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Eating Disorders service

Aged 8 to 18?

Visit our children and young people’s eating disorder service webpage.

What is the Eating Disorders service?

We are a specialist service offering a community based treatment for adults with a clinical diagnosis of an eating disorder.

An eating disorder is a mental health illness associated with a high mortality rate. It can affect anyone at any age and is often more about feelings and emotions than about food.

We cover the whole of Cornwall and our therapy team consists of:

  • psychologists
  • dietitians
  • occupational therapists
  • nurses
  • assistant psychologists
  • trainee mental health and wellbeing practitioners
  • peer support workers
  • administrators

Our team works with clients and other organisations, including integrated community mental health teams, GPs, and CAMHS for those transitioning from children’s to adult services and hospital services. The team has a designated transitions worker to support young people transitioning to our service from the Children and Young People Eating Disorder service.

People who need to be treated in hospital will be referred to an inpatient unit. There are a number across the country. Our closest is the Haldon Unit in Exeter. At times, we also use the Royal Cornwall Hospital in Truro.

How are referrals made to the service?

How are referrals made to the service?

All initial referrals to our service come via a GP or the Integrated Community Mental Health team.

What happens after a referral is made?

Once a referral is made, you will meet with a mental health professional from within this team. This person will review your mental health and social care needs before discussing treatment options.

If an eating disorder is thought likely, a referral will be made to us and an eating disorders assessment will likely be offered with one of our team. The assessment lasts for approximately 1 hour and 30 minutes.

Interventions offered by the Adult Eating Disorder service

Extended assessment

If after the assessment it is felt that treatment from our service may be useful to you, we will usually offer you an extended assessment. These are 6 sessions, lasting around an hour. This will give you an opportunity to talk about your eating disorder symptoms and to start making small changes if you feel able. It also allows some space for you to discuss the impact the eating disorder may be having on the rest of your life.

After the extended assessment, we will be in a better position to direct you into the most appropriate course of treatment. Either within our service, within other NHS services or outside agencies where appropriate.

What happens after the extended assessment?

There are a number of treatment options available within our service. These are either combined group sessions or single one to one sessions or a mixture of both. Depending on the outcome of your assessment the treatment options may be from one of the following.

Support from a dietitian

The first treatment session you will be invited to is our food choices group. This is an opportunity for people with eating disorders to explore information about food, nutrition and other topics related to weight control with a dietitian in a group setting.

In some cases you may be offered an individual appointment with a dietician. Initially the dietitians will offer a dietetic assessment to determine the nutritional adequacy of your diet and offer guidance as required.

Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) is a supported self-help group which involves exploring the psychological and physiological reasons for eating disorders, the factors that maintain binge-eating, vomiting and/or laxative use and restricted eating, regular balanced eating, problem-solving and the role of body image. This is a 2-hour session run over 7 sessions and weeks.

Cognitive analytic therapy

Cognitive analytic therapy (CAT) brings together understandings from cognitive psychotherapies (such as CBT) and from psychoanalytic approaches into one integrated, user friendly and effective therapy. CAT is a collaborative programme of looking at the way you think, feel and act and is tailored to meet your individual needs.

Radically open dialectical behaviour therapy

Radically open dialectical behaviour therapy (RO-DBT) is a therapy for people with an over-controlled coping style and with a treatment-resistant disorder such as depression and anorexia. RO-DBT helps address emotional loneliness and teaches useful skills for increasing awareness of how social signalling affects relationships as well as how to be more open and receptive to the environment in order to learn.

Maudsley model of anorexia nervosa treatment for adults

MANTRA is a specialist integrative therapy which was developed for the treatment of anorexia nervosa. It typically consists of 20 to 40 sessions which aim to address the cognitive, emotional, relational and biological factors which tend to maintain anorexia by working out what keeps people stuck and helping them find alternative and more appropriate ways of coping.

Family therapy

Family therapy is therapy which involves the client who has an eating disorder and their family. It is aimed at helping and supporting the family. This is usually a 1 hour and 30 minutes and can be a one off session or a series of sessions over a period of time.

Occupational therapy

The occupational therapist uses specialist assessment to identify how an eating disorder is affecting an individual’s occupational performance.

