He moana pukepuke e ekengia e te waka
A rough sea can still be navigated
The South Island Eating Disorders Service (SIEDS) is a specialist mental health service. We provide treatment and support to people experiencing an eating disorder. Working in partnership with whānau is encouraged at all stages of treatment. Most treatment is provided in outpatients; inpatient care is provided when appropriate.
Our team consists of consultant psychiatrists, nurses, clinical psychologists, occupational therapists, social workers, family therapist, dietitians, general medicine physician, physiotherapist, pukenga atawhai and a secretary. We are a teaching hospital, therefore you may be asked if health professional students can participate in your care.
We are a rainbow friendly service and we promote the Health At Every Size® (HAES®) philosophy.
We see people between 12 and 65 years old who have a moderate to severe eating disorder.
We accept local referrals from Christchurch Hospital, general practice and mental health services. Referrals are accepted from mental health services around the South Island.
Healthinfo
If you would like to know more about eating disorders, please see our partner website www.healthinfo.org.nz
Find information to increase your understanding and knowledge of eating disorders, and a list of further resources you can access, including organisations that can provide support for you.
Kia ora family member/whānau/support person
Ka mihi mahana ki a koutou katoa. Warm welcome to you all.
We have put together this information package in the hope it may be useful to you. Eating disorders can have an impact on the whole family-whānau and not just the person living with the illness. This information package is a starting point to increase your understanding and knowledge of eating disorders. We also provide a list of further resources you can access including an organisation that can provide support for you. Please feel free to ask questions of the staff members involved in the assessment process.
The South Island Eating Disorders Service is a specialist mental health service. We provide treatment and support to people experiencing an eating disorder. Working in partnership with whānau is encouraged at all stages of treatment. Family Based Treatment requires active involvement of whānau throughout treatment. Our team consists of Consultant Psychiatrists, Clinical Psychologists, Nurses, Social Workers, Family Therapist, Occupational Therapists, Dietitians, General Medicine Physician, Paediatrician, Physiotherapist, Pūkenga Atawhai and a Secretary. We are a teaching hospital, therefore your loved one may be asked if health professional students can participate in their care. We see people between the ages of 12 and 65 who have a moderate to severe eating disorder. We are a Rainbow friendly service and we promote the Health At Every Size® (HAES®) philosophy.
The assessment morning provides us with the opportunity to gather information, discuss it as a multidisciplinary team, make any possible diagnoses and determine recommendations for treatment. We would encourage you to contribute to this process as your input is very useful. We will usually spend time with the person on their own also in order to assess them individually.
At the end of the assessment process, treatment recommendations will be discussed with the individual and you where appropriate. Treatment is evidence-based and in line with international research. Your family-whānau member will receive individual treatment or group treatment.
Each person offered treatment will be assigned a Case Manager who will co-ordinate their care and review process. In the first instance, most treatment will be provided on an outpatient basis. Inpatient treatment is sometimes recommended for those not able to recover as an outpatient or for whom medical risk is significant and requiring hospitalisation.
All treatment is based on a structured programme that addresses the specific features of the eating disorder.
It is important to understand that recovery from an eating disorder can take a long time and there may be periods of relapse alternating with time when your family-whānau member is doing well.
It is important to understand that the development of the eating disorder is not the fault of the person nor anybody else’s fault.The origins of eating disorders are multifaceted and complex.
Eating disorders have both a psychological and a physical/medical component. Many of the symptoms which are so distressing are a consequence of starvation or malnutrition. Recovery from an eating disorder is hard work. You have a key role to play in supporting your loved one.
If you wish to speak to someone about your family-whānau member, you are invited to call their case manager. We welcome these phone calls and they can be very useful. We need to remind you that we are bound by the privacy law. However, even if your family-whānau member, does not want us to discuss things about them with you, this does not prevent you from giving information to the treatment team. We can provide you with a Whānau Education and Support Session, please speak to your family-whānau member’s Case Manager if you would like this.
Included in this pack is information about eating disorders, the risks associated with eating disorders, starvation syndrome, information for carers and helpful websites. We hope you find it useful.
Eating disorders do not discriminate, they affect people of all genders, ages, ethnicities, sexual orientations, socioeconomic statuses, body shapes and weights. An eating disorder is a mental illness characterised by disturbances in behaviours, thoughts and attitudes towards food, eating, and body weight or shape. Unhealthy behaviours someone may engage in include restriction of food intake, binge eating, counting calories, excessive exercise, fasting, self-induced vomiting or use of laxatives. Eating disorders can seriously impact personal (physical, psychological and social) and family functioning. They are a serious illness, with the highest mortality rate of any psychiatric disorder.
