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 patient, 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:

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.

 

SCOFF Questionnaire: BMJ 1999;319:1467