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Sunday, 29 January 2012

No no no

Perhaps if everyone shares this everywhere, we could get some kind of campaign going.....

And they called it....

I heard on the radio this afternoon that the Osmonds are doing a tour this spring.  Although I was too young to go to their concerts or scream at airports, I LOVED Donny, really loved him with the sort of crush that only a 10 year old can muster.

I think my lifelong predilection for purple comes from the fact that it is his favourite colour.

And I had a poster of him sellotaped to the wall above my bed so he was the first thing I saw when I opened my eyes in the morning.

I am not sure I want to ruin that fantasy by going to see him now he is old and grey.

Even though I am


This is a follow on to my post about telephones and the young. It made me smile this morning.

A couple more brain videos

Friday, 27 January 2012

For my daughters.

What an inspiration

Another cool brain video

Because it's Friday.....

Sharing the Treasure

Plans are afoot for a joint Maudsley Carers and Feast conference.  The proposed dates are 16th and 17th November and the venue is Nottingham.  We are hoping to welcome the ECHO project participants and many friends.

I have somehow got myself into this and am trying to wriggle out of it, without much success......

Discretion is the better part of valour!

In my teenage days, we perched uncomfortably by a telephone that was attached to the wall with a long curly cable.  The telephone, by necessity was in the central part of the house (the kitchen or the sitting room) so that everyone could hear the conversation as they meandered around doing whatever it was they were doing and privacy wasn't really an option.  It meant that I was unlikely to discuss my more intimate moments with a boyfriend or my friend's more intimate moments, for fear our parents would overhear.  Or, even worse, that our siblings would overhear and tell our parents.

Nowadays, between the texting and the what's apping and the MSNing, teenagers don't seem to actually hold conversations anymore.

The speed of modern communications also means that things are divulged in confidence to one person have spread around the county 15 minutes later.  Because this divulgence is all done electronically, it is written down and cannot later be denied.  So, if you tell a blatant lie about someone, this information can be communicated not only amongst the teenagers, but also to the parents within an hour.  This can lead to extreme awkwardness, especially as teenage boys tend to boast about their prowess in the downstairs department to impress their mates and teenage girls tend to say something in bitchy jest that is then redistributed as fact.

I vote for going back to the one on one, sitting on the stairs, phone cable stretched to maximum conversation.

Thursday, 26 January 2012

Anorexic Vampires

On a bit of a personal crusade to unearth the more absurd "explanations" of anorexia nervosa, I came across this.  I haven't laughed this much in ages.  You don't need to read it all because it is repetitive and boring but it is slightly bizarre to attempt to psychoanalyse anorexia, using "Interview with a Vampire" as a major reference source.


A lovely, long conversation with my old boss yesterday.  So lovely to catch up.  Lots to say and lots to hear.  This is for him.

My result:

You're Not A Perfectionist
You are definitely not a perfectionist. In fact, you're quite laid back. You may even benefit from striving a little more in your life--you may be surprised at what you can do! Just be careful to focus on the enjoyment of stretching yourself and growing, rather than worrying about the results too much. The following resources can teach you a little more about perfectionism, and about reducing stress in your life.


Let's move to Sussex...

In April 2011, F.E.A.S.T. launched the Google Yourself campaign.  As I was looking around local NHS websites in the South East of the UK recently, I thought I should point out some of the places you may choose NOT to live, based on their Eating Disorders websites.  Notes in red are mine - please note they have been tempered from my original notes which contained a lot of rude words!

