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Specialist Treatment for Eating Disorders

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Despite references to eating disorders in texts dating from the time of the ancient Pharoes, and even a mention in Shakespeare’s Measure for Measure, the development of effective treatments has been slow. 

However, a treatment called cognitive behavioural therapy (CBT) is now yielding results.   Indeed, as a result of research demonstrating its effectiveness, CBT is now recommended as the first line treatment for people who have not responded to a self-help approach.  

 At the heart of CBT lies the deceptively simple idea that eating disorders are driven by an irrational fear of uncontrollable weight gain.  This fear leading to counterproductive forms of dieting which, whilst intended to prevent weight gain, often have the opposite effect and thereby cause more distress and further reinforce the original fear.  CBT tackles the belief that strict diets are the only way to prevent weight gain by encouraging clients to see what really happens when they give up dieting and take up healthy exercise.

 For many with eating disorders the idea of consuming between 1,900 and 2500 kilocalories a day just to see what happens is a terrifying prospect and indeed the treatment is not for the faint-hearted.  But what most people find is that their body burns the energy they consume and their weight remains within healthy limits. 

 Treatment therefore provides a safe and supportive environment in which to take the plunge, give up dieting and see what happens.  And, at the end of six months treatment, if people don’t like the results of their experiment in normal eating, then they are free to return to the diets they were using beforehand.  

 Evidence suggests that about three quarters of people who complete the treatment find it useful.  Whilst this is a promising start, the quest to refine the treatment and thereby improve recovery rates goes on.

Doing CBT is a substantial commitment.  It takes time, energy, hard work, determination, perseverance and courage.  As I tell my clients, “you have to do all the hard work yourself”.  But if living with an eating disorder is ruining your life then it might be worth considering if treatment could be right for you.  If you’d like to talk to someone about whether CBT could help you overcome an eating disorder your GP will be happy to discuss it with you and to make a referral for treatment if necessary.

http://www.bristol.ac.uk/students-health/services/eating-disorders/

 

Chinese New Year 2013!

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Happy Chinese New Year to All Our Students.

A blog by Dr Clare Grant

Over the weekend, Chinese New Year was celebrated all around the world, including here in Bristol. Although Chinese students at the University weren’t lucky enough to get a statutory holiday to celebrate the New Year, I’m sure they enjoyed welcoming in the year of the Snake. Chinese New Year traditionally marks the end of the Winter Season, so that’s already one good reason to celebrate….roll on some Spring-like weather! Traditionally, it’s also a very family orientated time of year, when relatives get together and enjoy good food and each other’s company.

There are so many ways of keeping in touch with family once you leave home and come to University, even when leaving home means travelling thousands of miles to study in a different country. In fact, sometimes it feels hard to escape family ties: there always seems to be some way in which they can contact you! But, as we all know, it’s at family times like Chinese New Year, when the rest of our relatives get together without us, that we can feel particularly isolated and unsupported.

There are many International students at the University, with the largest single group being  from China. The personal and professional benefits of spending some time abroad studying in Bristol can be huge, but it can also be challenging studying away from home. All of the Bristol University Support Services (Students’ Health Service, Student Counselling, Disability Services, Multifaith Chaplaincy and Careers Service) are here to help our International Students as well as our home ones. These support services may be quite different to the ones provided by Universities in other countries, so it’s definitely worth having a look at their individual websites to see what they offer and how they might be able to help you.

Here at Students’ Health Service, we are experienced in helping International Students with their medical problems, wherever they come from in the world. In any one day, we can see students from at least 15 different countries! We are also aware of the physical and psychological health problems that can be associated with coming to study abroad. If you are experiencing health problems, please do make an appointment with one of our doctors or nurses, (our reception staff will help you decide who it’s best to make the appointment with): whichever country you come from, we are here to help you whilst you are studying at Bristol University.

 

Self Injury; a paradox…

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It is a strange truth that people self harm to make themselves feel better.

