Our vision is to support people to a life worth living and improved health for people in our population, via reduced eating disorder symptoms and distress, and improved functioning and safety.
The aim of the Community Eating Disorders Service (CEDS) is to work with service users whose difficulties are at the moderate to severe range of presenting concerns. In this sense, we are a specialist service.
We aim to provide assessment, support and therapy to service users and to their families and carers following NICE guidelines.
Our service users will meet the criteria for an eating disorder as defined by both ICD10 and DSM V.
We also provide consultation and advice to other services and GPs. We work in partnership with Caraline our local eating disorder charity and may refer service users for support to Caraline. If you would like to contact the service via email, please contact firstname.lastname@example.org.
When worries about your food, shape and weight get to the point where they affect your behaviour and everyday life, this can be indicative of an eating disorder.
Eating disorders can take many forms and so there are a number of indicators. These may include restricting food intake, excessive eating (bingeing), self-induced vomiting, laxative usage, excessive exercise, worries about body shape and weight, etc.
Whilst eating disorders can appear to be about food and weight, there are often other contributing factors that can lead to a person having an eating disorder, and these can differ greatly from person to person.
Often, eating disorders can give a sense of control when other areas of your life seem out of control. However, they can also be very difficult to manage in your everyday life.
If you think that you might have an eating disorder, the most important step forward to take is acknowledging that you may have a problem, as there is help available to you.
If you struggle with food and eating, first approach your GP who can make a referral to our service.
We take referrals from GPs within our catchment area.
We welcome referrals from CMHTs, IAPT services and from other statutory and non-statutory services however, we may ask these services to refer to us via a GP so that physical difficulties associated with eating disorders can be monitored safely.
Unfortunately, we are unable to accept self-referrals at the moment as we work in partnership with your GP to look after your physical health.
We can help people with symptoms of:
• Anorexia Nervosa (AN)
• Bulimia Nervosa (BN)
• Binge Eating Disorder (BED)
Unfortunately, we currently are not able to offer treatment for Restrictive Avoidant Food Intake Disorder (ARFID).
We work with adults aged between 18-65 who have a registered Luton or Bedfordshire GP, and meet the diagnostic criteria for an eating disorder.
Initial Appointment (Assessment)
The initial appointment is an opportunity for you to tell us what has led you to seek support for your eating difficulties and some background information about yourself. It will last around 50 minutes. You will meet one of our therapists.
Depending on your concerns one of our medical doctors, dietitians or assistant psychologists might join this meeting, too. In this meeting we will discuss your expectations, hopes, fears and any goals you might have. It is an opportunity for you to meet the service and for you and us to assess together whether we feel we will be able to work well together
You will be able to ask questions about our professional experience and remit and our approach to therapy. It is also opportunity for us to assess whether we are able to work with your concerns or difficulties.
If we decide to work together after our initial appointment, you will be placed on our waiting list and we will contact you as soon as a therapist becomes available.
If we do not feel that we are the right service for you we will let you know and we will sign-post you to services that might be able to help you.
We offer a number of treatments. Most clients will receive psychological therapy or monitoring & support in line with the NICE guidelines. In addition, you may receive dietetic support or psychiatric reviews depending on your circumstances.
Once a therapist becomes available, they will invite you to your first therapy appointment. During this appointment, we will decide together on a treatment approach. Your therapist will discuss the available options with you. These include the nationally recommended forms of psychological therapy for eating disorders: The National Institute of Health and Care Excellence (NICE) guidelines recommend offering one of four different psychological therapies for the treatment of Eating Disorder.
- For Eating Disorders such as Binge Eating Disorder, Bulimia Nervosa and other similar eating disorders, Cognitive Behavioural Therapy (CBT) is recommended.
- For Anorexia Nervosa and similar eating disorders there is no evidence available at the moment to indicate which of the four types of therapy works best, so it is recommended the therapy options are explained and discussed to see which therapy is most suitable.
Usually, we will start with 6-8 sessions of psychological therapy and review this once we have completed these sessions.
We will arrange a regular appointment, which will normally be on the same day at the same time each week and last 50 minutes unless otherwise agreed. In order for psychological treatment to be helpful, it is important to have regular sessions.
Where are countywide service and offer treatment in a number of locations. You may wish to wait for location closer to home then is offered or available, and your treatment will not be affected by this choice.
As part of your treatment, we will discuss with you whether you might benefit from dietitian support. If we decided together that this would be useful, our dietitian will offer you an initial appointment. This will last approximately 1 hour (with shorter 30-45 minute follow up appointments if required).
As part of the team, the dietitian will be aware of your goals and progress with therapy. The dietitian will work with you to help you understand and manage any physical symptoms, concerns or medical diagnoses you may have which impact your nutritional intake. The dietitian provides evidence-based advice and information and will identify any potential dietary deficiencies, will work with you to make an individualised eating plan to lessen any risks, and may work with you to expand and normalise nutritional intake. The dietitian will also support you to stay motivated throughout therapy to achieve your goals.
