Treating Eating Disorders and Addiction at Castle Craig

At Castle Craig we treat eating disorders that require lower levels of care, and only when there is an addiction to alcohol or drugs as a dual diagnosis. All eating disorder patients are assessed by a Consultant Psychiatrist to ensure that we meet the needs of the level of treatment they require. If a patient has a body mass index that is below our limit we will be unable to treat that person, but we can refer them on to other specialists in eating disorders who could help.

What is an Eating Disorder?

The term ‘eating disorder’ describes a psychological illness, affecting both men and women and covering a wide range of eating habits from compulsive eating to anorexia. The American Psychiatric Association’s mental health manual recognises the following eating disorders:

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge Eating Disorder
  • Eating Disorder Not Otherwise Specified (EDNOS)

The disorders that occur most commonly with substance abuse are bulimia nervosa and EDNOS. Those suffering from bulimia have often experienced anorexia in the past. An eating disorder that is dormant often re-emerges following substance abuse treatment when alcohol or drugs are no longer used.

Causes of Eating Disorders

All eating disorders are influenced by body image. Dissatisfaction with the body as a whole, or particular parts, can lead to an eating disorder and also maintain it as the person attempts to reach the frequently unattainable desired body shape and size. Sufferers usually display signs of denial—a powerful treatment obstacle.

According to NICE, Eating disorders are more prevalent among young men and women between 13 and 17 years of age. 

Eating disorders are characterised by denial, secretiveness, rituals and obsessive/compulsive behaviour, and pre-occupation with a substance (e.g. drugs, food). They may be life-threatening, and sufferers often move from one disorder to another.

There is no specific reason for the development of an eating disorder. Different eating disorders are due to a variety of factors:

  • Anorexia and bulimia: evidence of reduced serotonin activity in the brain
  • Anorexia: genetic vulnerability, family history of an eating disorder or obsessive compulsive disorder (OCD)
  • Bulimia can be triggered by food restriction in childhood
  • Binge eating disorder and bulimia can be triggered by ‘normal’ dieting
  • Characteristics of both substance abuse and eating disorders.

What assessments are used for eating disorders?

Many different physical and psychological assessments must be conducted to help build the full picture of a person’s eating disorder. It is important that eating disorder patients have a thorough medical and psychiatric assessment before entering an age-appropriate treatment programme. BMI and duration of the illness must also be taken into account as well as the patient’s physical health, mental health disorders such as anxiety, self-harm, depression, and obsessive compulsive disorder.

Eating Disorder Signs

The SCOFF Questionaire below will help you determine if you may have an eating disorder. If you answer “yes” to two of these questions, you may have anorexia or bulimia.

  1. Do you make yourself Sick because you feel uncomfortably full?
  2. Do you worry you have lost Control over how much you eat?
  3. Have you recently lost more than One stone in a 3 month period?
  4. Do you believe yourself to be Fat when others say you are too thin?
  5. Would you say that Food dominates your life?

Family members or friends may notice changes in the appearance and behaviour of someone suffering from an eating disorder. Possible signs to look out for include:

  • Loss of weight
  • A change in eating habits (eating less, binge eating, skipping meals)
  • Frequently mentioning weight and body shape
  • Obsessive calorie counting
  • They may seem depressed/distant
  • Wearing loose clothes to hide a change in figure
  • Experimentation with alcohol or drugs
  • Signs of self-harm
  • Complaining of low energy levels, dizziness, irritable bowel syndrome.

Eating Disorder Treatment Programmes

Treatment should result in restored physical health, education about eating disorders, relapse prevention techniques, coping skills, therapeutic recovery from concurrent mental health disorders, and a sense of purpose in living without self-destructive behaviours. Treatment options depend on the patient’s needs and the severity of their disorder:

  • Residential Inpatient: This is the highest level of care in which patients will have the most supervision. If your eating disorder has caused an extreme effect on your physical health, being in a residential setting is safest. Regularly served meals, private diet and nutrition, restorative treatments, and long hours of therapeutic healing are necessary to bring the body to a stable place. Residential care is especially important for you if you do not think you can abstain from harmful eating disorder behaviours which would worsen your condition.
  • Intensive Outpatient: After a residential program, the intensive outpatient level of care in a community-based setting, includes less supervision and therapeutic programming, but still offers a full day’s worth of treatment. If your eating disorder behaviours are becoming problematic but have not taken a disruptive role in your life, this level of care would be best for you.
  • Lower Levels Of Care: If you are stable in your life and are concerned about a growing problem with eating disorder behaviour, a lower level of care will offer you the therapy you need to confront the underlying causes of your eating disorder while learning practical tools for living without self-destructive behaviours.

What is Anorexia Nervosa?

Anorexia nervosa is a serious psychological condition most commonly occurring in females, in which the individual has a severely distorted image of their own body, a pathological fear of being “fat,” and engages in extreme dieting and calorie restriction that leads to severe weight loss.

