com
Includes links to videos and audio guidance. - Maudsley Parents
www.maudsleyparents.org
Includes useful information for parents/carers - B.E.A.T
www.beateatingdisorders.org.uk
The UK’s Eating Disorders Charity
Books
- Helping your Teenager Beat an Eating Disorder
By James Lock and Daniel Le Grange - Skills Based Caring for a Loved One with an Eating Disorder
By Janet Treasure and Grainne Smith - Anorexia and other Eating Disorders
By Eva Musby
- ATDTfb – A Group for Caregivers
This is a Facebook group offering peer support and advice for carers. This group is not run or moderated by the Trust.
Apps
- Headspace
An app for mindfulness meditation
Information for parents and carers
What is normal eating?
There is a wide range of types of food eaten, amounts of food, places to eat and times to eat that might be “normal”. What is normal for one family may be completely different for another. What is important is that the way a young person and their family eat is not ruled by the eating disorder. Our aim is to support you to return to normal eating for you.
Getting started
In the early stages it is really important that the parents/carers take back control around the provision of food. At this stage the young person with an eating disorder will find eating stressful and anxiety provoking and making the right choices about food and eating can be extremely difficult.
Establishing a structure and routine around eating helps in the development of a safer and more supportive environment; this can make it easier for the young person to eat. It may feel like a step back for some young people who have previously been independent with their eating, but it has been shown to be helpful in recovery.
As the young person gets better, responsibility can gradually be handed back.
Setting the scene
Plan as much as possible for meal and snack times.
It may be helpful to start by thinking about what meals are like in your family. Give some thought to:
- Who is in the house at meal times?
- Where does the family eat meals?
- Who eat together?
- Who shops for food?
- Who cooks the meals?
- Who portions the food?
- How have family meals changed? For example, have all the other family members changed to accommodate the young person with the eating disorder or is he/she eating in a completely different way to the rest of the family?
Planning and organising meals
All families are different in how they plan and organise meals, from ‘ad hoc’ to very organised. There is no right or wrong way, as long as the needs of the family are met. However, when a family member develops an eating disorder, it has been shown to be most helpful to adopt a more structured approach.
The following ideas may help you to have more structure around eating:
- Set a regular time for the family to sit down and plan meals for the week. It may be best initially for it to be just the parents/carers choosing the meals, working towards eventually including all the family. Include the whole family’s likes and dislikes when planning the weekly meals.
- Write a shopping list for the weekly shop.
- Everyone in the family should be eating the same meals (where possible).
- Agree on boundaries. At first it may help if one person does the shopping, cooking, portioning, etc.
- No diet foods. No low-fat or diet versions of normal foods.
- No weighing of food.
- Establish regular meal and snack times
- Where possible eat as a family.
- Decide in advance of the meal/snack who will support the young person.
If the young person with the eating disorder has a meal plan, this will have been developed to meet their nutritional needs. It is not necessary for all the family to follow the same plan.
Core parts of the meal should be the same but puddings and snacks may vary. For example:
- The family meal may be spaghetti bolognaise. Everyone would have this, although the young person with the eating disorder may also be expected to have a pudding, which would be optional for the rest of the family.
- The young person with the eating disorder may be expected to have a scone or chocolate biscuit as a snack, but the person sitting with them to support them may just have a drink.
Immediately before the meal
- Keep the young person with the eating disorder out of the kitchen. They should not be involved in shopping, food preparation, cooking or portioning.
- Plan with the young person to have an activity that distracts from their thoughts/anxiety in the lead up to the meal and while the food is being prepared and served.
- Plan for the young person to go to the toilet prior to the meal/snack, so they don’t have an excuse to leave the table during the meal or within half an hour of eating.
Support during the meal
The aim is to reduce the anxiety and stress around meal times as much as possible. However due to the difficult thoughts and feelings the young person has it will not be possible to get rid of the anxiety and stress completely. You will learn over time what is helpful and unhelpful for your young person, and the following may be helpful to get started.
What can work well and what may be best to avoid
Do
- Stay calm – It can be hard not to blame the person or blame yourself. Remember, the eating difficulties are no-one’s fault.