Surrey & Borders Partnership
What are the causes of eating disorders?
Basically, anyone can get an eating disorder. However, there are some "risk factors" that make it more likely that someone will get the symptoms of an eating disorder (The symptoms?  What do they mean by that - someone will get the symptoms.  Does this mean they do not have an eating disorder?  What a load of nonsense). This is not a complete list but some of the main ones include:
  • Disturbed relationship with parent or parents (although one study showed no connection with this at all er...I think you'll find it hard to find a RECENT study that connects parenting with eating disorders.) e.g. the child feeling over-controlled, not being able to talk properly to his/her parents, or with critical or unaffectionate parents Why don't you try and ram the point home harder - the Surrey NHS believes that parents cause eating disorders.  Run, people, run.
  • Being female - slightly more common in females, although the symptoms may show differently in males (Huh?)
  • Media influence - the "thin is good" message, with younger people trying to become thin to match this (so this is a self inflicted condition because younger ed sufferers want to look thin?)
  • Biological factors e.g. perhaps low serotonin in the brain may lead to a weakness towards having an eating disorder (There was a brief moment of a glimmer of light there but no, no mention of genetics, brain disorders, etc.  No.  Their take, alongside dreadful, disengaged, cold, heartless parents and wanting to look thin is that low serotonin may lead to a "weakness" towards an eating disorder - what language is that?  iPhone?)
  • Trauma in childhood (Everybody suffers some kind of trauma of varying degrees.  Not everybody gets an eating disorder)
  • Having mild depression as a child (3 times more likely) (Er, there's a clue.  Brain circuitry?)

What a load of codswallop.  Evidence base please, Surrey.  However, should you have the misfortune to be in Sussex, you are totally stuffed:

Currently Health in Mind cannot work with people who have the following difficulties as their main presenting problem:

  • Eating disorders
  • Personality disorders
  • Bi-polar disorder
  • Child and adolescent problems
  • Chronic fatigue syndrome or ME
  • Chronic pain.

Well, that's comforting.  Mental health problems in Sussex are obviously so non-existent they don't need services.  Let's all move to Sussex then.

In Kent, they proudly announce that their Eating Disorders information was last updated in 2007.  However, you cannot access any information on Mental Health or Eating Disorders, so Kent appears to be a black hole.

So how about Hampshire?  Well, after much too and froing I was eventually directed to the Mental Health Foundation, who have this to say:

Eating disorders such as anorexia nervosa and bulimia nervosa are serious mental health problems more common in women than in men.

What are eating disorders?

You may be diagnosed with an eating disorder if your eating habits threaten your health and happiness or threaten the health and happiness of the people who care for you. (Trying really hard not to be flippant...and failing...the eating habits of most teenagers threaten the health and happiness of parents.  Just saying)
The most common eating disorders are anorexia nervosa and bulimia nervosa. These affect about 2% of adult females and some men. Both are serious mental health problems and anyone experiencing them needs a great deal of help and understanding.

Anorexia nervosa

People with anorexia nervosa don't eat enough, usually because they feel that their problems are caused by what they look like. (I will leave Extralongtail to comment on that) They think that they appear fat even though they may look slim or even painfully thin to others. Their morale becomes low and their health can be seriously affected. Because they are not eating enough they may develop a number of physical problems including poor circulation, brittle bones and hair loss, as well as kidney disease.

Bulimia nervosa

People with bulimia nervosa can’t stick to a healthy eating pattern. They tend to binge, that is, eat a lot at once. This makes them feel guilty and out of control (Control?  In an eating disorder?  Now there's an evidence based concept.....) so they then panic and punish themselves by starving, making themselves sick, taking laxatives or over-exercising. This can lead to a number of physical problems including tooth decay, constipation and intestinal damage, as well as heart and kidney disease. Telltale signs of bulimia nervosa include making excuses to avoid eating in company or rushing to the lavatory after a meal.

What causes eating disorders?

Eating disorders usually have underlying causes. For example, if you are a teenager, hormone changes and lack of confidence, or problems such as bullying or difficulties with schoolwork, can trigger the conditions. Refusing or bingeing on food may make you feel you have some control over your life. (Arghhhh.  Control issues are a SYMPTOM of the illness, not the illness itself.  There is so much wrong with this paragraph that I want to cry!)
Some people attribute eating disorders to media and fashion. It is fashionable in western culture to be slim. This is not possible for everyone as we are naturally all different shapes and sizes. People with eating disorders very often feel that they can only ever be happy or successful if they can be more like images portrayed in the media. (This is, again, an end stage symptom of an eating disorder, not the disorder itself.  Again, I expect Extralongtail may have something to say about this.  Where is the evidence base for this stuff?  I have yet to meet an eating disorder patient who thinks they will be happy or successful, let alone someone who thinks they will be happy or successful if they look like someone in the newspapers........)