Sufferers restrict the amount that they allow themselves to eat and exercise excessively to burn calories, use amphetamines and appetite suppressants and may also vomit, take laxatives, enemas or diuretics. According to the National Institute of Mental Health (NIMH), Anorexia has the highest mortality rate of any mental health disorder.

Signs & Symptoms of Anorexia

Some symptoms of anorexia include:

  • Extreme thinness
  • Intense fear of being “fat”
  • Distorted ideas about one’s own weight
  • Lethargy
  • Severe dieting and/or excessive restriction of sustenance
  • Menstrual cycle disturbance
  • Preoccupation with body appearance (specifically thinness)
  • Brittle skin and nails
  • Depression & anxiety
  • Obsessive exercising
  • Obesessive compulsive disorder
  • Other emotional disturbances.

For a comprehensive list of behavioural signs as well as medical symptoms of anorexia, visit The BEAT website.

Contributing Factors to Anorexia Nervosa

There is no one pathway to anorexia. Many individuals diagnosed with anorexia have experienced emotional and/or physical traumas in the past; struggle with anxiety, depression, or other mental health conditions, or were exposed to intense pressure to perform and achieve early in their lives.

A licensed medical or mental health professional will assess for these factors in a clinical evaluation of any eating disordered behavior.

How to Recover from Anorexia

There are a wide range of inpatient and outpatient treatment modalities used to treat anorexia, including individual, group, and family therapies; medication therapies; skills training; medical nutrition therapies; creative therapies such as art and music therapies; as well as others. Family and peer support, and ongoing therapy from a licensed professional, can play a significant role in helping maintain recovery for an individual with anorexia.

Severe anorexia is best treated at a specialist eating disorders unit. For more information please see our helpful resources at the bottom of this page. 

Anorexia and Addiction Treatment

At Castle Craig we treat some eating disorders that may be present alongside an addiction, but we do not offer a full eating disorder treatment service for severe low-weight anorexia and bulimia. 

What is Bulimia?

Bulimia is a serious eating disorder characterised by a cycle of severe overeating marked by a feeling of losing self-control and followed by drastic behaviors intended to negate the overeating episode, such as intense and excessive exercise, self-induced/forced vomiting, use of laxatives or diuretics with the purpose of expelling the consumed food, or a combination of these actions.

Bulimia can continue for many years without the knowledge of family or friends as sufferers often appear to eat normally and don’t necessarily lose much weight.

Signs & Symptoms of Bulimia

The observable signs of Bulimia are not as readily apparent as those of anorexia, as individuals with Bulimia usually maintain a relatively normal bodyweight. Certain behaviors, such as those suggesting binge eating, frequently excusing oneself to the restroom or other private area immediately after eating are indicative of bulimia. Other signs and symptoms include:

  • Isolation or social withdrawal
  • Unusual preoccupation with tracking calorie intake and weight or body image
  • Changes in dentition
  • Reports of unexplained gastrointestinal distress and/or heartburn
  • Excessively strict and/or rigorous approaches to exercise are some of the possible signs of bulimia
  • Depression and anxiety frequently co-occur with bulimia.

In addition to emotional and psychological distress, bulimia has severe medical/physical health implications that can be life-threatening, most notably severe electrolyte imbalances that can result in heart attack or stroke. Other medical complications include dehydration, tooth decay, and a range of serious gastrointestinal problems. Individuals who may be suffering with bulimia should have a complete evaluation by qualified healthcare and mental healthcare practitioners.

Contributing Factors to Bulimia

There is no single cause of bulimia. As with other eating disorders, bulimia may be preceded by or mark the onset of psychological conditions such as depression and anxiety. Like anorexia, in some cases bulimic behaviors may onset as a maladaptive coping response to extreme stressors or as an attempt to reestablish a sense of control when an individual is experiencing extreme feelings of helplessness or anxiety.

How to Recover from Bulimia

As with other psychological and eating disorders, Bulimia treatment includes intensive psychotherapy in a range of modalities, support from family and friends, and medical monitoring and treatment. Individuals with bulimia will likely benefit from participating in therapy for an extended period of time, beyond the cessation of eating disordered behaviors. Medications, counseling, and social support can play key roles in recovery from Bulimia.

More information

For additional educational information on Eating Disorders, visit:


Please note that Castle Craig is not an eating disorders crisis service and does not treat eating disorders as a stand-alone condition. We treat some symptoms of eating disorders that present alongside an addiction to drugs or alcohol as well as dual diagnosis mental health conditions. This webpage is designed to offer information and helpful resources only. If you or a loved one are seriously ill or concerned and need immediate medical help, please contact your GP or NHS 111.

Page published: August 7, 2019. Page last reviewed and clinically fact-checked January 21, 2022