Depending on your needs we might also decide together to make an appointment with the team psychiatrist, who will see you on her own or with another member of the team, depending upon your needs at the time.
The role of the psychiatrist is to assess medical and psychiatric risk , offer clinical opinion about any comorbidities, and advice regarding further management including medication, physical health monitoring and risk management
We have some limited capacity at present to support carers of clients under the care of our service. If you are looking for support you can contact our service and we can discuss this on an individual basis. Unfortunately, our capacity to support is very limited at present but we are working on this to change in the future.
As a service we also sometimes invite carers, family members or loved ones of our patients to joint sessions in order to facilitate recovery.
CEDA the Carers Eating Disorder Association offers support to carers and family members of people with eating disorders in Bedforshire and Luton. Their contact details can be found on: https://www.drcbeds.org.uk/
Cognitive Behavioural Therapy for Eating Disorders
CBT targets the thoughts, feelings, physiology and behaviours, which keep eating disorders going. With your therapist, you will explore what is keeping your eating difficulties going and work together to gradually change these. You will be required to record what you are eating each day along with changes in thoughts and feelings. Each week you will look at these records together and collaboratively monitor your weight. With help from your therapist, you will identify and plan how to change your eating to erode the eating disorder. Together you will tackle the thoughts, feelings and situations, which make change hard. This may include how to reduce body image concerns, how to manage negative thoughts and how to develop non eating disorder interests. In CBT an emphasis is given to developing new skills and knowledge that can be used between therapy sessions and once therapy has finished. This means at each session you will agree to complete certain tasks between sessions. These could include reading information, keeping records, practicing a skill or trying out a new way of doing something and recording the outcome.
There are typically three main stages in the therapy; in the first stage you will collect and evaluate information to help draw up your personalised diagram of what is keeping your difficulties going and decide goals for therapy. In the middle stage you will be working on making changes and in the last stage you will be working on how you maintain the changes you have made. CBT-ED typically consists of 20 sessions but may be extended in certain circumstances. Early in therapy you will discuss whether to involve significant others and plan how to do this if appropriate.
The Maudsley Model of Anorexia Treatment for Adults (MANTRA)
This therapy helps you and your therapist gain a clearer understanding of how and why your eating difficulties began and why they keep going. It helps you consider how your relationships with others, your thinking style and your ways of coping with emotions are related to eating difficulties. With this greater understanding you and your therapist will look at ways to make changes to help you break away from anorexia.
At the start of therapy, you will be given a workbook and you and your therapist will decide which exercises to look at during the sessions and in between sessions. The exercises are designed to help you gain better understanding of the difficulties and develop new ways of responding. During the therapy you will be encouraged to involve others, if appropriate, and think about ways you can draw on the help and support from those around you.
MANTRA typically consists of 20 weekly sessions but may be extended in certain circumstances. The therapy progresses through an Early, Mid and End phase. In the Early phase you start get to know MANTRA, consider your reasons for wanting to change, start thinking about using support around you and take stock of your nutritional needs. After this, in the first part of the Mid phase, you will draw together an understanding of how and why your eating problems started and why they keep going. Using this diagram, through the rest of the Mid phase, you will work on tackling each of the factors involved in keeping anorexia going, these could be thinking styles, emotion management, interpersonal relating and/or others. In the end phase, more focus is given to developing a non-eating disorder identity and moving forward.
Specialist Supportive Clinical Management (SSCM) for Anorexia
SSCM combines clinical management, like giving information, advice and encouragement with a supportive therapeutic style. The aim of the therapy is to help you recognise the impact of your eating difficulties and support you to make a gradual return to normal eating and weight. At the start of each session, you and your therapist will discuss your eating difficulties and the changes you are trying to make. Once this part of the session is complete you will be invited to use the rest of the session to talk about what’s on your mind. In some sessions, you might choose to discuss your relationship with food, eating and weight or you might choose to talk about more general areas of life, it will be up to you. Your therapist will use counselling skills to listen, reflect and offer support across whatever topics you choose to bring.
SSCM typically consists of 20 weekly sessions and has three phases. In phase 1 your therapist will introduce you to SSCM and together you will identify target symptoms and set goals around eating and weight restoration. In phase 2 together with your therapist, you will monitor your target symptoms, work on normalising eating and address any other issues you bring. In the final phase, you prepare to end therapy and draw up a plan for maintaining changes.
Focal Psychodynamic Therapy
In this therapy, you and your therapist will be considering what the symptoms of anorexia mean for you, how they affect you and how they influence your relationships with others. There are three phases. In the first phase, you will be building a therapeutic relationship, addressing pro-anorexic behaviours and beliefs and building self-esteem. In the second phase, you will look at relevant relationships with other people and how these affect eating behaviour. In the final phase, the therapy will focus on transferring the therapy experience to situations in everyday life and address any concerns you have about what will happen when treatment ends. Focal Psychodynamic Therapy is offered for 40 sessions over 40 weeks.