No one chooses to have an eating disorder. The factors that contribute to the development of an eating disorder are complex, and involve a range of biological and genetic, psychological and environmental factors. Someone with an eating disorder may look well yet can be extremely unwell.
A person with Anorexia Nervosa will experience significant weight loss due to food restriction and starvation together with an intense fear of gaining weight. While Anorexia Nervosa is characterised by extreme restriction, binge-eating may also occur, and the individual may engage in compensatory behaviours such as, self-induced vomiting, laxative use and excessive exercise. In those with Anorexia Nervosa their self-worth is very much tied up with their weight, shape or control over eating.
Bulimia Nervosa is characterised by recurrent episodes of binge eating, with associated sense of lack of control over their eating, followed by engaging in compensatory behaviours, such as vomiting, laxative use or excessive exercise in an attempt to prevent weight gain. Self-evaluation is unduly influenced by body shape and weight. Those with Bulimia Nervosa are usually a normal body weight.
Binge Eating Disorder is characterised by regular episodes of binge eating on a large amount of food, while experiencing a loss of control over eating. Those diagnosed with Binge Eating Disorder do not engage in compensatory behaviours (such as self-induced vomiting, use of laxatives etc.). Often eating in secret, eating past fullness and experiencing negative feelings such as shame following a binge are common.
Avoidant/Restrictive Food Intake Disorder is diagnosed when an individual avoids or restricts food due to a heightened sensitivity to sensory aspects of food such as texture, taste or smell, a fear of vomiting or choking or a lack of interest in food/eating (not due to body image concerns). Weight loss and/or nutritional deficiencies may occur.
A person diagnosed with OSFED experiences symptoms characteristic of other eating disorders, which cause significant distress and impairment, but do not meet full criteria for another eating disorder. OSFED is commonly diagnosed in adults and adolescents and is as serious as any other eating disorder.
Starvation or “Starvation Syndrome” occurs when the body does not receive enough energy. This is commonly seen in people with eating disorders whose food intake is restricted, irregular or unbalanced. A person does not need to be underweight to experience symptoms of starvation.
The best information about the effects of starvation in humans has come from a study conducted by the University of Minnesota in the 1940s. The study included 36 mentally and physically healthy young men who had agreed to participate in the experiment as an alternative to military service. The study involved restricting their food intake and carefully observing the effects on them. During the first three months of the experiment, the men ate normally. Then for six months they were restricted to approximately half of their original caloric intake. Over this time they lost, on average, 25% of their original body weight. Then followed three months of rehabilitation, during which the men were gradually refed. Throughout all three phases the men’s behaviour, personality and eating patterns were studied in detail. The researchers observed dramatic changes as a result of the starvation, which persisted during the refeeding phase of the study.
One result of starvation was a substantial increase in preoccupation with food. The men found concentrating on their usual activities increasingly difficult, as they were plagued by persistent thoughts of food and eating. Food became a principal topic of conversation, reading and daydreams. Many of the men began reading cookbooks and collecting recipes. Some developed a sudden interest in collecting kitchen utensils. Despite little interest in culinary matters prior to the experiment, almost 40% of the men mentioned cooking as part of their post-experiment plans. For some, the fascination was so great that they actually changed occupations after the experiment: Three became chefs, and one went into agriculture.
During starvation, the volunteers’ eating habits underwent remarkable changes. The men spent much of the day planning how they would eat their allocated food. The men often ate in silence and devoted total attention to consumption. The study participants were often caught between conflicting desires to gulp their food down ravenously or consume it slowly so that the taste and smell of each morsel could be fully appreciated. The men often made unusual concoctions by mixing foods together and increased their use of salt and spices. The use of coffee and chewing gum increased dramatically. During the rehabilitation phase, most of these attitudes and behaviours persisted. For a small number of men these became even more marked during the first six weeks of refeeding.
During the starvation period, all of the volunteers reported increased hunger; some appeared able to tolerate the experience fairly well, but for others it created intense concern. Several men failed to adhere to their diets and reported episodes of binge eating followed by shame and guilt. When presented with greater amounts of food during rehabilitation, many of the men found it difficult to stop eating. Even after 12 weeks of rehabilitation, the men frequently complained that they experienced an increase in hunger immediately following a large meal. For some of them, the binge eating persisted for many months after they were permitted free access to food.
Although the men were mentally healthy prior to the experiment, most experienced significant emotional changes as a result of starvation. Some reported periods of depression. Irritability and angry outbursts were observed. Anxiety became common and a few experienced mood swings. These emotional changes did not vanish immediately during rehabilitation, but persisted for several weeks, with some men actually becoming more depressed, irritable, argumentative, and negative than they had been during the starvation phase.