Some people have a glass of wine after a bad experience, some eat a huge bag of crisps or a bar of chocolate. But some people cut themselves, or burn their skin, take an overdose, or punch a wall. All of these options are a human way of coping with stress, though not a healthy way.

Most days at Students’ Health Service we see male and female students who have recently harmed themselves. Our nurses are very sympathetic, brilliant at wound care and completely non judgmental. The GPs would like to help you too, and discover what’s behind the self injury and distress. We are not easily shocked and we have seen many unusual ways that students harm themselves, secondary to depression, anxiety, obsessive thoughts or psychosis.

Alcohol usually makes self harm more frequent, or the injury worse.

Nationally self harm is thought to affect about 5% of people, though this is likely to be an underestimate (Meltzer et al 2002). In a school survey 13% of young people aged 15/16 reported having self harmed at some time in their lives, and 7% in the previous year (Hawton et al 2002).

It is important to assess and treat those who self harm, as the behaviour is often related to an underlying mental health condition, which, if treated, may lead to improvement not just of the depression/ anxiety/ schizophrenia etc but also of the self injury.

If you would like help with self injury, or would like to talk about your mental health in general, please come and see us soon. Don’t forget that the Student Counselling service is also there to help, and the team is very experienced in supporting students with such issues.

 Other support in Bristol;

Contact the Self Injury Self Help Bristol organisation, who provide services for men and women with self injury issues. They run support groups, and also run workshops related to achieving good mental health in general.

Email; sishbristol@yahoo.co.uk

 Phone; 0117 927 9600

Or, Bristol Crisis Service for Women; 07788142 999

Runs a text support service for managing your self injury and emotional distress.

The Change from Practice Nurse to Nurse Prescriber

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I have worked as a Practice Nurse since 2001 and at Students’ Health Service (SHS) since 2003, completing various courses over these years – minor illness/injury, contraception, sexual health and travel health. As a result of this experience and knowledge, I felt the next step was to be able to prescribe for certain conditions that I felt competent in; to complete episodes of care and to help reduce the number of doctors’ appointments within these specialities at SHS.

Therefore in 2011 I qualified as an Independent Nurse Prescriber, which involved undertaking a recognised Nursing and Midwifery Council (NMC) accredited prescribing course through a UK university.

Legislation to allow nurses to prescribe from an initially restricted list was introduced in 1986, and gradually nurses were given more autonomy, eventually culminating in Nurse Prescribers having full access to the British National Formulary (BNF) which has put nurses on a par with doctors in relation to prescribing capabilities. Although we have access to the BNF, this does not mean we can prescribe everything in there – we only prescribe within our own limitations and scope of competence. So, for example, I feel competent to prescribe antibiotics for certain conditions, and contraception methods, but I do not feel competent to prescribe anti depressants or diabetic medications.

Before the Change – Scenarios I would see in Practice…

“I feel REALLY terrible… I can hardly swallow as my throat is so sore, I can’t seem to get warm, but feeling freezing cold and sweating and I have painful swellings around my neck. I’ve come to Student Health and after waiting to see the nurse and having been assessed, I have been diagnosed with Tonsillitis. I’ve been given a leaflet with information about medicines I should take from the pharmacy to help with my symptoms, but I need to see the doctor for a prescription for antibiotics. I have to sit and wait now for my appointment. The waiting room is full, too much noise and I just want to go home and back to bed…”

“Oh… the nurse is running late… I’ve a lecture in 15 minutes. I just want to start the pill. My friends are all taking it and now I’m with Tom, I don’t want to repeat that episode with the split condom and having to take the emergency pill last month- how stressful was that… Hooray! I’ve been called in… after a few checks and lots of questions looks like I’m ok to take the pill- but the nurse cannot prescribe it and I now need to see a doctor… I’ll have to book an appointment on another day for my prescription as I need to go to my lecture…”

 

After the Change…

Advantages for me as a Practitioner

Being a Nurse Prescriber has increased my autonomy and independence at work leading to greater job satisfaction, especially in my specialised field of travel health medicine, which here at Students’ Health is now entirely nurse-led.This independence provides more streamlined care that is patient-focused.