Eating disorders can affect all areas of occupational functioning, such as:

  • meal preparation
  • food and clothes shopping
  • managing difficult emotions
  • work or study demands
  • socialising with friends and family

During occupational therapy, you will identify areas of your life that you wish to make changes in and work collaboratively with the occupational therapist to achieve these goals.

Occupational therapy can be provided on either a one to one basis or as part of a group.

Peer support

Peer support is a relatively new intervention offered by the Eating Disorder service. It recognises the role and value of lived experience when offering support to those with mental health difficulties, we currently offer a range of peer-based interventions, including:

  • sharing recovery stories
  • supporting clients to create recovery plans and decide on recovery goals.
  • attending community appointments or activities together
  • signposting to resources, activities, and opportunities
  • community interventions such as attending coffee shops together or completing weekly food shopping.
  • supporting with clinical groups by offering a lived experience perspective
  • individual support offered before and after initial assessments

The interventions are person-centred and designed to meet the client where they are at, offering a non-clinical space in which to reflect on possible ways toward recovery.

What are your opening hours?

We are available Monday to Friday, 9am to 5pm (excluding bank holidays). An answerphone may sometimes be on during these times, but it is checked regularly throughout the day, so we will call you back as soon as possible.

If you need urgent help outside these hours, call the out of hours mental health services on 0800 001 4330.

If you are in crisis, visit our mental health crisis webpage.

Can I get support anywhere else whilst I am waiting to be seen?

We recommend the following websites to support people with an eating disorder and their families.

  • Centre for Clinical Intervention: A self-help resource for those suffering with mental health problems, including eating disorders.
  • BEAT: A UK based charity which offers lots of support for those suffering with an eating disorder and their families, including a helpline.

FREED

FREED is a pathway within the Adult Eating Disorder service. It stands for 'first episode rapid early intervention for eating disorders'.

In Cornwall, it is a service for 18 to 25-year-olds who have had an eating disorder for 3 years or less.

FREED is designed to give young people rapid access to specialised ;evidence-based treatment and support tailored to their needs. In line with FREED’s early assessment and intervention principles, we aim to complete an engagement call within 48-hours of the referral being received. During this call if appropriate we will book the client in to one of our FREED assessment slots.

Core components of the FREED model

  • Easy access to treatment and proactive engagement.
  • Developmentally adapted evidence-based treatment.
  • Emphasis on early dietary change.
  • Family involvement in patient care.
  • Focus on transition management.

Young people accessing FREED can access the interventions provided by the wider Adult Eating Disorder service.

Food choices videos

The dietitians in the Eating Disorder service have produced a 3-part video series focusing on 3 topics:

  1. Metabolism (session 1).
  2. Regular balanced eating (session 2).
  3. Body composition (Session 3).

The aim of the videos is to provide reliable, scientific information about our bodies, what they need, and how to meet these needs. These videos last approximately 35 minutes each and can be used as a self help tool for people with eating disorders.

Session 1: Metabolism

Session 2: Regular balanced eating

Session 3: Body composition

Cornwall adult eating disorders groups

These groups are by invitation only following an assessment by the service.

Cognitive behavioural therapy for bulimia nervosa

If you are attending this group, fill in the CIA, EDE-Q, PHQ-9 and consent form at session 1 and session 7.

Instructions

Place an X in the column which best describes how your eating habits, exercising or feelings about your eating, shape or weight have affected your life over the past 4 weeks (28 days).

CIA and Change

Note: Questions marked by * are mandatory


Over the past 28 days, to what extent have your … eating habits … exercising or feelings about your eating, shape or weight …
  Not at all A little Quite a bit A lot
*This is a mandatory field. 1 … made it difficult to concentrate?
*This is a mandatory field. 2… made you feel critical of yourself?
*This is a mandatory field. 3… stopped you going out with others?
*This is a mandatory field. 4… affected your work performance (if applicable)?
*This is a mandatory field. 5… made you forgetful?
*This is a mandatory field. 6… affected your ability to make everyday decisions?
*This is a mandatory field. 7… interfered with meals with family or friends?
*This is a mandatory field. 8… made you upset?
*This is a mandatory field. 9… made you feel ashamed of yourself?
*This is a mandatory field. 10… made it difficult to eat out with others?
*This is a mandatory field. 11… made you feel guilty?
*This is a mandatory field. 12… interfered with your doing things you used to enjoy?
*This is a mandatory field. 13… made you absent-minded
*This is a mandatory field. 14… made you feel a failure?
*This is a mandatory field. 15… interfered with your relationships with others?
*This is a mandatory field. 16… made you worry?
To change or not to change?
  Not at all A little Quite a bit Very
How motivated are you to change?
If you decided to change how confident are you that you would succeed?
How ready are you to change?
*

After submitting the form, complete and submit the forms in the drop-down boxes below.