Eating disorders can lead to a number of physical health issues. You may need physical monitoring from your GP as an essential part of your care alongside therapy from our psychology led team. This will be needed when you are referred to our service, and after that as frequently as your GP advises. What is needed depends on your situation but some examples might be blood tests, pulse/blood pressure etc. We are a psychological therapy led service, therefore GPs will remain medically responsible for clients open to us and provide regular monitoring of their physical health throughout the course of their treatment with us.
Specialist eating disorder inpatient admissions are usually considered when a person reaches a high level of physical risk that cannot be treated safely by outpatient services and sometimes when the issues are so severe they cannot be addressed without more intensive support. These are considered on an individual basis according to your circumstances and are fully discussed with you by your therapist if the need arises. They are not very common; most people we see have outpatient treatment. In the event of an eating disorder unit becoming necessary we make the referrals, keep in touch during admission and will offer support after discharge. The service fulfils a gate keeping role, referring service users for inpatient admissions to Specialist Eating Disorder Units which are commissioned by the East of England Specialised Commissioning Group (SCG). Whilst a service user is an inpatient in a specialist EDU, the staff team will aim to attend an early Care Plan Approach (CPA) meeting and one CPA meeting near discharge, in order to participate in care planning to facilitate transition between inpatient and outpatient care.
- The Centre for Clinical Interventions in Australia has some helpful workbooks and resources on the topic of disordered eating and other mental health difficulties: https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Disordered-Eating. On the website you will find both information sheets on different topics and also complete work-books that you can complete either in preparation for therapy with us or by yourself.
- For people with symptoms of Bulimia or Binge Eating Disorder we can recommend 'Overcoming Binge Eating' a self-help book written by Christopher Fairburn. It is based on the principles of CBT. This book provides information to help you understand bulimia and binge eating and make a start at challenging unhelpful thoughts and behaviours. Whether you are working with a therapist or on your own, clear, step-by-step guidelines will support you with making changes.
- Another helpful book for people with Bulimia or Binge Eating is ‘Getting better Bite by Bite’ by Ulrike Schmidt, Janet Treasure and June Alexander.
- For people with symptoms of Anorexia, we can recommend a book called 'Beating Your Eating Disorder: A Cognitive-Behavioral Self-Help Guide for Adult Sufferers and their Carers' by Glenn Waller. It teaches skills to both carers and people with eating difficulties. If you are not yet sure whether or where to find help, your doctor or others recommend that you try a self-help approach or you are waiting for therapy with a eating disorder clinician this book might be a good resource for you.
- For your family we would also recommend ‘Skills Based Caring for a Loved One with an Eating Disorder’ by Anna Crane, Grainne Smith and Janet Treasure.
- BEAT, a national Eating Disorders Charity offers Online Resources, including courses and workshops for carers and family members of people with eating difficulties. They also offer a helpline where you can talk to someone about your experiences. You can find more on: https://www.beateatingdisorders.org.uk/support-services
- If you are a parent looking for information how to help your child you might also have a look at this website: https://anorexiafamily.com/. It is written by Eva Musby, a mum of two daughters with eating disorders.
Diabetics with Eating Disorders (DWED). DWED is the only UK charity that supports and advocates for people that struggle with both type 1 diabetes and any kind of eating disorder. Provides information, resources and support to those suffering, and professionals providing care. Website: www.dwed.org.uk
- MaleVoicED - Male voices with eating disorders is a charity which recognises and values the lived experience of males who have experienced, or are experiencing, eating disorders, disordered eating and associated co-morbid conditions. Website: www.malevoiced.com
- FREED - First Episode Rapid Early Intervention for Eating Disorders (age 16-25). The FREED website provides information on eating disorders, the importance of early intervention, and how to seek help. There are resources you can download and stories from young people who have recovered from an eating disorder. Website: www.freedfromed.co.uk
- In the event that you need more urgent support
Please be aware that we are not an emergency service. If you are experiencing a mental health crisis the following options are available to you.
- Call 111 for free and choose option 2. Open to people of all ages 24/7. A trained mental health professional will be able to offer assessment and support. Also use this to access Crisis Resolution and Home Treatment (CRHT) teams.
- Call 01582 722225. Open to adults (18+) Tuesday-Friday 5pm-11pm. Use this to access phone support delivered by a trained mental health professional from Mind Crisis Cafes.
- Call 116 123 for free or email email@example.com. Open to people of all ages 24/7. Use this to contact and talk to a Samaritans listening volunteer.
If you are experiencing a physical/medical health crisis, the following options are available to you.
- Call 111 for free. Open to people of all ages 24/7. A trained call assessor will be able to offer assessment and support and signpost you to the most appropriate care for your condition.
- Contact your GP within business hours.
If the above options do not resolve the mental/physical/medical crisis and you need immediate support to remain safe, please call 999 or attend an Accident & Emergency department (A&E).