Eating Disorder Service (adult)

NHS Tayside Eating Disorders Service (TEDS) is based within the NHS Tayside Psychological Therapies Service premises at 15 Dudhope Terrace, Dundee, and provides outpatient clinics in Dundee, Angus, and Perth and Kinross.
 
The service forms part of the North of Scotland Managed Clinical Network for Eating Disorders, and through this, has shared access to 10 inpatient beds at the Eden Unit, Royal Cornhill Hospital, Aberdeen.

The Service itself provides offers specialist outpatient assessment and treatment to adult sufferers of, primarily, Anorexia Nervosa, Bulimia Nervosa, and their variants, having access to psychological, psychiatric, nursing and dietetic interventions, and part-time administrative support.

Adults aged 18 to 64 years (or 16+ years if no longer in full-time education), who present with any of the following primary problems:

Anorexia Nervosa (ICD-11)

• Significantly low body weight for the person’s height, age and developmental stage that is not due to another health condition or to the unavailability of food (BMI < 18.5kg/m²). Rapid weight loss (e.g., more than 20% of total body weight within 6 months) may replace the low body weight guideline as long as other diagnostic requirements are met
• Low body weight is accompanied by a persistent pattern of behaviours to prevent restoration of normal weight, which may include behaviours aimed at reducing energy intake (restricted eating), purging behaviours (e.g., self-induced vomiting, misuse of laxatives), and behaviours aimed at increasing energy expenditure (e.g., dysfunctional exercise), typically associated with a fear of weight gain
• Low body weight or body shape is central to the person’s self-evaluation or is inaccurately perceived to be normal or even excessive

Bulimia Nervosa (ICD-11)

• Frequent, recurrent episodes of binge eating (e.g., once a week or more over a period of at least one month). A binge eating episode is a distinct period of time during which the person experiences a subjective loss of control over eating, eating notably more or differently than usual, and feels unable to stop eating or limit the type or amount of food eaten
• Binge eating is accompanied by repeated inappropriate compensatory behaviours aimed at preventing weight gain (e.g., self-induced vomiting, misuse of laxatives or enemas, dysfunctional exercise)
• The person is preoccupied with body shape or body weight, which strongly influences self-evaluation
• There is marked distress about the pattern of binge eating and inappropriate compensatory behaviour or significant impairment in personal, family, social, educational, occupational or other important areas of functioning

Binge Eating Disorder (ICD-11)

• Frequent, recurrent episodes of binge eating (e.g., once a week or more over a period of several months). A binge eating episode is a distinct period of time during which the person experiences a subjective loss of control over eating, eating notably more or differently than usual, and feels unable to stop eating or limit the type or amount of food eaten
• Unlike in Bulimia Nervosa, binge eating episodes are not regularly followed by inappropriate compensatory behaviours aimed at preventing weight gain (e.g., self-induced vomiting, misuse of laxatives or enemas, dysfunctional exercise)
• Binge eating is experienced as very distressing and is often accompanied by negative emotions, e.g., guilt or disgust
• There is marked distress about the pattern of binge eating and inappropriate compensatory behaviour or significant impairment in personal, family, social, educational, occupational or other important areas of functioning

Where patients do not present with the full syndrome of either Anorexia Nervosa or Bulimia Nervosa, diagnosis should be made with reference to the closest symptom profile above, but please note that an Eating Disorder diagnosis should only be made where the specific psychopathology of pronounced body dysmorphia is present. ICD-11 lists additional eating problems such as Avoidant-Restrictive Food Intake Disorder (ARFID), Pica and Rumination-Regurgitation Disorder. None of the eating behaviours associated with these conditions is motivated by preoccupation with body weight or body shape and, hence, they are not the core business of TEDS currently. TEDS clinicians are able to offer guidance about appropriate referral options in these cases however.