Advantages for you as a Patient

Continuity of care, with particular reference to the scenarios as above – these are consultations I see fairly frequently and can complete independently in one appointment without the need for referral to a doctor for a prescription. This ensures timely access to medicines and treatments, increasing convenience for you.

Advantages for Students’ Health

Nurses being able to prescribe at SHS increases service efficiency by freeing up our doctors’ time to care for patients with more complex health care needs. We have three Nurse Prescribers at SHS.

Advantages for Secondary Care (Hospitals)

Evidence has shown that Nurse Prescribing helps to avoid unnecessary A&E and hospital admissions and improves access to treatment.

So please, when booking your appointments at SHS, check to see if a Nurse Prescriber can help you with your health care need – we are here to help you.

Students With Children!

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Combining studying at University with raising a family can be a challenge but we are here to help. We recognise that not all students are the same. Whilst we offer a specialised Students’ Health Service tailored to the needs of our patients, we are also an NHS general practice. As such we provide services that student parents may be interested in. This includes antenatal and postnatal care for mothers. Then after the baby is delivered we offer the full range of child health checks and recommended immunisations.

 When necessary we also provide travel advice and immunisations for children as well as adults. We work closely with our Health Visitors to support families. Within the university there is now even a coffee morning run by the UBU. It takes place every Thursday during term time 9.30-11am. Students can go along to meet other parents and bring their children. Click on the link to find out more;

www.ubu.org.uk/studentparents

The Olympic Games and the Untold Legacy

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This blog is a personal viewpoint from the service’s eating disorders specialist…

Will Devlin, clinical psychologist and specialist in eating disorders for the University of Bristol, looks almost sheepish as he describes his mixed feelings about the great sporting achievements we watched with pride just a few months ago:

“…Don’t get me wrong,” he says, “there’s no doubt that the Olympic Games were a proud moment in the history of the country and many of us have been inspired by the achievements of athletes like Jessica Ennis, Jonnie Peacock, and Anthony Joshua.

“But what I can’t help wondering is what effect images of these almost superhuman, super lean, super muscled athletes is having on people who are unhappy with their bodies.  Very few of us have the genetic make up, let alone the motivation, dedication, sponsorship, training and time to develop the kind of body which we’ve seen so much of during the UK’s summer of sport.

“It’s one thing to be inspired to get fit by the Olympics, even I’ve been inspired to get back to the gym.  But the fact is,” Will says with a smile, patting his tummy, “like most of the population I’ll never have the body of an Olympian however hard I try! 

His fear is that amidst the pride and positive social change inspired by the Olympics, one untold legacy will be an increase in the number of people at risk of eating disorders: “I worry that if more of us end up unhappy with our bodies, then more of us might resort to unhealthy attempts to shape up as we aspire to a rippling six-pack, tight buns or super-pert breasts.

It’s not a popular view, that inspiring a nation with acts of sporting heroism could actually be bad for some people, but as I listen to Will’s concerns I do see his point: “Condemnation is growing on all sides at the use of size zero models on the catwalk, and Kate Moss was roundly criticized for endorsing starvation when she said, ‘nothing tastes as good as skinny feels’ …but it’s not easy to say that super lean athletes might have just the same effect as emaciated supermodels on those of us who want the perfect body but simply can’t have it.  “And don’t forget,” Will says, “the athletes themselves face these same pressures, eating disorders are rife amongst sports men and women, in fact it is estimated that more than one in 10 elite athletes may have an eating disorder.”

Will’s comments get me thinking about this untold legacy, and what some of the unintended outcomes of our summer of sport might be.  There’s no doubt that the efforts of Team GB and our paralympian heroes have the power to inspire a generation, but perhaps it’s also important to recognize that the pursuit of athletic success and the body beautiful may also have its downsides.

Will works at the University’s Student Health Service.  If you think you might have an eating disorder, talking to one of the service’s GPs will ensure you get access to the specialist help you need.