EDE-Q questionnaire

Eating Disorders service questionnaire

Note: Questions marked by * are mandatory


The following questions are concerned with the past 4 weeks only (28 days). Please read each question carefully and tick the appropriate box. Please answer all the questions.
On how many days out of the past 28 days:
  0 days 1-5 days 6-12 days 13-15 days 16-22 days 23-27 days Every day
*This is a mandatory field. 1. Have you been deliberately trying to limit the amount of food you eat to influence your shape or weight (whether you have succeeded or not)?
*This is a mandatory field. 2. Have you gone for long periods of time (8 waking hours or more) without eating anything at all in order to influence your shape or weight?
*This is a mandatory field. 3. Have you tried to exclude from your diet any foods that you like in order to influence your shape or weight (whether you have succeeded or not)?
*This is a mandatory field. 4. Have you tried to follow definite rules regarding your eating (for example, a calorie limit) in order to influence your shape or weight (whether you have succeeded or not)?
*This is a mandatory field. 5. Have you had a definite desire to have an empty stomach with the aim of influencing your shape or weight?
*This is a mandatory field. 6. Have you had a definite desire to have a totally flat stomach?
*This is a mandatory field. 7. Has thinking about food, eating or calories made it very difficult to concentrate on things you are interested in (such as working, following a conversation, or reading)?
*This is a mandatory field. 8. Has thinking about shape or weight made it very difficult to concentrate on things you are interested in (such as working, following a conversation, or reading)?
*This is a mandatory field. 9. Have you had a definite fear of losing control over eating?
*This is a mandatory field. 10. Have you had a definite fear that you might gain weight?
*This is a mandatory field. 11. Have you felt fat?
*This is a mandatory field. 12. Have you had a strong desire to lose weight?
Questions 13 to 18: Please fill in the appropriate number in the text box on the right.
Over the past 4 weeks (28 days):
Questions 19 to 21: Please tick the appropriate box. Please note that for these questions the term binge-eating means eating what others of your age and gender would regard as an unusually large amount of food for the circumstances, accompanied by a sense of having lost control over eating.
  0 days 1-5 days 6-12 days 13-15 days 16-22 days 23-27 days Every day
*This is a mandatory field. 19. Over the past 28 days, on how many days have you eaten in secret (such as furtively)? Ignore episodes of binge eating.
*This is a mandatory field. 20. On what proportion of the times that you have eaten have you felt guilty (felt that you’ve done wrong) because of its effect on your shape or weight? Ignore episodes of binge eating.
*This is a mandatory field. 21. Over the past 28 days, how concerned have you been about other people seeing you eat? Ignore episodes of binge eating.
Questions 22 to 28: Please tick the appropriate box using a number on the scale.
Over the past 28 days:
  Not at all Slightly Moderately Markedly
*This is a mandatory field. 22. Has your weight (number on the scale) influenced how you think about (judge) yourself as a person?
*This is a mandatory field. 23. Has your shape influenced how you think about (judge) yourself as a person?
*This is a mandatory field. 24. How much would it have upset you if you had been asked to weigh yourself once a week (no more, or less, often) for the next 4 weeks?
*This is a mandatory field. 25. How dissatisfied have you been with your weight (number on the scale)?
*This is a mandatory field. 26. How dissatisfied have you been with your shape?
*This is a mandatory field. 27. How uncomfortable have you felt seeing your body (for example, seeing your shape in the mirror, in a shop window reflection, while undressing or having a bath or shower)?
*This is a mandatory field. 28. How uncomfortable have you felt about others seeing your body (for example in communal changing rooms, when swimming, or wearing tight clothes)?
Thank you for completing this questionnaire
*

