Eating Disorder Service – South Hams and West Devon GP Practices

Scope

Eating Disorder Service, Plymouth is based in Plymouth but serves the population of Plymouth, West and South Devon and part of Torbay area.

Community Eating Disorder Service (EDS) – Plymouth

EDS is a non-statutory, non-urgent, 18+ psychotherapy service (short to medium-term) primarily aimed at offering early psychological intervention to support individuals as part of a recovery pathway (includes step-down from more intensive interventions such as discharge from specialist in-patient care).

EDS offers a range of NICE guidelines psychological input (individual and/or group) in conjunction with specialist dietetic support.

Clients are required to be ready to commit to and be willing to engage in this mode of input if referred.

Please see under Referral for referral criteria for this service

Out of scope

Exclusion Criteria:

All clients under the age of 17.5
Clients who are not registered with local GP's
Clients who do not satisfy DSM-5 criteria of an eating disorder
Clients who have other physical and /or other mental health problems which preclude them from making use of psychotherapy as a form of intervention

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Signs and Symptoms

For initial screening, please refer to GP screening tool

Assessment (DSM-5 criteria)

What is Anorexia Nervosa?

Persistent restriction of energy intake leading to significant weight loss (in context of what is minimally expected for age, sex, developmental trajectory and physical health)
Either an intense fear of weight gain or becoming fat, or persistent behaviours that interferes with weight gain (despite being significantly low weight)
Disturbance in the way one's body weight or shape is experienced, over-evaluation of own weight/shape or persistent lack of recognition of the seriousness of current low weight

What is Bulimia Nervosa?

Triad of:

Recurrent episodes of binge eating excessive amounts of food (e.g. 2 hours period) that one cannot stop or control how much one is eating
Over-evaluation of shape and or weight with BMI either average or above
Recurrent compensatory behaviours to prevent weight gain, this may include self-induced vomiting, laxatives or diuretics or other medications (prescribed or not) misuse, fasting or excessive exercise

What is Binge Eating Disorder?

Recurrent & persistent episodes of binge eating (over 3 months)
Absence of compensatory behaviours
Marked distress regarding binge eating

History and Examination

Please refer to GP screening tool and the Maudsley guide to medical risk assessment

Differential Diagnoses

Chronic debilitating physical disease
Brain tumours
GI disorders e.g.: Crohn's disease, malabsorption syndrome
Loss of or increase appetite, secondary to drugs e.g. SSRI, amphetamines
Depression/OCD

Management of Anorexia Nervosa in primary care

Rapid exclusion of other conditions
Risk assessment: BMI, Sit up-Squat-Stand (SUSS) Test , bloods, ECG
Refer if rapid weight loss or BMI less than 17.5, also refer urgently to CMHT if BMI less than 15

Please refer to the Maudsley guide to medical risk assessment

If there are identified physical risks, GP should continue to maintain physical assessment in accordance with NICE recommendations.

Management of Anorexia Nervosa in primary care

Rapid exclusion of other conditions
Risk assessment: BMI, Sit up-Squat-Stand (SUSS) Test, bloods, ECG
Refer if rapid weight loss or BMI less than 17.5, also refer urgently to CMHT if BMI less than 15

Referral Criteria

Community Eating Disorder Service (EDS) – Plymouth

EDS accepts referrals for people affected by Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder.
The service will accept referrals from professionals as well as self-referrals
The services works with clients age 18 or over but will accept referrals for clients aged 17.5 onwards to facilitate a gradual transition process. (EDS Transition Policy available on request)
Referrals can be made via telephone, fax, post and email
If there are identified physical risks e.g. BMI 15 or below or weight dropping consistently and likely to continue to fall to this level, then clients must be referred to CMHT concurrently in order to facilitate risk management via care co-ordination
After assessment, if clients are appropriate for the service, a clear plan of input will be drawn up (post-assessment letters sent to referrers and client), clients will be placed on the waiting list before commencing contracted therapy of 20 – 30 sessions (variable according to the models of input offered)
Three months must lapse after completion of therapy (either at EDS or other services) before clients can be referred again. This allows time/space for clients to process/assimilate previous input
Where clients have mental health or other health co-morbidities/risks, it is necessary to have information of services involved to ensure communication regarding a care package or joint working to maintain safety/support

Helpful information for referral – if available

Eating Disorder history, if relevant and available. Detailed mental health information would help to decide appropriateness of referral or if alternative services may be required
Physical investigations result e.g. blood chemistry, weight, height and or BMI.
Other physical or psychological (psychiatric) problems/risks (include drug/alcohol dependency) and prescribed medications
Other social difficulties or potential risks e.g. vulnerable children, child protection, education, employment.
Other services (statutory or non-statutory) involvement with clients

If there are identified physical risks, GP should continue to maintain physical assessments in accordance to NICE recommendations.

A guide to the medical risk assessment for eating disorders NICE guidelines for eating disorders (2004)