Transformation Partners in Health and Care has worked closely with a group of experienced clinicians and experts by experience to develop a set of guiding principles on disordered eating, and how to best support and meet the needs of this group. This blog has been published as part of a series to explore the topic of disordered eating in more detail and will feature many of the experts by experience and clinicians who helped develop this work. Find out more about this series here.
Blog by Louise Miller – GP at The Phoenix Practice and Clinical Lead CYP Mental Health, Transformation Partners in Health and Care
I’m writing this blog to raise awareness of disordered eating, share some of my experience and to provide support to GPs. I have worked as a GP in London for over twenty years and in a mental health clinical lead role for five years in North London and more recently for Transformation Partners in Health and Care (TPHC) too.
Arguably pressure, time and workloads for GPs are busier than ever. That’s why I wanted to write this short and, hopefully, informative blog to share some ideas and resources for fellow GP’s to use when supporting young people and families. As part of my role as Clinical Lead for the Children and Young People’s mental health team at TPHC I have been supporting the development of Disordered Eating guidance.
Outlined below are some tips for GPs to consider if they have any young people presenting with eating disturbances or restricted eating.
Do not assume all presentations of disordered will lead to a primary eating disorder diagnosis:
For GPs assessing young people presenting with eating disturbances or disordered eating it is important that we take a holistic view and not assume that all cases will lead to a primary eating disorder such as anorexia nervosa, bulimia nervosa or binge eating disorder. Young people with disordered eating may often have other mental health difficulties or psychosocial challenges for example dysregulation. For many it may be a symptom relating to either their neurodevelopmental needs, or in the case of dysregulation, part of alternating patterns of disordered eating behaviours, self-harm, and other impulsive behaviours used as a means of managing distress.
When making referrals we should include a full picture of other mental health disorders
Consider a holistic approach when making assessments and referrals
The recent guidelines developed by TPHC have shown that for young people with a disordered eating presentation, eating disorder focused treatment can worsen the clinical picture. That’s why it is important for GPs and those making referrals to consider the wider context in a comprehensive and holistic way. When making referrals we should include a full picture of other mental health disorders; the young person’s developmental history, eating history, family history and social context. This will help health professionals to identify the core needs and develop care and treatment plans that will meet the needs of the young person. This approach is useful in all cases and helps enormously when there are complex cases with diagnostic uncertainty.
Help manage expectations of young people and families
A group of young people and parents were recruited as experts by experience and supported us in developing the Disordered Eating guidelines. The group fed back that not getting the diagnosis they were expecting, or not being accepted into a service was very difficult. One of the key things that we can do as GP’s is to manage the expectations of young people and families. It is important that we reassure the patient that their concerns are being taken seriously and that we will work to ensure that they get the support that they need. As part of this, we should explain that changes in eating can be caused by several factors and that it is important to wait until a full assessment has been undertaken to identify the best treatment pathway. This should help the young person and family to feel validated no matter what diagnosis they receive and to engage with the treatment that is offered.
It is important that we reassure the patient that their concerns are being taken seriously
Please use and share the resources and information on disordered eating and eating disorders
The Disordered Eating Guidelines have been set up to support GPs and health professionals to learn more about disordered eating. Included in the guidelines is a section which explores the definition and patterns of behaviour which I think are a quick and useful tool for GPs to quickly review some of the patterns of behaviour to look out for when you have young people presenting with eating disturbances. In addition TPHC also developed further resources for GPs to spot the signs of eating disorders which are available on their website here.
I hope that this blog has provided you with some tips and tools for supporting young people presenting with disordered or restricted eating. GPs play a crucial role in helping young people and families to access the support that they need from the wider health system. As busy GPs, we don’t necessarily see that many cases of disordered or restricted eating. What has been useful for me is to make a note of these tools and resources so that I can quickly access them when I need them. As part of my role supporting the CYP team at Transformation Partners in Health and Care I’m working to ensure that the great resources that have been developed for GPs are accessible to us when we need them.