- Stick with it – Your emotions, as well as the young person’s, may be highly charged. You may feel like shouting, crying or walking off. However, it is more helpful if you take a few deep breaths / count to ten / switch off your emotions, and remember the task is to remain seated and eat.
- Be a good role model. By eating in a normal way you will encourage the young person to do the same.
- Chat about everyday things. This can help to decrease anxiety and distract the young person. Encourage other family members to join in discussion during the meal.
- Offer encouragement and notice the effort. For example “I believe in you – I know you can do this”, “you are doing so well in your struggle”, you are doing really well – I know you find the plan difficult”.
- Set time limits for meals and snacks. For example 30 minutes for a meal and 15 minutes for a snack. It can be helpful to agree to let the young person know how much time is left both halfway through the meal/snack and 5 minutes before the end of a meal/snack.
- Eat together as a family. The young person may have isolated themselves around meal times. Overcoming eating difficulties requires participation in the communal eating of meals, and eating together as a family will provide the basis of this.
Don’t
- Discuss food. Food should not be a topic of discussion at meal times and there should not be any negotiation around food choices/ portions etc… Once the meal is served, the whole meal needs to be eaten.
- Discuss feelings whilst eating. Acknowledge how the young person is feeling, but be firm and say this will be explored later when they are not eating.
- Disagree or argue. Don’t get drawn in. Bring the focus back to eating the meal/snack and move the item of disagreement for discussion at the next meeting, and out of mealtimes.
Some scenarios and ways of managing
The young person says “I’m not eating that”:
- We agreed when we did your plan that this was what you would eat.
- You really need to eat the meal.
- Your body needs this food – we all need food to fuel our bodies.
- It must be hard for you – it is so long since you’ve eaten this food, but you need to make a start and take the first mouthful.
- Pick up the fork.
- You need to put some food on the fork.
- You can do this – your health is the most important thing.
- If you choose not to eat your weight will continue to go down, which could result in you becoming unwell and needing to go to hospital.
The young person is messing around with the food on the plate and taking a long time to eat:
- I can see you are finding this difficult, but you need to put more food on the fork.
- We agreed that a reasonable time to finish a meal was 30 minutes – you need to focus on eating.
- Moving the food around the plate isn’t going to help – it is just prolonging things. You need to eat the food.
- Don’t let anorexia win. If you finish within the planned time it will mean you have more time to do things you enjoy.
- Cutting your food up into tiny pieces isn’t going to help. You are still going to have to eat everything on the plate.
The young person is leaving a small quantity of food on the plate:
- I can see that you have left some food on your plate. You need to overcome your eating disordered thoughts and finish.
- You have smeared the food over the plate. It is important to acknowledge this eating disordered behaviour and overcome it.
- You have done well so far with this meal – you just need to finish that last piece off.
Unhelpful behaviours to watch out for
- Secreting food during the meal/snack, for example up fingernails, in pockets/tissues, up sleeves.
- Feeding of pets/siblings when monitoring is not constant.
- Hiding of food behind radiators, in plant pots, under chairs, in cushions.
- The young person gradually getting themselves back in control of food preparation/cooking/meal planning/portioning when they have not reached a stage when they are ready to manage this responsibility.
Immediate support following the meal or snack
Young people report that they often have negative thoughts after meals and may feel guilty for eating or feel they have eaten too much. They may have urges to exercise or to make themselves sick. So support following a meal/snack is important and what is needed will vary between individuals. Initially plan on providing 30 minutes to one hour following meals and snacks. Discuss what the worries or anxieties may be and plan together what will help after a meal or snack. Some suggestions include:
- watch tv together
- listen to music
- do a puzzle/play a game
- read a magazine
- sew/knit/craft work
- relaxation exercises
- walk (a gentle supervised walk, as agreed appropriate with the team
Support after a meal is to help manage distress and urges. It is not a good time to look at their issues or reflect on the meal experiences
Discussion time
Set time aside, outside of meal times, to deal with any issues which have arisen at meal times. Initially this may be done on a daily basis, moving towards weekly. It is a time where worries and emotions around food and eating can be acknowledged and discussed.
L1089, V3, 01/10/2021 (Archive: 01/10/2024) and L1089a, V3, 01/10/2021 (Archive: 01/10/2024)