Oxfordshire and Buckinghamshire are pretty unforthcoming about anything at all but they do link you to this, so I suppose that is good.  However, Berkshire gets the gold star for information sources and lack of prejudice.  It is not exactly perfect, but at least they admit that they don't know, rather than spout forth some outdated prejudice.

This involves eating habits rooted in a fear of being overweight, which involve eating either too much or too little and often using harmful methods to prevent weight gain. It is thought that one million people in Britain suffer from an eating disorder. The two most common disorders are anorexia nervosa and bulimia nervosa.
Useful Information sources
If you, a friend or relative are experiencing mental health problems for the first time and need treatment, you shouldcontact your GP. They will be able to refer you, if necessary, to the most appropriate mental health service in your area.

Tuesday, 24 January 2012

Lipstick Junction

The brilliant Carrie Arnold has written this blog, which just about sums up everything that is BAD about the whole "If you love your body, you won't get an eating disorder" nonsense.  Just to warn you that with Eating Disorders Awareness Week coming up, we are about to see a whole lot more of this unhelpful nonsense peddled around as "research".

Instead of talking about lipstick and not wearing make-up for a week, to stand in solidarity with those who suffer from an eating disorder, how about doing something much more useful.  Eating disorders are brain circuitry disorders (thank you, Katie) and not about make-up.  Why don't we talk about that?  How about support for the families who are being peddled nonsense about not hugging their children enough as babies and enmeshment issues?  Or signing the Men Get Eating Disorders Too Petition?

Oh and keep your lipstick on.  Not wearing it for a week won't prevent anyone getting an eating disorder.

Saturday, 21 January 2012

Shaping the future

I am rather overwhelmed and deeply flattered to find that I have a younger audience who read my blog.  This article is probably one of the most important ones to read.

The Diet Industry is a multi-billion pound con-trick.  This quote sums it up:

"The dieting industry is the only industry that I know of that can sell a consumer a product and then blame the consumer for it not working."

Diets don't work.  Please don't get sucked into a vortex of self-recrimination, insecurity and misery based on what you look like.  Please don't spend your (or your parents') hard earned money on following some expensive fad, that is often unhealthy (both physically and mentally) and dangerous.

It is time to stand up to the bullies who aren't interested in you, but are out to cream off every penny in profit that they can.  These diets are sold to you with little or no evidence-base.  Your generation can be the ones to make a difference and stop both men and women torturing themselves to conform to an ideal that is based not on science, but on the misconception that being thin is about self-control and therefore makes you a better, cleverer, more worthy member of society. It doesn't.  It just makes you miserable and misery shows in your eyes and on your face.

If you need further encouragement, that following a over-controlled, permanent hungry life shows on your face, just look at these pictures:


The fairy blogmother has opened an interesting discussion on the term "brain disorder" and what it means to an individual.  Once again, we are divided by a common language and this time the word is "mental".  When I hear the word "mental" (without the qualifying PC "illness" after it), I hear a Grange Hill type insult, a pre-teen, pre-watershed, playground derision of someone, spouted forth in a urban accent, with a hint of fear and aggression all mixed in.

6. Slang
a. Emotionally upset; crazed: got mental when he saw the dent in his new car.
b. Offensive Slang Mentally or psychologically disturbed.

I suspect our American cousins hear a different word entirely:

men·tal 1  (mntl)
1. Of or relating to the mind; intellectual: mental powers.
2. Executed or performed by the mind; existing in the mind: mental images of happy times.
3. Of, relating to, or affected by a disorder of the mind.
4. Intended for treatment of people affected with disorders of the mind.

For those of you with the time, please join the debate about whether "brain disorder" is a more acceptable term than "mental illness".  Personally, I am with Katie.