Patients requiring emergency medical treatment linked to an Eating Disorder – should be referred to acute medical services in the first instance, with a concurrent, urgent referral made to TEDS. TEDS offers multidisciplinary liaison and follow-up to acute medical services managing patients with eating disorders. TEDS will prioritise urgent referrals if they meet criteria for primary Eating Disorder diagnoses.

Patients requiring urgent review due to psychiatric risk – should be referred to General Adult Psychiatry CMHT/Crisis services in the first instance. They will be offered a routine assessment appointment by TEDS if they also meet criteria for Eating Disorder treatment. Patients with a primary Personality Disorder, Psychosis or Substance Misuse problem should be referred to General Adult Psychiatry services or Tayside Substance Misuse Service in the first instance.

Patients with BMIs > 30 – and a weight-related health condition should be referred to Tayside Adult Weight Management Service (TAWMS) in the first instance. Patients with BMIs > 35 who are otherwise healthy should also be referred to TAWMS. Please note that TEDS is not a weight loss service.

Patients under 18, over 64, or with a primary Learning Disability – should be referred to CAMHS, Tayside Older People’s Service or Tayside Learning Disabilities Service, as appropriate. Patients between the ages of 16-18 but no longer in full-time education, would be reviewed under our adult service TEDS, instead of CAMHS.

Patients with phobias related to eating or psychogenic vomiting - should be referred to Adult Psychological Therapy Services. 

The Service is happy to receive referrals, with the vital/helpful Information below, either electronically, via SCI-Gateway listed under Eating Disorder Service (adult) or in writing to: TEDS, 15 Dudhope Terrace, Dundee DD3 6HH.

Please note that we do not accept emailed referrals at this time.

For advice about a potential referral, or in general, please telephone 01382 346556 (Monday to Friday) or email tay.eatingdisorders@nhs.scot.

If any of the following questions are answered yes, please mark the referral Urgent:

• BMI 15 or under?
• If BMI <15, is the patient losing >1kg weight per week?
• Medical complications as a result of disordered eating?
• Psychiatric co-morbidities?
• Pregnant?
• Insulin-dependent Diabetic?

Please include the following essential information:
To help establish the patient's risk, it would be very helpful to have baseline bloods and temperature/pulse/BP please prior to referral.

• For baseline bloods, please see ICE; Long-term Conditions; Eating Disorders Clinic Bloods or ICE; Mental Health; Eating Disorders Clinic Bloods. (Baseline bloods would include; FBC, U&Es, LFT, fasting glucose and TSH - please note any abnormalities of these in the referral). 

• Current weight, height and BMI: please document if the patient refuses to be weighed and provide some information on their weight status
• Any recent weight loss?
• Does the patient:

• Does the patient take :

• Please provide a brief summary of diet consumed
• Any fear of weight gain?
• Any episodes of amenorrhoea longer than 3 months?
• What is the patient’s level of motivation for change?

Additional helpful information:

• Any previous referral to or contact with TEDS?
• Any current or recent contact with other Mental Health Services?
• Any relevant physical health problems e.g. -

• Current medication 

Please note that, at present, TEDS does not have access to on-site blood and cardiac monitoring facilities. Where patients require ongoing physical health monitoring, this will be arranged by TEDS in consultation with the relevant GP surgery/community hub, as appropriate. In order to minimise risk, efforts will be made to prevent low-weight patients travelling long distances for physical health monitoring purposes. TEDS clinicians have access to ICE to request and review results. 

For advice about a potential referral, or in general, please telephone 01382 346556 (Monday to Friday) or email tay.eatingdisorders@nhs.scot or use the electronic advice request service on SCI-Gateway via Eating Disorder Service (adult) option.

• BEAT - beating eating disorders website. Beat is the UK eating disorders charity and its website provides information about and support with all aspects of eating disorders, including helplines for patients and online training resources for professionals. 
• The Royal College of Psychiatrists Faculty of Eating Disorders Psychiatry website includes links to resources and reports, including guidance for Managing Medical Emergencies in Eating Disorders.