Eating problems

Explains eating problems, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

Your stories

Workplace bullying and eating disorders

Mel blogs about the impact being bullied at work had on her.

Mel
Posted on 24/05/2017

Do I have a right to recovery?

Lucy talks about how not ever having a diagnosis has impacted on her recovery.

Lucy P
Posted on 30/11/2016

My anorexia diagnosis and finding help

Jess blogs about being diagnosed with anorexia and the challenges she faced in getting the right treatment.

Jessica Mell
Posted on 23/02/2016

What treatment is available?

Treatment can help you develop balanced and healthy eating patterns and help you face – and cope with – the underlying issues which may be causing your eating problem. This page covers:

Note: we've included information on the recommended treatments for anorexia, bulimia and binge eating disorder. If you have been diagnosed with other specified feeding or eating disorder (OSFED) or you do not have a diagnosis, your doctor should offer you the recommended treatment for the diagnosis that most closely matches your symptoms. You shouldn't need a diagnosis to get treatment.

Ultimately, my psychologist, occupational therapist and dietician saved my life.

Talking to your doctor

Talking about your eating problems can be scary, but if you'd like treatment and support, the first step is usually to visit your doctor (GP). They should be able to refer you to more specialist services.

See our pages on seeking help for a mental health problem for more information on how to prepare for an appointment and having your say in treatment.

Online self-help programmes

If you are diagnosed with bulimia or binge eating disorder, or your eating problems have similar symptoms, you may be offered support through an online self-help programme at first. You should receive short support sessions alongside the programme. These may be face-to-face or over the phone. If you are finding it hard to complete, or don't find it helpful, ask your GP for more support.

Talking treatments

The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in health care – recommends the following talking treatments for eating problems:

  • Cognitive behavioural therapy for eating disorders (CBT-ED). This is an adapted form of CBT specifically for treatment of eating disorders, including anorexia. There are alternative forms of CBT for bulimia nervosa (CBT-BN) and binge eating disorder (CBT-BED). (See our pages on CBT for more information.)
    • For anorexia, you should be offered up to 40 sessions, with twice weekly sessions in the first two or three weeks.
    • For bulimia you should be offered at least 20 sessions, and may be offered twice weekly sessions at first.
    • For binge eating disorder you should be offered group CBT sessions at first. Tell your therapist or your GP if you do not find these helpful or if you would like individual therapy.
  • Family therapy. This means working through issues as a family with the support of a therapist and exploring the dynamics or situations that might have prompted the feelings underlying an eating disorder. It can help your family understand your eating problems and how they can support you. Family therapy is often offered to people with anorexia, especially younger people.

Cognitive behavioural therapy really helped me to change the distorted thoughts flying around my head and move on from my eating disorder.

(See our pages on talking treatments for more information about these kinds of therapies.)

Accessing talking treatments

You can access talking treatments through the NHS. Your GP should be able to make a referral. There can be long waiting lists on the NHS, so you may also want to consider seeing a therapist privately – but be aware that private therapists usually charge for appointments. You can find a private therapist through the British Association for Counselling and Psychotherapy (BACP).

You may also be able to find free counselling services and support groups through the eating disorder charity b-eat.

Additional treatments for anorexia

These are some additional treatments which you may also be offered to treat anorexia:

  • Maudsley Anorexia Nervosa Treatment for Adults (MANTRA). This treatment helps you work towards recovery by helping you understand what keeps you attached to anorexia, and gradually learn alternative ways of coping. This should be done at a pace that suits you and your needs. You should be offered at least 20 sessions.
  • Specialist Supportive Clinical Management (SSCM). This is not a type of talking treatment, but talking treatment may be included within it. During SSCM you will have weekly meetings where you receive support for weight gain, physical health checks, education and advice. You will also have a chance to talk about key issues you are experiencing and think more about your symptoms and behaviour.
  • Focal Psychodynamic Therapy (FPT). If other treatments have not worked, you may be offered eating disorder-focused psychodynamic therapy.

Medication

There are no drugs specifically for eating disorders, but you may be offered medication to treat some underlying factors (such as depression or anxiety). The most common medication prescribed to people experiencing bulimia or binge eating disorders is a type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs). If you have anorexia, you may be offered antidepressants or antipsychotics. Most people are offered these drugs alongside talking treatments – medication shouldn't be the only thing you're offered.

Being underweight can mean that drugs are absorbed more quickly into your bloodstream, which could make medication harmful or not as effective as it should be. Your doctor will decide whether to offer you medication, and you can decide whether you want to take it.

(See our pages on antidepressantsantipsychotics and psychiatric medication in general for more information about these drugs, including what to know before you take them and your right to refuse medication.)

Admission to a clinic

You may need to go into hospital or to a clinic if your doctor or care team feel you are very unwell or underweight, if other kinds of treatment haven’t worked, or if your home environment is making it hard for you to stay well.

If you are an outpatient or day patient, you will go home most evenings and weekends. If you are an inpatient, you will stay in the hospital or clinic for most of your treatment. How long you are admitted for will depend on how much help you need to recover.

You will normally receive a range of support as an inpatient. The staff at the hospital or clinic could include: 

  • doctors
  • dieticians
  • psychotherapists
  • occupational therapists
  • social workers
  • family and relationship therapists
  • specialist nurses.

Treatment can include:

  • talking therapies
  • working in groups with other people experiencing eating problems
  • medication
  • refeeding.

Your weight and general health will be monitored. There may be guidance on buying, preparing and serving food, how to cope with stress and anxiety, how to be more assertive, and how to manage anger and communicate well.

With the daily routine, support system, classes and therapy I was able to start to rationalise anorexia’s thoughts and slowly become stronger.

What is ‘refeeding’?

Refeeding means being given food with the aim of bringing your weight up to a healthy level – it involves helping you to gain weight so that your energy levels and your physical health improve. You may be given specific foods because they have certain nutritional values or are particularly good at helping people gain weight.

How this works varies from one clinic to another. Some doctors may do this over a longer period of time, allowing you to gradually increase your weight, whereas others will want to help you back to a healthy weight as soon as possible.

This can be a distressing process, especially if you do not want to gain weight, and may be something you want to talk about with your doctor in more detail.

There are only a few NHS eating disorder clinics, so you may not always be able to access treatment close to where you live. This may mean going to a clinic further away, or it could mean going to a general mental health hospital. You can ask your GP or care team if you’d like to know more about specialist clinics.

There are also private treatment centres. Some may offer similar treatment to NHS clinics, while others will have a wider range of complementary and art therapies. The eating disorder charity b-eat has a directory of services that you can look at to see what’s available.

Could I be forced to go to a clinic?

If a group of medical professionals agree that you are at risk of harming yourself or anyone else then they could force you to go to hospital under the Mental Health Act (often called being sectioned). This could happen if your eating problem is having a significant impact on your physical health, and medical staff are concerned that you won’t be able to recover without support.

If you are worried about being sectioned, see our legal pages on sectioning.

Read Nicole's blog about treatment in a clinic and saying goodbye to anorexia.

Non invasive brain stimulation techniques

Researchers are investigating techniques that stimulate the brain using magnetic fields or a weak electrical current. Among other things, they may help reduce symptoms of anorexia and food cravings.

These treatments are not currently recommended by NICE. More research is needed to see whether these techniques could be developed into treatments for eating problems.


This information was published in June 2017. We will revise it in 2010.


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