"I have come round to the phrase, but it was only when Dr Insel added "circuitry" into it during his talk at the symposium that I really saw where he was coming from. Brain circuitry disorder makes an awful lot more sense to me. Before that, I approached "brain disorder" from the organic, but-there's-no-hole-in-my-head front. Brain disorder makes me think of lesions and visible pathology, brain CIRCUITRY disorder and the analogy of heart arrhythmias makes perfect sense"

Friday, 20 January 2012

More Autism and the Psychoanalyst.

I have been following and support Le Mur in their campaign to get their film released AND to end the dreadful, cruel and totally un-evidence based practice of Packing for autistic children in France.

This article needs sharing, reblogging and supporting

Thursday, 19 January 2012

AQ as opposed to IQ

Following Miranda's comment to me, the known link between autism and anorexia and my new friend, K's bewilderment at the re-emergence of OCD symptoms, I thought I would link this.

Simon B-C is another one of my brain crushes.  If I could just get him to squeeze in Bear Grylls' body......

Getting there

Kate Thornton's brave documentary on anorexia last night. An interesting watch and, although a little too much emphasis on control for my liking, an all round myth-busting programme.

When people talk about "control", I hear anxiety, fear and compulsion.

Cognitive Remediation Therapy

I love Kate Tchanturia and I am very excited about the prospect of a CRT study being done with the help of the forum.  Thank you to Maudsley Parents for this video.

Cognitive Styles in Eating Disorders from Jane Cawley on Vimeo.

Wednesday, 18 January 2012

Understanding Eating Disorders from Jane Cawley on Vimeo.

Thank you for Karen Barber for this.

Education education education

I am pursuing the monoist/dualism thing all over the place, both on this blog and on the forum.  Katie kindly put me on to Emergence.  Sadly, Wiki is down today in the UK. So I found this paper.  I am glad that I downloaded this on to my Kindle last week and had already started to read it.

For the record, I got an A in Biology 'O' level in 1981 and a 'B' in maths.

This is tough stuff.

Tuesday, 17 January 2012

Mirror neurons 2

Having watched the video, can you then tie this article and this thread together?

For M - Happy New Year

Seriously cool brain guy


My daughter is going to be 16 next week.  To me, it seems like yesterday - bad back, really unattractive maternity trousers, too hot, 17 pillows to sleep with, a craving for citrus fruit that was so bad I actually went and bought 5 boxes of oranges and limes off the market.  And now here she is, all grown up.

She has been investigating things she can now legally do at 16 (apart from the obvious).  She has asked for money for her birthday and my fear is that she will now buy this or this.  You are allowed to buy animals at 16, except no cows, which is quite a relief, as we have too many of those already.

She is also allowed to buy a chain saw (Arghhhh!) but not the petrol to go in it (Phew).  She is also not allowed to buy the hot man wielding the chain saw in the picture....

Luckily, last night, Brian Cox came back on our screens.  She now says she wants a telescope.  Thank goodness for Brian......

Monday, 16 January 2012

Depressing day?

Today is supposed to be the most depressing day of the year.  I have to say is "a bit parky" this morning and the frost is still deep in the ground, despite glorious sunshine, a cloudless sky and the air being sharp, clean and fresh after some rather dank days.

It is also that time of year when more and more parents are joining the forum, after discovering the breadth and depth of their child's eating disorder over the Christmas holidays.

My task for the day?  To try and educate myself about the law, the Mental Health Act, capacity and sectioning.  My first sticking point has come with the question of Monoism and Dualism, not something that I had really considered before.  Having read David Wood's brilliant opening chapter (short relevant excerpt here)  of Bryan Lask's Eating Disorders and the Brain, I am inclined, for the purposes of advocacy, to be a monoist.

Yes, yes, I get that means giving up my free will and the religious, ethical and moral considerations that this statement implies is scary.

Any thoughts?

Sunday, 15 January 2012


It has been 9 weeks since I finished my radiotherapy.  I am fine for the most part but every now and again, I get wiped out by fatigue.  Yesterday was one of those days.  I just needed to go to bed and snuggle down, blessing my mother and her Christmas present and loving HWISO for his Christmas present

Having never been granted an official duvet day when working, I am now becoming a bit of an expert at them.  Do you think I should add this to my list of qualifications?

