Who do we treat?

We work with children and young people aged 8 to 18 who have an eating disorder and require intensive, inpatient treatment and support. Many of the young people we work with have co-morbidities (other diagnoses or difficulties in addition to their eating disorder). As a national, specialist unit, we support young people with high levels of need and complexity.

Anorexia nervosa

The majority of children and young people with anorexia nervosa can be supported within a community-based treatment programme. We work with people who cannot safely or effectively be treated within the community (both restrictive and binge-purge sub-types of anorexia). Often, the young people we work with can have co-morbidities, such as depression, social anxiety and autism spectrum conditions (ASC).

Bulimia nervosa

People with bulimia nervosa occasionally require inpatient treatment, for example if an individual’s physical health is being put at risk. We can work with young people whose
bulimia nervosa is part of a wider picture of emotional disturbance such as multi-impulsive bulimia nervosa.

Other disorders presenting with disordered eating

There is growing awareness that a number of disorders may present like anorexia nervosa but are significantly different. These patients require a dedicated pathway; treating them as if they have anorexia nervosa is likely to make things worse. Other conditions such as ASC and emotional dysregulation may be significant, body dissatisfaction may not be relevant. Diagnostic clarification and personalised treatment and support are vital.

Avoidant Restrictive Food Intake Disorder (ARFID)

ARFID is now a recognised, defined eating disorder in the DSM-5 classifications. Previously known as Selective Eating Disorder, it is characterised by an overwhelming phobia of certain foods and food groups, resulting in a highly restrictive and insufficient nutritional intake. Unlike anorexia nervosa, ARFID is not precipitated or maintained by body dissatisfaction. It often develops pre-puberty and is associated with Autistic Spectrum Conditions (ASC).

Pervasive Refusal Syndrome

Pervasive Refusal Syndrome, previously known as pervasive arousal withdrawal syndrome (PAWS) is characterised by a severe lock down of all functions, encompassing self-care, eating and drinking and social interaction. Like ARFID, there is no relationship to body dissatisfaction, while there are close associations with ASC. Both require a treatment approach which is different to an anorexia pathway, need multi-disciplinary input and a gentle pace of change.

Emotion deregulation, trauma, attachment disorders

In some young people, interpersonal and emotional difficulties are expressed in disordered eating. This can encompass emotional dysregulation, disordered attachment and trauma. Body dissatisfaction may be involved, but emotional deregulation, trauma and attachment disorder are the dominant features.

Autistic spectrum conditions, including pathological demand avoidance

A significant proportion of the young people we work with have autistic spectrum conditions (ASC), together with an eating disorder diagnosis. However, many will not have a diagnosis; females with high functioning autism are under-diagnosed because some of the identifiers most closely associated with the condition may be masked or unclear.

Identifying autistic cognition is essential because this will be a significant feature in the development and maintenance of an eating disorder. Pathological demand avoidance is a sub-type of autism, characterised by an overwhelming pattern of oppositional behavior, even against the individual’s own interest and this can be expressed in food behavior.

If we believe an ASC assessment may be valuable, this will be undertaken once a young person is at a normal body weight as functions are likely to be impaired at a low weight.

Transgender and body dysmorphia

We work with young people who are experiencing gender identity difficulties and eating disorders. If someone is experiencing these difficulties, they may restrict food intake in order to delay puberty and the changes encountered at puberty. In so doing, an eating disorder may be triggered, typically anorexia nervosa. We have worked with young people with this presentation and have links with the Tavistock Clinic, the nationally recognised specialist centre in this field. Our staff have undertaken training led by the Tavistock Clinic. Our approach is to fully address anorexia nevosa before any gender alignment decisions are made, because cognitions are compromised while an individual is at a low weight.

Getting a full diagnosis: an assessment admission

A full and accurate diagnosis is essential: we often see young people who have an initial diagnosis which does not correlate with their presentation, or one that fails to recognise co-morbidities and the impact they have upon their eating disorder.

An assessment admission enables our specialists to fully assess an individual, taking into account co-morbidities which may be significant and how different factors may be interacting. Assessment admissions are normally two to four weeks in duration.