PHQ-9 and consent form

PHQ-9 Depression

Note: Questions marked by * are mandatory


Over the last 2 weeks, how often have you been bothered by any of the following problems?
  Not at all Several days More than half the days Nearly every day
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3.Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed? Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way
Consent form for service audit
To monitor the quality of groups we provide, we would like your permission to use information from your questionnaires regarding your experience of and the impact of taking part in the CBT guided self-help group. This information will be used to help us to plan future groups. The information will be used in an anonymous form (each participant will be assigned a number). All the information will be stored securely.
I consent to the eating disorders service using my questionnaires to inform further service development. I understand that my participation is voluntary and that non-participation will not affect the service I receive, and that I am able to withdraw consent at any point.
*

Recovery stories

Andrea’s story

High point in my journey towards recovery

I think one of my favourite high moments a recent holiday to Budapest. And it was probably just the most relaxed I've ever felt within myself and within someone else's company. Just in terms of recovery as well, it was the first time in so long that I felt like I could completely unwind and relax on a holiday and I could appreciate every single moment. We had so many nice memories. And we both opened up a lot to each other and it solidified our friendship. It's that friendship that has really helped my recovery from the start.

My lowest point

I think one of the lowest points was when I had to be an inpatient for the third time. It was a really low point in my life in a lot of aspects, like things were not very well between my parents, my mum was not very well, and it really impacted on my sisters. I think that we just reached a breaking point where we cannot do this. Like it's gone on too long. I think I was looking for something or someone to make me better, like a fix that I could not find myself when really, it was in me all along.

It's just really sad that I had to go through all of that. And I guess I spent a lot of time not believing in myself that I could get better and it's weird now, to be a totally different person. Because I never thought I'd be where I am now. To be honest, I do not think many people did.

Turning point

For me, it was moving here. It might seem miniscule, to other people, but just finding the friends I've got now where you kind of realise there's more to life and life is okay. And we started having like weekly dinner parties and stuff. And that took the fear out of food and replaced all the scary memories and all the panic and control that I had around food and I was just enjoying it and having fun and no one cares.

I also think turning points were coming out of a relationship break up and realising that I need to find myself again and do things for me and get better for me, and also the university saying that if you do not get better, then you cannot come back.

And then maybe the biggest turning point was reaching a healthy weight and realising that nobody was worried any more, which was a really nice feeling. Like no one at all was worried about my safety or tiptoeing around me which is really nice.

The next chapter

I'm just about to start third year of university, which I did not really think I’d get to and it's flown by. I live in a house with all of my really good friends. I'm going to start writing a dissertation, which I'm quite excited about. And maybe there'll be a bit more travelling this year and I'm definitely going to stay in Cornwall. There's also possibility of starting an apprenticeship which I’m really excited about. It's just like, all of my dreams are falling into place, and I wish I could go back and say to myself "it's going to be okay", like it’ll all fall into place. Like, it might not be what you expected, or when you expect it, but just keep working on it.

Olivia's story

High point in my journey towards recovery

For most girls, getting their first period is more likely to be associated with trepidation and discomfort but for me, it was like one of those moments when you hear, “You’ve got the job!” or “The award goes to..” For me, it meant an irreversible shift in my world. It meant that suddenly a door, that I had thought to be locked and stuck-fast, had now opened up and provided a glimmer of the opportunities that I never thought would be available to me.

Low point

My lowest point came when I was approaching my 30s and still had no signs of being able to produce, let alone carry, a baby. It felt like time was running out, made even more apparent as I had just married the love of my life and was desperately wanting to complete the dream for both of us. No matter how angry or frustrated I got with myself, I felt like I could not get off the endless slippery slope that anorexia laid out for me. It took me a while to realise that it took more strength and courage to ask for help than it did to carry on the futile battle alone.

Turning point

It wasn’t until a day or 2 before my final therapy session that I got the “smack in the face”. That was when I realised that somehow or other, I had spent a whole year at a healthy weight. It hit me that all those things I had been dreading ever since that first diagnosis at 13, they hadn’t happened. All those things that anorexia had told me about what would happen, how I would feel, what people would think of a healthy weight me, just weren’t true.

Next chapter

Becoming a mother is still very important to me and I know that I can never be too recovered for that, so I continue to practice the skills and strategies that I have learnt with the help of the eating disorder service team. I also feel that I have gained a new perspective on myself and on the world. I feel stronger and, like I’ve actually got something to contribute to the world. I have the courage to stand by my own ideas and, even if they are wrong to accept that we all make mistakes.