While we are on the subject of names

This is a bit of fun.  Thank you to my sister-in-law for putting me on to this.

I am Jet Hot Clever Banana.

The Fairy Blogmother gets the best one, though - "Comically Enthralls Nurses"

What's in a name?

Certain names resonate with me.  For instance, I have five close girlfriends called Sophie.  I automatically like people called Sophie.  I don't know why but early experience obviously taught me (rightly or wrongly) that people called Sophie are soft, warm and kind (Yes Mrs D, I am talking about you!).

Over the years, as the local town creeps ever nearer our rural idyll, farmers become even more reviled and the economic situation in our country makes it harder and harder to continue farming, we have flirted with the moving.  Firstly, to France, where farmers are revered and have huge political sway.  Or to my brother's part of Italy, where a farmer averages 2/3 crops per year and they all drive Lamborghinis. No, not the car -  the tractors.

However, thanks to a forum member, I have now decided I want to live here, just because of the name.  The fact that it has 3 breweries, the Gibson Guitar company and was once the ancestral home of the wonderfully named Potawatomi Chief Match-E-Be-Nash-She-Wish helps and the fact that I can sing the name - Kalamazoo, zoo zoo zoo etc.

I have also discovered a wonderful therapist with a wonderful name there - Rhonda Overberger - suitably Welsh first name, suitably strong surname.  All I have to do is persuade her to change her middle name to Sophie and my life will be complete.

Thursday, 12 January 2012


I have been accepted as a Mumsnet blogger.  I will have to mind my p's and q's.  I am very honoured, actually and hope that I can reach a wider audience with evidence based advice and help for parents with eating disordered children.

It has been an up and down day.  This is one of the ups.  Along with great news from my dear friend C.  I surprised the checkout queue in Tescos by whooping out loud over her email.  (Note to self: now you are a Mumsnet blogger, try not to be quite such an Idiot!).

I hate ed

Just sayin.....

They could have just asked us

This research has just been published highlighting the efficacy of Exposure therapy in treating patients with anorexia nervosa, who may have a co-morbid Anxiety condition or are on the OCD spectrum.

C&M made a film about this a year ago and it has been something we have been discussing on the forum for some years now and offering practical guidelines.

Now we are all in favour of anything that helps in the recovery from an eating disorder.  But credit where credit is due?

Wednesday, 11 January 2012


So I have done the What. The When (Now) and the How.  Now the Why.  Why should you act hard and fast to refeed your child/loved one, as the beginning part of the process of recovery from an eating disorder.

Effects of Anorexia Nervosa

Starvation: Starvation can have very serious effects on all major body systems and organs. The basic metabolic response to starvation is to conserve body tissues and energy. However, the body will also start to use its own tissue, including muscle and organs, for energy since the body has no food to use instead, The liver and intestines
typically lose the highest percentage of their own weight during starvation, followed by the heart and kidneys which both lose a moderate amount of weight. This often causes permanent damage to the organs in the process. Because someone's heart size may be reduced, they will experience low blood pressure and a slowed pulse. It cans also lead to cardiac arrest or kidney failure. Total starvation is usually fatal in 8 to 12 weeks.

Dehydration: the healthy functioning of cells and tissues is dependent upon a certain level of water content in the body. Also, salt and other minerals need to be kept within a narrow range. In a person who has become dehydrated, it's possible they are suffering from a depletion in salt as well as water. Long-term dehydration can
ultimately lead to kidney failure.

Muscle and cartilage: Over-exercise can put a huge strain on muscles and cartilage, particularly if the exercise is concentrated on one area for long periods of time.

Bones: Osteoporosis is a loss of protein matrix tissue (density) from bones, leaving them brittle and susceptible to fracture. Although it is a natural part of the aging process, the chances of developing osteoporosis later in life are significantly increased for anorectics, due to hormone changes. Bones may also stop growing, which causes stunted growth in younger anorectics.