The men became progressively more withdrawn and isolated. Humour diminished markedly amidst growing feelings of social inadequacy. The men became reluctant to plan activities, to make decisions, and to participate in group activities. They were less interested in dating or sex; relationships became strained. During rehabilitation, sexual interest was slow to return. Even after three months, the men judged themselves to be far from normal in this area. However, after eight months of refeeding, virtually all of the men had recovered their interest in sex.
The men reported impaired concentration, alertness, comprehension, and judgement during starvation; however, formal intellectual testing revealed no signs of diminished intellectual abilities.
As the six months of starvation progressed, the study participants exhibited many physical changes, including: reduced heart muscle, gastrointestinal discomfort, decreased need for sleep, dizziness, headaches, hypersensitivity to noise and light, reduced strength, fluid retention, hair loss, sensitivity to the cold, visual and auditory disturbances, and tingling or prickling sensations in the hands or feet. Various changes reflected an overall slowing of the body’s physiological processes. There were decreases in body temperature, heart rate, blood pressure, and respiration, as well as in basal metabolic rate. At the end of starvation, the men’s basal metabolic rate had dropped by about 40% from normal. This drop, as well as other physical changes, reflects the body’s extraordinary ability to adapt to low dietary intake by reducing its need for energy.
In general, the men responded to starvation with reduced physical activity. They became tired, weak, listless, apathetic, and complained of a lack of energy.
While eating disorders are a mental illness, they can be associated with significant health complications and reduced quality of life. In order to avoid severe and irreversible health outcomes, it is important for everyone with an eating disorder to regularly consult with a medical practitioner.
Heart problems may cause a person to feel dizzy, faint, feel the cold, fatigue easily, have a slow or irregular heartbeat or have chest pains. When a person loses weight, the size and strength of their heart may decrease. Vomiting, use of diuretics and laxatives can cause fluid loss which can lead to fluctuations in electrolytes (e.g. potassium and sodium). These problems can be serious and may cause a heart attack or sudden death.
Loss of bone density is common in individuals with eating disorders, damage can occur at any time during the course of an eating disorder and could be irreversible. Insufficient growth or bone damage often occurs alongside malnutrition and low weight, which increases the risk of developing osteoporosis. In order to reduce the risk of bone damage, the eating disorder and malnutrition must be treated.
Regular vomiting can cause irreversible damage to tooth enamel, leading to brittle and sensitive teeth. While discontinuing vomiting is the most effective solution, if someone is still vomiting it is not recommended to brush teeth immediately afterwards, instead rinsing out the mouth with water to prevent further damage from stomach acid.
Gastrointestinal Risks
Those with eating disorders often experience nausea, reflux, constipation, diarrhoea, bloating and abdominal pain. Many of these symptoms are not caused by a particular food group (e.g. gluten and dairy), rather by a restrictive diet, lack of nutrients, irregular eating, binge eating or slowed gastric emptying. Laxatives are not usually recommended instead regularity and adequacy of dietary intake is needed along with an adequate fluid intake.
Hormone levels can be negatively impacted when someone is not eating adequately for their body’s requirements, is engaging in excessive exercise and is below the weight that is healthy for their body. Low levels of reproductive hormones can result in a higher risk of infertility and reduced bone density, regardless of gender.
Symptoms of low hormones can include low libido and irregular or loss of periods (amenorrhoea).
While there are significant physical risks as a result of having an eating disorder, it is also common to experience other mental, social and emotional problems. These can be discussed in treatment.
Other people have found the following helpful:
Other people have found the following less helpful:
If engaged in Maudsley Family Based Therapy, please review these tips with your therapist.
National Eating Disorder Collaboration Australia – Facts about Eds, & resources for support people
Centre For Clinical Interventions: Information sheets & Workbooks
EDANZ is a New Zealand charity for advocacy and education in eating disorders
BEAT is the UKs national charity for eating disorders
F.E.A.S.T: the global support and education community of and for parents of those with eating disorders
Eating disorders families Australia
anorexiafamily.com Help for parents of children and teens suffering from anorexia and other eating disorders
Video: What is Family Therapy? A summary of MFBT by the Maudsley Centre for Child and Adolescent Eating Disorders. Time to watch: 6.04
Audio: An audio recording from leading researchers and experts discussing the evidence base for MFBT. Time to listen: 15.57
Video: Explaining Family based treatment and its evidence Time to watch: 14.20
YouTube video: How to help you child when they get stuck with eating Time to watch: 21.10
YouTube video: Helpful things to say during meal times Time to watch: 05.25
Page last updated: 21 February 2023
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