Eating disorders refers to a group of conditions that are characterised by disordered eating patterns and an over-concern about weight, shape and body image. The most common eating disorders are anorexia nervosa and bulimia nervosa.

Anorexia Nervosa

Anorexia nervosa is defined as a refusal to maintain body weight at or above the minimal normal weight for height and age. People suffering from anorexia nervosa may also experience intense fear of gaining weight or being fat, a preoccupation with body weight and shape and may place exaggerated influence of body weight on their self-evaluation. In women, periods may stop due to low weight.

Bulimia Nervosa

Bulimia nervosa is defined as periods of binge-eating which are characterised by eating an amount of food that is larger than most people would eat during a similar period of time and under similar circumstances, and a sense of lack of control over eating during the episode. This is then followed by recurrent compensatory behaviours to prevent weight gain such as self-induced vomiting; misuse of laxatives, diuretics, enemas or other medications; fasting and/or excessive exercise. As in anorexia nervosa, there is a preoccupation with body weight and shape and self-evaluation is unduly influenced by body weight.

Atypical Eating Disorders

Atypical eating disorders refer to conditions that are very similar to anorexia nervosa or bulimia nervosa as described above but that not all symptoms may be present.

Who is affected by eating disorders?

Eating disorders can affect anyone regardless of age, gender, social class, or cultural or racial background. Although it is more common among women, men also develop eating disorders and research suggests that there are between 10% and 20% of male sufferers. This figure may be higher because eating disorders are less commonly recognised in men. Eating disorders often appear around the ages of 14­ to 25; however, it is not unusual for an eating disorder to present itself in middle age.

What causes eating disorders?

There are many reasons why someone might develop an eating disorder. Often there is no single cause but a series of factors involved that contribute to development of the disorder. Research has highlighted some common psychological, interpersonal, social and biological factors that people with eating disorders may experience. It's important to recognise that the factors contributing to an eating disorder are unique to each individual and some people will develop an eating disorder without experiencing these difficulties:

Psychological factors

• Depression
• Low self-esteem
• Anxiety
• Feelings of lack of control
• Perfectionism and a need to please others
• Obsessive tendencies
• Difficulties in expressing emotions

Interpersonal factors (relationships with others around us) that could be triggered by:

• Bullying
• Pressures at work, school or home
• Bereavement and loss
• Transitions in life such as moving house, changing jobs or leaving home
• Physical, sexual and/or emotional abuse

Social factors

• Societal and cultural pressures to be a particular body shape
• Valuing people based on physical appearance rather than inner qualities
• Positive reactions from others about weight loss
• Negative stereotypes about obesity

Biological factors

• Genetically-inherited predispositions
• Research has suggested that certain chemicals in the brain that control, hunger, appetite and digestion are imbalanced in people suffering from eating disorders.

Eating disorders are complex conditions that arise from a variety of factors. Once established, they can create self-perpetuating cycles that are unhelpful and destructive.

People with unhealthy eating behaviours such as restricting their food intake, bingeing and/or purging may disrupt their physical, psychological and social wellbeing. Medical complications can arise which can be life-threatening.

We know that eating disorders are complex; an eating disorder can be a person’s way of coping with underlying psychological problems. That's why our approach is to restore a healthy food intake and body weight and to address psychological problems during treatment.

Some people find it difficult to maintain the motivation they need to work on treatment for their eating disorder because it feels frightening to contemplate weight gain and behaviour change. Our approach is to work closely with them on identifying the costs and benefits of change and finding ways in which their motivation can be increased and maintained throughout their treatment.

We use our outpatient and community-based services most of the time but occasionally it's necessary for us to refer people for hospital treatment because of their medical risks (slow heart rate, dehydration) or psychiatric risks (suicidal thoughts and actions). In these cases, we ensure that we work collaboratively with hospitals so that the transition of care goes as smoothly as possible.

If you think you're suffering from an eating disorder, we recommend that you visit your GP first and talk through your concerns with them. Your GP can then discuss with you whether it might be helpful for you to be referred to us for further assessment.

It may be necessary for you to have some blood investigations before you come and see us so that we can get a better picture of your physical health.

Your referral will be discussed in our team meeting and if we feel that we're the right service for you, you'll be invited by post to opt into the service for an assessment within seven days of receipt of your referral.

If you opt into the service, you will receive a triage assessment appointment within four weeks of your referral.

Referrals deemed urgent by clinical staff will be offered an appointment within ten days on receipt of referral. Urgency is determined by factors including (but not limited to):

• the rate of your weight loss
• the presence of clinical complications
• your Body Mass Index (BMI)

Once you're referred, our first step is to assess your needs. This helps us decide how we can best help you. People often bring a relative or friend to their initial assessment appointment; they can support you if you're feeling worried about the assessment and it can be helpful for the assessor to hear what your relative or friend's concerns might be.