Irregular or abnormally slow heart rate: An irregular or slow heart rate can mean that the heart muscle is undergoing changes. This is likely to lead to low blood pressure and, the lower blood pressure and heart rate goes, the greater the risk of heart failure.

Heart failure: The heart muscle is extremely sensitive and can become thin and flabby from nutritional deficiency. A lack of calories and protein can have a negative effect on the heart, and body chemical may become so imbalanced that heart failure occurs.

Sexual function: the body does not have enough fat to produce oestrogen in females, which will cause amenorrhea (cessation of periods) and infertility, and testosterone in men, resulting in low sex drive.

Lanugo growth: lanugo (fine hair) grows all over the body to keep it warm, compensating for the lack of insulating fat in the body.

Hyperactivity: The body relies on adrenaline (a hormone that is normally released during times of stress and fear) instead of food for energy. This causes excitability.

Effects of Bulimia Nervosa

The frequent purging that occurs with bulimia does serious damage to the body.

Self-induced vomiting:

  • Damages the digestive system: it can cause a peptic ulcer which is an area of the stomach or duodenal lining which becomes eroded by stomach acid. These are known as peptic ulcers. The symptoms can vary, with some people not noticing anything out of the ordinary but others may vomit blood and experience abdomen or chest pains. The pain is usually increased when the individual eats or drinks. Peptic ulcers can be serious and need immediate attention if you are vomiting blood or passing digested blood in your stools.

  • Damages the oesophagus (throat), since stomach acid irritates the oesophagus, which can cause inflammation and raw areas, sometimes making swallowing painful. Of greater concern is a rupture of the oesophagus, because this can be fatal in some cases. A Mallory-Weiss tear is the technical term for the rupture or tearing of the mucous membrane of the oesophagus at its junction with the stomach. It is caused by repeated vomiting and the person will have bright red blood in their vomit. You should always consult your doctor if you are vomiting blood.

  • Brings stomach acids into the mouth, causing the tooth enamel to wear away, and tooth decay to occur, giving the teeth a ragged appearance and cavities. Eventually all teeth may need extraction. If you are bulimic, it is recommended that you do NOT brush your teeth straight after vomiting. Instead you should drink water, as this will be gentler on your teeth and help replenish lost fluids.

  • Swollen salivary glands

  • Stomach cramps and difficulty in swallowing 

  • Dehydration: The healthy functioning of cells and tissues is dependent upon a certain level of water content in the body. Also, salt and other minerals need to be kept within a narrow range. In a person who has become dehydrated, it's possible they are suffering from a depletion in salt as well as water. Long term dehydration can ultimately lead to kidney failure. Amongst bulimics, dehydration usually occurs because the stomach is being emptied of its gastric fluids.

  • Abuse of laxatives and diuretics:

  • Causes constipation, sicne the body can no longer produce a bowel movement on its own

  • Bloating, water retention, and oedema (swelling) of the stomach. 

  • Because the body is constantly being denied the nutrients and fluids it needs to survive, the kidneys and heart will also suffer. Specifically, a lack of potassium will result in cardiac abnormalities and possible kidney failure, which can also result in death.

  • Effects of binge-eating

    The phsical effects of binge eating are not as severe as with anorexia and bulimia, since the body is not denied food or put through purges. However this is not to say that there are not still serious consequences.

    The obesity suffered by many binge eaters can cause complications such as diabetes type II, or heart problems.

    High blood pressure: overweight people between the ages of 20-45 have a six times higher incidence of hypertension than do peers who are normal weight. The risk appears to be even greater for older obese people.

    Diabetes: even moderate obesity, especially when the extra fat is carried in the stomach and abdomen (instead of hips and thighs), increases the risk of non-insulin dependent diabetes mellitus.

    Osteoarthritis: arthritis can occur in obese individuals because of the extra strain being placed on the joints by the weight of the person.

    Heart attack: high blood pressure and cholesterol dramatically increase the chances of having a stroke or heart attack.

    Yo-yo dieting can cause hypertension, and long-term damage to major organs, such as the kidney, liver, heart, and muscles.

