Eating Disorders

If your patient meets the criteria detailed below, please complete one of the following referral forms:

• Shropshire Eating Disorder Service Referral Form (.docx)
• Staffordshire Eating Disorder Service Referral Form (.docx)

Referral Criteria

The Eating Disorders Service offers assessment and evidence based treatments for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and Atypical Eating Disorders. We accept new referrals for patients aged 18 years and over. For patients aged between 17.5 and 18 years consideration is to be given as to whether the person is likely to benefit most from a referral to CAMHS or Adult ED Services. If you have any questions regarding a patient's suitability for referral to the service or queries about a patient you are currently seeing, please do not hesitate to contact us as we are more than happy to discuss these issues with you.

Although we will repeat routine blood tests at assessment, please arrange for the following laboratory tests to give us a baseline measurement: FBC, U&Es, LFT, Phosphate and Thyroid Function Tests. In addition a routine ECG should be arranged prior to a referral if possible.

Referrals are categorised as:

• Priority
• Routine (to be seen within 11 weeks)

Priority Referrals are defined as:

• very low body weight (BMI below 15)
• rapid weight loss (more than 1 kg per week consistently over the last 3 to 4 weeks)
• compensatory behaviours such as vomiting or severe laxative / diuretic abuse resulting in significant deterioration in physical health

Please note: should the patient exhibit cardiac arrhythmias, acute abdominal or chest pain or severe dehydration as medical complications associated with the eating disorder, please make your referral direct to the general medical services in the first instance.

Diagnostic Criteria for Eating Disorders

Anorexia Nervosa

• Over-evaluation of shape and weight and their control; that is judging self-worth largely, or even exclusively, in terms of shape and weight and the ability to control them.
• Active maintenance of an unduly low body weight (typically defined as maintaining a body weight less than 85% of that expected or a body mass index of 17.5 or below).
• Weight loss is caused by food restriction or one of the following; self-induced vomiting, self-induced purging, excessive exercise, use of appetite suppressants and / or diuretics or laxatives.

Atypical Anorexia Nervosa

Disorders that fulfil some of the features of Anorexia Nervosa but in which the overall clinical picture does not justify that diagnosis. For instance, one of the symptoms such as BMI < 17.5 may be absent in the presence of other key symptoms. This diagnosis should not be made in the presence of known physical disorders associated with weight loss.

Bulimia Nervosa

• Over evaluation of shape and weight and their control, as in Anorexia Nervosa.
• Recurrent binge eating. A “binge” is an episode of eating during which an objectively large amount of food is eaten, given the circumstances, and there is a sense of loss of control at the time.
• Extreme weight-control behavior (eg, sustained dietary restriction, recurrent self-induced vomiting or laxative misuse). People with diabetes may refrain from using their insulin treatment.

Atypical Bulimia Nervosa

Disorders that fulfil some of the features of Bulimia Nervosa, but in which the overall clinical picture does not justify that diagnosis. For instance, there may be recurrent bouts of overeating and overuse of purgatives without significant weight change, or the typical over concern about body shape and weight may be absent.

Binge Eating Disorder

Recurring episodes of binge eating characterised by eating a much larger amount of food than most people would consider normal under similar circumstances and within the same time frame (eating may continue for several hours) and a feeling of loss of control over the amount of food or type of food being consumed.

Binge eating episodes are related to at least three of the following:

• Eating until feeling uncomfortably full.
• Eating large quantities of food when not even hungry.
• Eating noticeably faster than is considered normal.
• Eating alone due to embarrassment of overeating.
• Feelings of disgust, depression, or guilt after a binge.
• There is obvious distress concerning binge eating behavior.
• On average, binge eating takes place twice weekly, and has done so for 6 months.
• There are no recurring efforts to compensate for binge eating, such as purging or excessive exercise. The disorder occurs at times other than during episodes of Anorexia Nervosa or Bulimia Nervosa.

Avoidant / Restrictive Food Intake Disorder (ARFID)

An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and / or energy needs associated with one (or more) of the following:

• Significant loss of weight (or failure to achieve expected weight gain or faltering growth in children).
• Significant nutritional deficiency.
• Dependence on enteral feeding or oral nutritional supplements.
• Marked interference with psychosocial functioning.
• The behaviour is not better explained by lack of available food or by an associated culturally sanctioned practice.
• The behaviour does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa, and there is no evidence of a disturbance in the way one’s body weight or shape is experienced.
• The eating disturbance is not attributed to a medical condition, or better explained by another mental health disorder. When is does occur in the presence of another condition/disorder, the behaviour exceeds what is usually associated, and warrants additional clinical attention.