Assessment

Once you've been referred to our service, we'll offer you an appointment in assessment clinic. The purpose of this appointment is to assess your current difficulties and plan how best to treat them. It's also important that we measure your height and weight during this appointment, so that we can better assess any physical concerns. The appointment normally lasts for an hour and a half.

We then discuss your assessment as a team,  so we can plan what treatment may be appropriate. At this stage in some cases, we ask your GP to carry out some medical monitoring of your physical health, such as blood tests or ECG. Sometimes we will signpost you to another service that might be better able to meet your needs.

Questionnaires

At assessment, we encourage you to complete a number of questionnaires. These questionnaires aim to capture the nature and severity of your eating problems and how such issues may be affecting your life.

Care Plan

At the end of the assessment process, a member of the team will work with you and agree a care plan that will highlight the areas to focus on and provide a clear plan and rationale for treatment. The team will review and adjust the care plan with you at regular intervals. Find out more about the Care Programme Approach.  

Transition from Child and Adolescent Mental Health Services (CAMHS)

We work closely with CAMHS and the Eating Disorder Service for Children and Young People to ensure that young people who are entering our service from these services have a smooth transition of care.

The treatments we offer are based on National Institute of Clinical Excellence guidelines. This means that they're based on research and practice which is approved nationally in the eating disorders field. The aims of treatment are to improve physical, psychological and social functioning in order to help people regain healthy control over day-to-day living.

Outpatient Service

Initially treatment is aimed at reducing the behaviours which keep eating disorders going. Many of our treatments are offered in groups, which people find supportive once they have overcome initial anxiety about sharing problems.

Further treatment is adapted to each individual's needs. These may include the following and are usually be offered by any professional from our team:

• Psycho-education and dietary advice
• Monitoring of weight, physical and mental health
• Motivational Enhancement Therapy
• Counselling about past and present problems
• Individual talking therapies e.g. enhanced Cognitive Behaviour Therapy for Eating Disorders (CBT ED) or Interpersonal Psychotherapy (IPT)
• Self-help groups
• Support in activities of daily life such as food shopping and preparation, leisure activities and vocational choices
• We also offer support for friends and families of people affected by an eating disorder.

Day Care Service

We always try to avoid hospital admission and aim to provide treatment in the least restrictive way possible, whilst being mindful of the medical and psychological risks that might affect eating disordered individuals.

Our day care service in Guildford offers more intensive support to people who are struggling to make the necessary changes through outpatient treatment alone. It's also used as a 'step down' from inpatient treatment, for example  where we feel it's likely that someone will struggle to adjust from a period of intensive inpatient treatment to outpatient clinic appointments.

Day care offers an intensive approach with the aims of restoring and maintaining a normal body weight and understanding the thoughts, feelings, experiences and behaviours that lie behind the eating disorder. People are expected to attend the programme each weekday from 8:30am – 3:30pm and are supported to eat two meals plus two snacks every day.

Inpatient Service

For more information about the inpatient service that we are linked to, please visit the South West London and St George’s NHS Trust website.

Recovery from an eating disorder takes time and determination but it's important to remember that it is possible to achieve.

Building up the motivation and strength to start working on change is possibly the most important step to take towards recovery.

It's important to not give up hope of recovery: many people find that they go through treatment in different settings a number of times before they manage to get on top of their eating difficulties. This can be for a number of reasons such as life circumstances at the time, strength of personal resolve and sometimes just not feeling confident about life without an eating disorder.

Some of the people we see sometimes decide to leave treatment after a period of time as they begin to feel stuck and are unable to continue on their journey to recovery. Many often return when they feel that they are ready to do some more work on their eating problems as they realise that a partial recovery from an eating problem limits their life choices.

Others continue to need support from time to time as life stressors occur but many people recover and gain the confidence to continue their lives free of the eating disorder.

We use a team approach. Our team is made up of staff from different professional backgrounds including:

• Specialist nurses
• Psychiatrists
• Clinical psychologists
• Dieticians
• Occupational therapists
• Psychotherapists

We are supported by an administrative team.

This type of team involving people from different professional backgrounds is often referred to as a multi-disciplinary team or MDT. Each one has specialist training in eating disorders and a wide range of mental health concerns.

Anyone who is referred to our service may be seen by any member/s of staff in the first instance at assessment, and they may see a combination of team members for different aspects of their treatment depending on their individual needs.

“To anyone considering Day Care at Farnham, do not give it a second thought – go! It can change your life and help you reclaim your life. It is hard but your life is worth fighting for.”

“I have suffered from an Eating Disorder for some years and even when I gave up on myself, the service never did. Thankfully they supported me through intensive treatment and have never failed me. The staff are extremely experienced and dedicated and should be commended for the good work they do.”

“After many years of treatment in and out of hospital, I am presently in recovery at a healthy weight. This time I have pushed through each hurdle and especially during my time at Farnham [Day Care], I would not have got through without the support of staff and other patients.”

“What’s normal when starting treatment? Feelings of anxiety, stress, panic and fear are all “normal” feelings when you first start but be reassured, this subsides as you become more familiar with the treatment programme.”