    Tuesday, 10 January 2012

    Fluffy bunnies?

    For those of you who have half an hour, here is a fun way to spend it (not!).  Whilst I am aware that these people have their hearts in the right place, it seems to me that the news that eating disorders are a brain disorder (sorry Extralongtail!) has not yet reached them.

    Whilst I think that "fat talk" is uncouth and unnecessary, I have no particular problem with a few wrinkles and was totally unaware that "wrinkle" talk was now being targeted, in an effort to make us feel better about ourselves (and thus "prevent" an eating disorder???).

    This survey is written and skewed so that it can be produced during Eating Disorders Awareness Week with a great fanfare, saying how much women hate themselves.


    1. Men?  They are not exactly encouraged to participate.
    2. Calling the girl who thinks she's fat, Anna, is not particularly clever - is this subliminal messaging?
    3. Who is going to fill in this survey outside of the eating disorders world?
    4.  Why?  Just why?

    RCPsych Awards 2012

    Call for Entries – RCPsych Awards 2012

    The call for entries for the RCPsych Awards 2012 has been announced.

    As in previous years, these Awards are to recognise and reward the most dedicated psychiatrists, innovative teams and services, the most talented trainees, the best academic/researcher and the most influential public educator.

    New for 2012, we will also be presenting Awards in two categories that give recognition for the contribution service users and carers make to developing and improving mental health services.

    The full list of categories for the RCPsych Awards 2012 is:

    ·         Core Psychiatric Trainee of the Year (CT1–CT3)
    ·         Advanced Psychiatric Trainee of the Year (ST4–ST6 and SpR)
    ·         Psychiatric Trainer of the Year
    ·         Psychiatric Academic/Researcher of the Year
    ·         Public Educator of the Year
    ·         Service User Contributor(s) of the Year
    ·         Carer Contributor(s) of the Year
    ·         Mental Health Services Provider of the Year
    ·         Psychiatric Team of the Year
    ·         Medical Manager/Leader of the Year
    ·         Psychiatrist of the Year

    These Awards are your opportunity to nominate those outstanding teams and individuals who are making a real difference to mental health services.

    For entry forms, category criteria and rules of entry, visit or go the College website home page and follow the link in the Members and Trainees section. 

    The closing date for entries is Monday, 27th February 2012.

    For queries about the RCPsych Awards, please email Nicola Boyce at

    We look forward to receiving your entries.

    Professor Sue Bailey


    So I have covered the "What to do" and the "When to do it" (Now!) and we come to "How to do it", the tricky one.

    Sadly, it is not a case of preparing some food, putting down in front of the eating disordered patient and asking them to "Please, nicely, finish it up" or "Please, try and eat something, darling" or "Do you think you could manage this bowl of cereals/glass of milk/apple?"

    How it helped me was to reframe it from the patient's point of view. (Caveat, not all patients are the same and this is our experience).  What I was doing was putting down a plate of hissing cobras and asking if my daughter would like to try and eat them.  Her brain was in full "fight or flight" mode, her andrenaline was pumping, her heart was racing, she was ready to run and I was asking her if she could "manage" to eat a bit of a hissing cobra.  Er...No!  Her whole brain was telling her that this was an extremely dangerous and life-threatening action and to run, run, run.  Her dear old mother had morphed into some evil bitch queen and was asking/telling/yelling to eat?  No wonder she thought I was mad.

    It came as a complete shock to us to see her distress.  It wasn't willful, oppositional or defiant or teenage moodiness or her being stubborn, or angry or upset.  It was deep deep fear.  As with all animals backed into a corner, she came out fighting.

    Our problem was how to overcome this fear, how to feed her her medicine and how to rebuild the trust that had been smashed almost beyond repair.  Calm, kind and supportive confidence during and after mealtimes (for the most part) but an absolute requirement to eat whatever what put in front of her, whoever is in charge, however long it takes.

    We found Janet Treasure's animal models extremely helpful and C&M produced a few short films here to model effective parenting in the face of extreme resistance.

