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CAMHS Eating Disorder Service – Oxfordshire

Please see below for our service leaflets (please note that our offices have now moved to Raglan House, rather than the Boundary Brook address listed in the leaflets below):

Specialist CAMHS eating disorder leaflet for professionals

Specialist CAMHS eating disorder leaflet for GPs

For schools please refer to our Disordered Eating for School Staff leaflet, and our Seelf-harm guidelines for school staff leaflet.

Early signs of eating disorders

Physical – loss of weight, fainting/dizziness, loss of energy, muscle weakness, sleep disturbance, susceptibility to infection, loss of menstruation, constipation/bloating, repeated vomiting, , swollen glands under the jaw or frequent dental problems (if there is repeated vomiting).

 Behavioural changes – counting calories, restricting the amount or range of food eaten, eating alone or missing meals, secretiveness, hiding food, frequent visits to the toilet, taking a long time to eat meals, cutting food into small pieces, excessive body-checking, over-exercising, wearing baggy clothes.

Psychological – preoccupation with food and eating, concerns about weight and shape, feeling compelled to restrict intake, fear of eating.

Non-specific signs that may accompany eating disorders

Psychological – low mood, loss of interest, poor concentration, withdrawal, disturbed family relationships

 Social/educational – withdrawal from family and friends, loss of interest in activities, poor concentration, difficult family relationships

NB The non-specific signs may also be a feature of other mental health disorders such as depression or anxiety

 Diagnostic features

Anorexia nervosa

Weight loss at least 15% below the body weight expected (or BMI less than 17.5) or failure to gain weight as part of normal growth and development.

Weight loss is self-induced by avoidance of “fattening “ foods

Over-evaluation of weight or shape

Abnormal hormonal function (loss of menstruation in females)

Bulimia Nervosa

Recurrent binge eating

Purging (self-induced vomiting, laxative or diuretic abuse, restrictive dieting or over-exercise)

Over-evaluation of weight and shape

 Atypical eating disorders

Eating disorder symptoms that do not meet all the above criteria although cause significant concern/impact (common in young people).

Young people with eating disorders (anorexia nervosa, bulimia nervosa or atypical eating disorders) are seen within the service.

In all of these conditions, the young person will have significant concerns about their weight and shape. The service is not commissioned to see young people with obesity or those who have feeding/eating problems related to other diagnoses such as anxiety/depression/ASD, where the core problem is not an over-evaluation of weight and shape.

Referral protocol

If an eating disorder is suspected, an early referral to CAMHS is recommended using the standard GP referral pro-forma. The box relating to possible eating disorder (or a referral letter should be completed (including information on weight, height BP and PR, and recent blood results). The referral can be sent through our single point of access.

If the case is urgent, e.g. very low weight, rapid weight loss or serious psychiatric comorbidity such as suicidal risk, we suggest ringing the service direct, backed up by a written referral (marked urgent and emailed to the service).

In the case of a physical health emergency the young person should be referred immediately to Paediatrics (Under 16) or General Medicine (16/17 years).

A useful guideline for assessment and management of physical risk is the Junior MARSIPAN Guideline

Once the referral has been received by the SPA team it will be passed to the Child & Adolescent Eating Disorder Service.

The service aims to carry out urgent assessments within one week of referral and routine assessments within four weeks. Specialist treatment, if appropriate, is normally started on the day of assessment.

 Cases referred to CAMHS from other referral routes

If a young person is referred from non-medical referrers (including school health nurse, counsellor or self-referral) the young person will be asked to see their GP for physical assessment and blood screening (to exclude other causes of weight loss) as soon as possible. A medic in the Eating Disorder Service will make contact to discuss this.

Joint Care with CAMHS

Once the referral has been assessed by the Child & Adolescent service, any further blood investigations will ordered by the Eating Disorder Service and the patient asked to attend the phlebotomist at their local GP practice or Paediatrics outpatients. In rare circumstances the GP may be asked to regularly review the young person’s weight and physical health (if the patient will not engage with the Eating Disorder Service and is at risk, but will agree to be reviewed by the GP).

Physical assessment and investigations

If an eating disorder is suspected, physical assessment is indicated to exclude other causes of low weight and identify any physical consequences of the disorder.

This will include weight and height, BP and PR as well as more general examination to exclude other causes of weight loss. For those with low pulse rate (under 50) an ECG may be indicated to identify any serious cardiac abnormalities.

Recommended initial blood investigations include: FBC; ESR; urea and electrolytes (including phosphate, Mg, Ca); liver function tests, glucose, folate, B12; Iron; thyroid function tests.

Please see the Joint CAMHS paeds ED protocol v 7 for guidelines on the interface between CAMHS and Paediatrics.

For management of medical risk please see the Junior MARSIPAN guidelines, Royal College of Psychiatry

Please see our detailed referral page for information on how to access our services. Our offices are located at Raglan House, 23 Between Towns Rd, Oxford OX4 3LX, and our phone number is 01865 902839.

If you are a GP or a healthcare professional who needs to send information over a secure address, our single point of access email address is

Children & Young People services

Last updated: 5 April, 2018

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