 

Reflections on Body Image

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Last month the Students’ Health Service had a visit from our local MP Stephen Williams, a member of the All Party Parliamentary Group on Body Image. He was interested to hear about our work with students with eating disorders, but we also talked through the challenges of being a student with a condition such as Body Dysmorphic Disorder, and the misuse of body building drugs such as anabolic steroids in some parts of our population.

Negative body image underlies much of the mental health work we do, whether it leads to low self esteem (which can itself lead to depression or self harm), anxiety, social phobia, and more obviously anorexia and bulimia.

The report highlights more positive ways to view ourselves and our bodies, such as the Health At Every Size movement, which focuses on health rather than weight/ Body Mass Index. This movement tries to encourage us to eat healthily and engage in appropriate amounts of physical activity and has been shown to lead to higher levels of self esteem, and better blood pressure and cholesterol levels.

Anecdotally the medical community is certainly becoming increasingly wary of using BMI as a ‘one size fits all’ measure, as we watch the generations increase in height and muscle mass. Even traditional children’s measurement charts have had doubt thrown over them, with a current study from the University of Worcester identifying healthy children as being incorrectly labelled ‘obese or overweight’ by the National Child Measurement Programme. This could then lead to those children developing neuroses about their height and weight in the future, in our ‘weight obsessed society’.

Fixating on a particular weight may not be the best approach for us, and it might be better to take a more holistic approach  with better health being the best outcome measure to aim for; focus on Fitness rather than Fatness, if you like.

If you are worried about your weight/ shape or health, then please do come and see us to talk it through. We are very used to discussing these issues, and I hope you will find us good at listening and keen to help.

 

http://issuu.com/bodyimage/docs/reflections_on_body_image

 

 

Eating Your Heart Out

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Many of us eat chocolate when we want a treat, or when we’re having a bad day – and where’s the harm in that? 

 

We don’t just eat for health; the fact is eating is one of life’s pleasures.  There’s no reason why we shouldn’t enjoy food or use it now and then to lift our spirits: as the saying goes, “all things in moderation.” The difficulty comes when comfort eating becomes our main way of dealing with upset. 

 

Comfort eating provides a distraction from difficult thoughts and negative emotions but when it’s our only way of coping it can easily get out of hand: a bar of chocolate or a slice of toast can be the trigger for a full on binge.  Many people who overeat like this say that whilst they’re bingeing everything else seems to stop: they feel in a world of their own where difficult thoughts and feelings can’t touch them.  It’s only afterwards that the distress returns, only when it does it’s made worse by uncomfortable bloating, concerns about weight gain, frustration, guilt and shame. 

 

Such negative feelings in the aftermath of a binge can erode self esteem and increase vulnerability to future stresses and from here it’s easy to see how a vicious cycle can develop: upset leading to binge eating and binge eating leading to greater vulnerability to future upset so making binge eating ever more likely.  Many specialists see such vicious cycles as being at the heart of eating disorders.

 

There’s no harm in eating for comfort now and then, but if you find yourself trapped in the vicious cycle then it can be useful to know that there are ways of breaking out.  Whilst many people can break out on their own and with the support of friends and family, some people will need professional help. 

 

If you are struggling to manage disordered eating then perhaps the Student’s Health Service can help.  The Service offers specialist support for people with eating disorders and many students have used it to turn their lives around.  If you think you might need specialist help then the first step is a visit to your doctor.  Whilst it can be embarrassing to talk about such problems, all our doctors are fully trained and highly experienced in working with people battling eating disorders.   they may refer you to the practice’s psychologist or on to a more specialised doctor. There’s no shame in seeking help: rest assured you’ll be treated in confidence, with respect and sensitivity.

www.b-eat.co.uk

 

 

Club Drugs; help is at hand!

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My name is Dr Tim Williams and with my colleague Elaine Driver we run Bristol’s ‘Club Drug Clinic’. This is only the second such clinic nationally and is a response to changing trends of drug use in young people.

