Care Forum South Glos
-Eating Disorders
• Introduction to STEPs
• Motivational Work
• Eating Disorders
• Questions
Lydia Pym - Occupational Therapist
Alysun Jones – Clinical Psychologist
STEPs Eating Disorder Service
STEPs Eating Disorder Service
• Adult Service offering specialist service interventions and
consulting to a wide geographical area
• Commissioned to work with people with a diagnosis of Anorexia,
Bulimia and EDNOS, excluding Binge Eating Disorder
• 10 Bed In-patient unit, 8 place Day Therapy programme* Outpatient and Community services
• Primary Care Service- First Step
• Multidisciplinary Team
• Variety of treatments
• Supporting Carers
Treatments Offered
• Compassion Focused Therapy – Dr Paul
Gilbert 2006
• Cognitive Behavioural Therapy – Dr
Christopher Fairburn
• Motivational work – Dr Josie Geller
• LEAP group, Cooking sessions,
Dietitian, Physio community group
• Other specialist therapy (EMDR, CAT)
Cognitive Behavioural Therapy
– 20 Sessions for BN
– 40 for AN
– Developing regular eating plan, diary,
weight charts, body image work,
understanding and challenging beliefs
about food and weight.
Prochaska & DiClemente’s Six Stages of Change
• How and why did we develop our
current model of working?
Motivational Work
• Listen
• Step back
• Learn
• Be curious
• Invest less
Is it any good?
• Benefits Staff, team and Clients
1. Clearly defined from the outset – no surprises
2. Agreed by staff & clients if possible
3. Not arbitrary, but with good justification
4. Consistently applied by all staff
Diagnostic Criteria - Anorexia
A. Restriction of energy intake relative to requirements leading to a
significant low body weight in the context of age, sex,
developmental trajectory and physical health. Significantly low
weight is defined as a weight that is less than minimally normal, or
for children and adolescents, less than minimally expected.
B. intense fear of gaining weight, or becoming fat, even though
C. disturbance in the way in which body weight or shape is
experienced with undue influence of body weight on selfevaluation, or denial of seriousness of current low body weight
Restricting type - no bingeing or purging during last 3 months
Binge - eating / purging type - regular bingeing or purging during last
3 months
Bulimia Nervosa
A. Recurrent episodes of binge eating
1. Eating in a discrete period of time an amount of food that is definitely
larger than most people would eat in similar time and under similar
2. Sense of lack of control over eating
B. Recurrent inappropriate compensatory behaviour to prevent weight gain
- vomiting, laxatives, diuretics, enemas, fasting, exercise, other
C. Bingeing and compensatory behaviour more than twice per week for
three months
D. Self-evaluation unduly influenced by body shape and weight
E. Disturbance not occurring exclusively during episodes of anorexia
Other specified feeding or
eating disorder
Atypical Anorexia nervosa
as AN but in or above normal range
Sub-threshold BN
as BN but binge eating less than once a week and/or less
than 3 months
Sub-threshold BED
As BED except bingeing less than once a week and/or less
than 3 months
Purging disorder
Recurrent purging, no binge eating, intense fear of weight gain
Night eating syndrome
Other feeding or Eating condition not elsewhere classified
Prevalence – 0.7% (school & college girls)
Incidence range from 0.37 – 4.06 per 100 000
Female-to-male ratio of 10:1
Primarily white (>95%) & adolescent (>75%)
High concordance rates for monozygotic twins
Complex condition - biological, psychological, and social
– Developmental condition
• Predisposing - Female sex, family history of eating
disorders, character (low self-esteem & perfectionism)
& family dynamics
• Precipitating – cultural & peer group group pressure,
peer acceptance for dieting & weight loss, autonomy
• Perpetuating – secondary gain (attention), biological
factors (starvation)
– Certain groups increased at risk - dancers, longdistance runners, skaters, models, actors, wrestlers,
Symptoms - AN
Symptoms - BN
Full recovery more common in those with a short history
Some may be left with atypical ED or BN
20% make a full recovery
60% fluctuating course
20% remain severely ill
Most severe cases – 15% mortality (suicide & cardiac
• Assessing and Managing risks – bloods, weight, Squat
tests, driving, cognitive function, mood, DSH, suicidal
Referring to STEPs
• If already in secondary mental health services the
referral is direct to STEPs.
• GP refers to PCLS.
• PCLS and STEPs offer a joint assessment.
• Decision about treatment is usually made at
• What we can offer, treatment, joint working,
supervision, teaching.
Thank you for listening
Any questions?
Please contact us at:
STEPs Eating Disorder Service
Clifton Building
Southmead Hospital
BS10 5NB
Tel: 0117 3236113

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