I am not sure what the next chapter holds but, I feel ready for it. I now know my strengths and no longer hide them behind my weaknesses. I am prepared.

Roxy's story

What do you think was the lowest point in your recovery?

When I was younger, I experienced some really horrific bullying which really affected the way I felt about myself and was really difficult for my family and friends too. That was definitely the lowest time of my life, without a doubt. But you can’t change what happened. You just have to learn to get over it and get used to it and understand it.

And the high point?

I have now realised it's okay to be me. I am who I am. Everyone is different. No one should be the same. I've just learned that my opinion is valid and you've got to put yourself first-you can't look after anyone else if you don't put yourself first. So that's my highest point, having that realisation that I have self-worth and I am worthy of what I want to do.

What were the turning points in your recovery?

When the dietitian was showing me how much your body needs in a day, that was a turning point, because I didn't know what your body needed, and I realised just how little my body had. Another turning point was our therapy letters on our last time we met, the comparison between the first letter and the last letter you wrote me is huge, I can see massive differences. More recently, I've started to challenge my mental health and take ownership and say, no, I'm in control of you, you’re not in control of me any more.

What is the next chapter in your story and what comes next?

For once I'm very excited to answer this, it used to be something I couldn't see. I had no optimism I couldn't see the future. Now I am planning a change in career. I now want to help other people and get involved with institutions around Cornwall as much as I possibly can. I see happiness in the future. I don't know what's coming around the corner, but I see a good relationship, hopefully a new house and a new job. And I am determined to just be me, to do what I want to do and not what anyone else wants me to do.

Reflections

It's been a hard journey, because you have to get over so many obstacles. Now it feels like I'm a different person. I feel like I've gained this alter ego. I have said goodbye to the herd of sheep and now I’m a lion! I've taken control. That's how I feel. I've got my voice. And I can use it. And that's something that has been a must for me because I've never had a voice due to the bullying. I lost it. And now being able to confidently say I am me feels really good, it feels really good.

Sara’s story

High point

I recently went out for a friend’s birthday dinner and drinks. And I think it was realising that, before recovery, I would have really worried and panicked about going and being there. I would have been so preoccupied with what I looked like and people seeing me eat that I would have had a really bad time. And then I would have gone home afterwards and probably restricted the next day too, just in case. But I didn’t do any of that! I had a really nice time, and it was really lovely just to go out and enjoy it.

Low point

There were quite a few low points to be fair. I think there were times where I wasn’t really showering or going out because I was so disgusted with myself that I couldn’t even look at myself and do basic things, that was a very low time. Or one time, I was away for a weekend, and I was sharing a room so I knew I wouldn’t be able to stick to my normal routine and I ended up purging and waiting until they’d gone in the shower back in the room so I could exercise. And I think it’s just weird to look back and be like, wow, why was I like that? I was so miserable. Now I feel bad that I spent so much time putting myself through that.

Turning points

I think the change was in working on my positive self-talk. I think because I didn’t really notice the shift until something happened and I thought, oh if this happened before I would have really berated myself and been really mean to myself but recently in those moments, I’ve been giving myself a very nice talking to and I’ve been trying to do that a lot more. I think that sort of mindset change has been quite a big turning point in helping me with other parts of recovery.

Next chapter

Hopefully I will graduate with my degree and maybe go travelling. I think I have more of a there’s a life I want to go live for me now rather than a life I have to live attitude. Most of the way I lived before was based on me being convinced that everyone cared what I did. Even just walking down the street, I was convinced everyone was judging me and looking at me. And I think a lot of what I thought I needed to do was for other people’s approval. Whereas I think now, I’m happy that I’ll go and do what I like. This year, hopefully I’ll be able to enjoy Christmas properly. That would be nice.

Reflections

I think it has been such a big part of my life in not a good way, and recovery is really a full time thing so it’s still part of my life in quite a big way. Its quite strange to look back and not ‘miss’ it-maybe in the same way you might miss a toxic friend. But then, also thinking about those things makes me realise how far I’ve come because I can think oh I’m having such a bad day, but then I’m like, actually, if I think about what a bad day used to mean, I’m still in a much, much better place and I’m so glad.