“Everyone needs to start somewhere and the EDS at Farnham and Chertsey is a great support and lifeline if you use it properly. When first deciding to go into treatment you may not want to think about getting to a healthy weight but you may want to change how your life – or lack of it – has become.”

“It’s tough and some days you’ll want to give up, however you just have to keep plodding along. In the hard times the staff will support you and over time you will start to see glimpses of life – when you experience these, write them down and keep a log. This is really motivating when times are tough.”

Friends and family members often find that living with someone experiencing an eating disorder is very challenging. We also know that it is friends and family who provide invaluable support to those suffering from an eating disorder. We feel that involving family and friends in the treatment that their loved one is receiving can be helpful, and we endeavour to encourage such involvement where possible.

Of course, we respect confidentiality but we also understand that you may have things you want to share with us, and are happy to talk to you either face to face or on the phone. We are also willing to receive communication via email or letter.

If your own health is suffering as a carer you are entitled to a carers assessment. This is not to assess your ability to care, but to think with you about what can be done to help you. A carers assessment can be a chance to discuss what help you need to help you maintain your own health and to balance caring with other aspects of your life. You can also register as a carer at your GP surgery and we are happy to provide you with a form to enable you to do so.

As a carer you're welcome to attend our monthly drop-in support group (download our 2024 timetable). There's no need to book in advance, just turn up on the day.

The group is facilitated by staff members of the eating disorders service, usually a combination of dieticians, occupational therapists, specialist nurses and clinical psychologists.

The group aims to:

• Provide specialist support and advice about caring for someone with an eating disorder
• Provide useful information and resources about eating disorders
• Allow for a supportive space for sharing of experiences.

Self help resources for family members and carers

• Waller, G. et al. (2010). Beating Your Eating Disorder: A cognitive-behavioural self-help guide for adult sufferers and their carers
• Smith, G. (2004). Anorexia and bulimia in the family: One parent’s practical guide to recovery
• Treasure, J. (1997). Anorexia nervosa: A survival guide for families, friends and sufferers
• Treasure, J. Smith, G., & Crane, A. (2007). Skills-based learning for caring for a loved one with an eating disorder: The new Maudsley method
• Useful website: www.b-eat.co.uk for information on eating disorders and sources of support.

Eating Disorder Information for Carers

For further information and guidance, download this sheet.

There are many organisations and self help resources available for people who have an eating disorder and their friends, families and carers.

Resource packs

We have developed a resource pack for people who use our services and a version for families and carers. These packs contain useful information on available support, helpful websites, support groups, books and apps.

• Resource pack for people who use our services
• Resource pack for families and carers 

Support groups

Woking Mind 

Woking Mind provides a safe, welcoming space to support adults living in Surrey with mental health difficulties so they can live more independent fulfilling lives. They offer support groups, one to one support, programme of creative and physical activities, signposting and drop-in sessions. Email: info@wokingmind.org.uk

Royal College of Psychiatrists

The College has accessible, well-researched leaflets about eating disorders.

MIND

Offers a range of advice and support on a variety of mental health issues.

National Institute for Clinical Excellence

The NICE website contains everything they have produced on the topic of eating disorders, including related guidelines and NICE pathways.

British Dietetic Association 

This BDA website provides a large amount of information for anyone interested in food and nutrition as well as dietetics as a career. 

The standards of proficiency for dietitians

The Health and Care Professions Council provides the standards of proficiency for dieticians. 

Self-help books

• Cooper, P.J. (2009). Bulimia Nervosa and Binge Eating: A self-help guide using cognitive behavioural techniques
• Fairburn, C. (1995). Overcoming Binge Eating
• Freeman, C. (2002). Overcoming Anorexia Nervosa: A self-help guide using cognitive behavioural techniques
• Schmidt, U., & Treasure, J. (2003). Getting better bit(e) by bit(e): A survival kit for sufferers of bulimia nervosa and binge eating disorders

Self-help books for family members and carers

• Waller, G. et al. (2010). Beating Your Eating Disorder: A cognitive-behavioural self-help guide for adult sufferers and their carers
• Smith, G. (2004). Anorexia and bulimia in the family: One parent’s practical guide to recovery
• Treasure, J. (1997). Anorexia nervosa: A survival guide for families, friends and sufferers
• Treasure, J. Smith, G., & Crane, A. (2007). Skills-based learning for caring for a loved one with an eating disorder: The new Maudsley method.

Information for GPs and referrers

Please contact your local service for a referral form. We can also provide guidance on screening for diagnosis and advice on assessing medical risks. Limited input is offered to service users with Binge Eating Disorder, usually a group.

Referrals of young people aged below 18 years should be addressed to the Children and Young People's Eating Disorder Service.

Contact details

• Eating Disorder Services for Adults, West Surrey (and Hampshire borders)
• Eating Disorder Services for Adults, East Surrey
• Eating Disorder Service for Adults, Day Care Programme