Treatment options

The UK Government confirmed its commitment to providing better treatment services for eating disorder sufferers when it commissioned the National Institute for Clinical Excellence (NICE) to produce guidelines for the treatment of eating disorders, based on the best available researched evidence and expert opinion. The guideline was published in January 2004 and has set the standard for NHS treatment. Whilst there are still huge variations in the availability of specialist treatment in different areas around the country, this was a major step forward in establishing acceptable treatment regimes for eating disorder sufferers. I refer to the guideline throughout this chapter.

There is a wide range of treatment options. While many young people with anorexia respond well to out-patient care, in-patient care is necessary when an eating disorder has led to physical problems that may be life-threatening, or when an eating disorder has reached a level where psychological or behavioural problems are severe. Many of the effects of anorexia are physical, but many are psychological. Treatment of anorexia must address both issues, and most treatment regimens include a combination of re-feeding to regain a normal body weight and a range of therapies to address the underlying issues. I have outlined some of the treatment options later on, but first it is worth pointing out two of the findings from the Eating Disorder Association (EDA) review of the provision of healthcare services for men with eating disorders which was published in 2000:

1. Men find it hard to acknowledge they have an eating disorder and then to seek help.

2. It is clear that the general lack of recognition of eating disorders in men makes it more difficult for them to access specialist eating disorder services. Their problems are less likely to be recognised and diagnosed by professionals including GP's and psychiatrists and therefore their illness may be well established before treatment is offered.

These findings certainly coincide with our experience. Not only did Joe find it difficult to acknowledge that he had an eating disorder, we also felt it was unlikely because, 'boys don't get anorexia do they?' In addition our GP our friends and the teachers at school found it difficult to believe that this 12-year-old boy could have an eating disorder. Only when Joe was very ill did we finally all agree that he had anorexia.

An important message to parents or carers of a boy who looks as if he may have an eating disorder is: don't wait for too long before seeking specialist help.

As I have already explained in Chapter 1, growing boys who restrict their diet can do themselves a great deal of long-term damage. Early treatment is likely to have the best outcome in the shortest time, but even then full recovery is likely to take at least a year. Patients with established eating disorders may well take at least five years to recover. By the time you as a parent/carer starts to worry that your son has an eating disorder, his condition is likely to have already started to become established. Weight is one of the key indicators. A teenage boy who doesn't gain any weight over a three-month period may well be restricting his diet and alarm bells should start ringing. A teenage boy who is actually losing weight should see a GP as a matter of urgency. In any event, if you have been unsuccessful in trying to persuade your son to eat a sensible diet and he continues to restrict his food intake it is vital to seek professional specialist help. Joe managed to lose 25% of his body weight in just four months. In the end he nearly suffered a heart attack and his pulse and blood pressure had dropped to dangerously low levels.

Whether you choose to use the NHS or go privately, your first port of call is your GP However, be warned that many GP's have little or no experience about eating disorders. The UK Government's NICE guideline says that, 'People with eating disorders seeking help should be assessed and receive treatment at the earliest opportunity.' However, hardly a week goes by without the Eating Disorder Association (EDA) hearing from a family whose story includes the fact that their GP either didn't pick up on the problem or didn't act quickly enough.

To maximise the likelihood of an early diagnosis being made, you need to go armed with enough facts about the deterioration in your son's health that your GP will sit up and take notice. There are three key things your GP is likely be interested in and which will help him to recognise that your son might be suffering from anorexia:

1. How much weight has your son lost and over what time period?

2. How has his behaviour changed and has he developed any rituals or unusual habits?

3. What have you tried at home to reverse the weight loss and why do you think this has not succeeded?

It is very likely that your son will deny he has a problem with eating. He may claim that all the boys in his class are equally skinny, and if the doctor suggests to him that he should try to eat a bit more 'if only to keep his mum happy', he is likely to promise the doctor that he will do that. If your son's physical observations, such as pulse and blood pressure, are within the normal range it is very likely that the doctor will send you home to give your son a chance to fulfil his promise of eating more. Don't be disheartened. Give your son a chance to prove he can change his eating pattern. If he doesn't, then go back to your GP a week later. If necessary keep going back once a week, either until your son has improved his eating habits or until your GP takes notice. If your son has anorexia he will very quickly lose more weight, which should help your GP to be more sympathetic. My doctor suggested that I was a fussy mum when I first approached him with concerns about Joe, but later on, when he could see that Joe's health was deteriorating, he was invaluable in referring us on to the specialists qualified to treat patients with eating difficulties.

A GP with knowledge of eating disorders, or who has healthcare professionals with these skills within the practice, might suggest an initial plan of action that involves caring for your son at home with the help of this professional expertise. This could include a dietician or nurse therapist providing basic nutritional and health education, perhaps with referral to a local eating disorder self-help group. It is very often the case that a teenager, who refuses to listen to his parents, will listen very carefully to a warning from a GP or nurse over the dangers of severely restricting food intake over a period of time.

Unfortunately, in the UK not many GP's have sufficient knowledge of eating disorders or are in practices that are lucky enough to employ eating disorder specialists. In most cases the GP will refer your son on to a paediatrician and/ or child psychiatrist for further assessment.

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