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Young people with eating disorders – the slow road to recovery

Supporting troubled teenagers back to health makes unique demands on nurses, but is richly rewarding

Supporting troubled teenagers back to health makes unique demands on nurses, but is richly rewarding

‘Take yourself back to the age of 15. What thoughts swirled around your head? Did you worry about how you looked or what your friends and teachers thought of you?’


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Wendy Clarke, specialist lead for eating disorders at Aneurin Bevan University Health Board in South Wales, believes nurses should be asking themselves these questions if they are to fully empathise, engage with and help young people with eating disorders.

Ms Clarke’s 15 years of experience in this specialty led her to establish a nurse-led eating disorder service, seeing around 60 new teenage patients a year.

Engaging with patients

‘It’s crucial that nurses fully engage with these patients to unpick what is going on in their heads,’ she says. ‘Eating disorder triggers are still poorly understood and each personal story is unique.

‘But we know that a combination of low self-esteem, peer-group pressure, concerns about body image and exam anxiety are contributory factors at a transitional time in young people’s lives.’

Increasing public awareness of this mental health condition means referrals to eating disorder units nationwide are rising. After admission and assessment by a dietitian and nurse, including a patient’s level of risk and their own perception of the problem, a treatment plan is agreed.

‘If physically frail, patients may require ward admission,’ says Ms Clarke. ‘Alternatively, after a meal management plan, and individual and family therapy have been arranged, patients are seen in our day unit with one-to-one nurse supervision, or supported by our community team at home’.

With an ongoing caseload of almost 100 patients, Ms Clarke knows there are no quick and easy treatments, and it takes time to recover from an eating disorder.

Making progress

‘Even though parents are distraught with worry, teenagers often become attached to their eating disorder,’ she says. ‘Nurses supervising meal management need to decide what treatment tool to use for individual patients and progress at their pace, patiently empathising, but firmly challenging, their beliefs to implement recovery’.

Cairán Newell, Dorset University NHS Foundation Trust consultant nurse in eating disorders, manages a nurse-led eating disorder service at Kimmeridge Court in Poole.

He agrees that despite a full patient assessment, tailored therapy, family intervention and community support, recovery from an eating disorder can be ‘glacially slow’.

‘Unlike other patients who readily accept treatment because they know it will cure them, an eating disorder patient’s approach to recovery is completely different,’ says Dr Newell. ‘They also want to get better, but are fearful of eating the food which, as their medicine, will help them regain full health.’

Years to recovery

Samantha Swinglehurst, who has received an MBE for her work in this field, agrees that full recovery takes time.

‘Causative factors need to be thoroughly investigated, understood and treated with a variety of therapies before a patient’s weight, and full mental and physical health are regained. This can take up to five years,’ says Swinglehurst, who is lead nurse, specialist practice, for the Royal Free London NHS Foundation Trust’s Child and Adolescent Eating Disorder Service, which serves six London boroughs.

Having established a nurse-led, intensive, eating disorder service – employing 18 nurses and including both inpatient and outpatient units as well as outreach care – Swinglehurst acts in a bridging role to ensure young patients continue as normal a life as possible during treatment. Parents are supported and informed through family therapy and workshops.

Training strategy

Most eating disorder nurses have a mental health or paediatric nursing background before receiving additional training. Dr Newell’s unit provides six-month eating disorder training, and Clarke has developed a three-part training strategy, including an educational DVD, a day course for health professionals and a two-day workshop on therapeutic interventions.

But Ms Swinglehurst, who oversees an in-house training scheme which is to be extended to degree status, says this is not enough, and that awareness should be raised among nurses.

It is unclear how much education on eating disorders is received by nursing students in the UK, but placements are provided by these major eating disorder units, as is local university input.

‘Occasionally, after speaking to students about eating disorders, I will be approached during the break and they will tell me about their own problems,’ says Ms Clarke.

Nurse involvement

RCN practice forum chair Marie-Therese Massey believes practice nurses’ involvement in eating disorders is crucial.

‘All practice nurses should have a good knowledge of local referral pathways, enabling them to respond to the needs of clients with eating disorders and ensure they receive timely treatment,’ says Ms Massey, who is a senior lecturer at Sheffield Hallam University.

‘Practice nurses working in areas with a high prevalence of these conditions, such as student communities, might also consider increasing their eating disorder expertise through additional training’.  

Academic pressure

Clarke says referrals to eating disorder clinics are highest in autumn and spring, when academic pressure on teenagers rises. ‘Pressure to do well in school exams often triggers anorexia in ambitious high achievers,’ she says. ‘But this could help us engage with our patients – by suggesting that if they want to succeed, they will need to eat and regain a healthy weight’.

School and Public Health Nurses’ Association professional officer Sharon White says school nurses have many opportunities to identify young people with an eating disorder.

‘This could be through routine health checks, pupils’ self-referral to drop-in centres or via social media sites such as Chat Health,’ she says.

‘Most eating disorders are triggered by exam pressure, life transitions and concerns about body image,’ she adds.

Qualities needed

Compassion, empathy, patience and positivity are qualities all nurses need. But the depth of holistic, family-centred, patient engagement required to help these young patients seems unique.

‘The complexity of working with a group of patients who have been pushed to the edge calls on all of one’s nursing skills,’ says Dr Newell.

Ms Swinglehurst agrees. ‘Finding joy in small improvements, and helping to peel off the layers to find a healthy young person behind their eating disorder, is an exceptionally rewarding
type of nursing.’

Main types of disorders and their effects

Anorexia

  • Losing weight by dieting, excessive exercise or using laxatives. Can cause diminished muscle or bone strength, arrested development, cessation of periods, infertility, lowered temperature and growth of fine body hair.

Bulimia

  • Being caught in a cycle of binge eating and initiating vomiting, although usually retaining normal weight.

Binge eating disorder

  • Excessive overeating. Can result in obesity, raised blood pressure and cholesterol, and feelings of self-disgust.

Common factors in eating disorders

  • All are mental health conditions associated with low self-esteem, anxiety, depression, self-harm and denial. Often concealed from others.

Source: YoungMinds and BEAT charities

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