In the last 10 years there has been a steady reduction in young people using drugs such as cannabis, ecstasy, cocaine, and heroin. Increasingly young people are buying compounds directly from internet sites for delivery. More and more young people are now finding they have developed a problem with internet substances and need some help and support. Others are wanting accurate information to ensure they are not using toxic substances. Since the media storm around mephedrone there has been a diversification in the market and new compounds emerging, usually from labs inChina, in rapid succession. Some of these compounds have been harmless but others have been poorly researched and trialled, resulting in psychoactive chemicals which are highly potent and have a very narrow safety window. Consequently in Bristol we have had several young people die after taking white powders that the press erroneously labelled as MDMA or ecstasy. The Club Drug Clinic aims to provide up to date information and advice to people who are using well known compounds such as ketamine, methoxetamine, and methiopropamine or branded internet compounds such as BenzoFury or NRG.

I am part of Professor David Nutts’ Independent Scientific Committee on Drugs (ISCD). The ISCD draws together experts in the field of drug science and allows us to have the most up-to-date information on what is out there. The forensic scientists on the committee have amazing knowledge and experience of analysing and characterising new compounds that come onto the market. Part of my role in the Club Drug Clinic is to get any information from users about compounds that have caused problems or side effects, so we are always interested in hearing about your experiences. Anyone can come in and talk to us anonymously for a chat and to share information.

If someone needed more help and treatment we would start seeing people regularly and could link into our extensive treatment services which includes detox if this was necessary.

 We are open for drop-in every Wednesday between 5-7pm at Colston Fort, Montague Place, Kinsdown, BS6 5UB. Its just off St Michaels Hill, just ring the buzzer and we would love to meet you.

Antidepressants; friend or foe?

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Antidepressants; friend or foe

 Two (unrelated) students asked me to write this blog. Independently they mentioned at the end of their consultations that there was a lack of positive stories about using antidepressant medication, and that other students might like to hear about some success stories such as theirs. They felt that these ‘good news’ tales might balance some of the very negative opinions that they and their peers were reading online.

Well I have worked at the Students’ Health Service for over 10 years and it has certainly been my experience that the vast majority of students that I treat with antidepressants get better. Treatment times vary, as does the need to try more than one type of pill before finding that one that works for an individual, but alongside psychological therapies, medication is usually successful in helping students return to normality.

Of course we must consider possible side effects (minimised by starting with a half dose for the first week in many cases), and appropriate length of treatment (6 months for a first episode, 2 years or more for recurrences ). It is also vital to withdraw the medication very slowly tailored to an individual’s response. The GPs at SHS are fastidious in planning regular follow up for patients on antidepressants and strive to have continuity of care to allow us to get to know each student as best we can, therefore giving a better overview of treatment response.

Evidence suggests that medication is most appropriate in cases of moderate to severe depression, so we are much less likely to prescribe it for mild cases, and we always encourage other supportive treatments such as increased exercise, counselling and psychological input as necessary.

Six million people are thought to suffer from depression in the UK, and in the last few years the NHS has noted a significant (26%) rise in the prescription of antidepressant medication. Much has been written and theorised on the reasons for this, but it is a phenomenon noted throughout the population, and students are no exception unfortunately. In the face of rising numbers of people with mental health issues it is good to have a treatment that works to offer them, and which shows benefit within usually 4 to 6 weeks. Sometimes people need to take something just to be able to get back to a point of functioning well enough to start talking therapies, of which there is steadily increasing availability on the NHS.

Antidepressants work for the majority of students that we treat, though it needs to be the right one for the individual. They can be life changing, and should always be considered and discussed as an option, though decisions should be made on a case by case basis of course.

I am confident in stating that antidepressants are an important option to be considered in the consultation between the GP and any student who is feeling depressed, and we see significant positive effects on an almost daily basis in our population. It is true that these good news stories don’t excite the media in the same way as negative stories, but that’s no great surprise.

If you are worried about your moods, or feeling low, please do come and talk to us, we really do want to know and help you, in whatever way suits you best.