    A very good place to start

    When you read, you begin with ABC.

    Where do you begin when your child has just been diagnosed with an eating disorder?  Well, if you are anything like me, you begin from a place of total ignorance, prejudice and despair.  Unhelpfully, the majority of Tier 1 clinicians in this country (GPs, Practice Nurses and the like) are also starting from this place.  I learnt that eating disorders are covered at medical school in an afternoon.  An afternoon, you say, to learn about the most lethal psychiatric disorder?  Surely not?

    Personally, I blame Freud.

    "Ever since a long time ago (1892), Freud was much more interested in describing closely the symptoms of Anorexia in every detail, attempting to describe it more precisely with each case but not with the purpose of realizing a medical profile identification. He preferred to establish the psychical mechanism that the symptoms were exhibiting.

    Freud established the "cannibal" or "oral" as the first sexual organization. The nutritional pulsion remained there supported.
    As a general knowledge, he enunciated that neurosis sometimes appears in pubescent girls. This fact reveals that these girls are not sexually "authorized" and thus present anorexia as a consequence.
    Freud associated nutritional neurosis (nervous anorexia) with Melancholy in presence of an under-developed sexuality:
    Freud settled anorexia as a hysterical mechanism."
    This kind of nonsense has permeated our understanding and treatment of eating disorders for over 100 years. This means that the majority of our GP's (and other non-ed specialist doctors) believe at an almost subconcious level, that eating disorders are self-induced, attention seeking behaviour from young girls who weren't breastfed, are in love with their fathers and have deep distress because they were born without a penis.  I think Sam Thomas might have something to say about this.
    Hence, when one presents with an eating disorder, it is hardly surprising that the GP's tend to view the sufferer with great sympathy and tell the concerned parent to "try and get her to eat a sandwich".
    A sandwich is not going to cut it.  Sorry.  This paper gives you some idea of what nutritional requirements are needed to help someone recover from anorexia and a sandwich is nowhere near going to make a difference.
    "Oral feeding requirements
    The estimated average energy requirement in the UK for healthy girls aged 11–
    18 years ranges from 1845 kcal to 2110 kcal (7750–8860 kJ) per day; for boys of the
    same age the range is 2220 kcal to 2755 kcal (9325–11 570 kJ) per day (Department
    of Health, 1991). As with adults, children and adolescents with anorexia require
    hypercaloric diets in order to gain weight, especially when approaching a
    minimum healthy level. Most authorities suggest that teenage girls who are
    anorexic require an energy intake in excess of 3000 kcal (12 600 kJ) daily to
    achieve full weight restoration, whereas the American Psychiatric Association
    (Anonymous, 2000) recommends 70–100 kcal/kg (295–420 kJ/kg) per day. Energy
    needs are obviously greater in young, growing adolescents and it often becomes
    difficult for those with anorexia to ingest enough energy to gain weight.
    Increased energy needs continue into the maintenance period. Kaye et al (1986)
    have shown that people with anorexia require an extra 200–400 kcal (840–1680 kJ)
    a day for up to 6 months after reaching maintenance weight. Weltzin et al (1991)
    reported that recovering patients required 45–50 kcal/kg (190–210 kJ/kg) per
    day to maintain 95% average weight for height, compared with 30 kcal/kg (125
    kJ/kg) per day in a healthy control group. The American Psychiatric Association
    (Anonymous, 2000) suggests using 40–60 kcal/kg (170–250 kJ/kg) per day during
    the weight maintenance period. It has also been demonstrated that people with
    restricting anorexia require significantly more energy than those with the binge/
    purging subtype (Kaye et al, 1986; Weltzin et al, 1991)"
    It would have to be an almighty sandwich.
    If it were me and I had my time again, I would use this menu, adding 200 calories per day until my d was gaining 1lb per week, minimum.  For us that required 3,500 calories a day, on average, for a whole year.  We didn't stick exactly to the menu after 10 days (and the risk of Refeeding syndrome had passed).  We branched out into a variety of other calorie dense food.
    For further help and information, I would suggest here and here