According to a recent article in ‘The Telegraph’, increasing numbers of patients with anorexia are being turned away from treatment in the UK because they are “not thin enough” and in 2016, one in three mental health trusts in the UK were found to be using weight measures to decide whether or not to accept patients with eating disorders, with some using weight loss alone to determine the presence of such conditions. Knowing what I do about people with eating disorders, and anorexia in particular, this ‘rejection’ will be interpreted by the sufferer in a negative way – either “I’m too fat” or “I’m not good enough” – which is likely to lead to a downward spiral. Tom Quinn, from the eating disorder charity B-eat, said: “Early intervention is key in halting the onset and development of these serious mental illnesses affecting at least 725,000 people in the UK and it’s vital that GPs don’t hesitate in sending patients on to get the help they need.”
As a previous sufferer of anorexia, I agree completely with Tom Quinn. Early intervention might not have prevented my anorexia, but the illness quickly became very entrenched. There were early warning signs of an eating disorder long before my weight loss became a concern, and had I received specialist treatment earlier, my illness might not have been so severe and prolonged.
The idea of early intervention was what drew me to child and adolescent mental health nursing. I had seen many adult patients return to hospital numerous times, and I had been one of those patients. If mental illnesses were caught early, I believed, they would not get so bad, and they might not recur. Key to early intervention, however, is early identification and recognition.
Whilst working as a Clinical Nurse Specialist in outpatient CAMHS (child and adolescent mental health services) I was often alarmed at the late stage at which girls (usually) were referred into the service. They would often be at a low bodyweight with very entrenched ‘anorexic’ thinking and behaviour. Critics of CAMHS would say that long waiting lists were to blame, and that referrals weren’t dealt with promptly, but referrals for young people with anorexia to our team were very definitely dealt with as a priority. In defence of the referring professionals, one of the difficulties with early detection and intervention is the sufferer’s skill in hiding and normalising their behaviour and symptoms. Parents are often seemingly slow to bring concerns to the attention of professionals for the same reasons.
As a previous nurse and manager of an inpatient adolescent mental health team, I can confirm that adolescent sufferers often bypass community mental health teams because they become so unwell before they are referred by their GP (or other referrer), but the flip side of the coin is that, at the discharge stage, community teams are often too stretched to be able to offer the intensive support needed post-discharge. This can lead to prolonged admission to hospital, and the possibility of developing a dependence, or discharge to home with inadequate support in the community, which often leads to relapse. Additionally, inpatient treatment all too often focusses on weight gain. There is an incredible pressure on beds, with some young people (and not just those suffering from anorexia) having to be admitted to hospital beds hundreds of miles away from home. Not only is this distressing for all concerned as it disconnects the sufferer from their loved ones and significant others, but it also removes them from their network of support, including school or work. The hospital bed that is found is usually the most available as opposed to being the most appropriate, and discharge in these cases rarely runs as smoothly as it should.
Guidelines from the National Institution of Health and Care Excellence (NICE) recommend that there is no delay in referring anyone with a suspected eating disorder to specialist services. It is better to refer and be wrong about the eating disorder, than to wait and allow the situation to worsen. Although specialist teams are under pressure, they should have a process by which they triage referrals and prioritise those with highest risk. Below are some of the early signs of anorexia. These signs can be quite subtle and may be there before any weight loss is noted. Remember, it is much better to seek help early (and possibly be wrong) than to wait and be too late.
Early warning signs of anorexia
- Disproportionate concern about their weight
- Unexplained dental damage.
- An increased interest in food and recipes
- Preparing food for others but not eating themselves
- Measuring food and reading food labels intently
- Secrecy around food and eating
- Finding food choices difficult
- Cutting out food groups suddenly – e.g. becoming vegetarian or vegan, not eating dairy etc
- A preference for eating alone
- Finding excuses to skip meals
- Visiting the bathroom soon after eating.
- Body checking behaviours – e.g.looking in mirrors / reflections in shop windows
- Increased level of activity /exercise
- Withdrawal from family and friends
- Significant weight loss (may be hidden under baggy clothes) or failure to gain weight / develop as expected