Adult Eating Disorders Service for age 18 and over, Lothian wide, is based at Royal Edinburgh Hospital with access to the Regional Eating Disorders Service (REDU) based at St John’s Hospital.
People under the age of 18 should be referred to Child and Adolescent Mental Health Services.
NHS Lothian Eating Disorders Services Website
Who to refer:
GP identification, management and referral pathway for adults with eating disorders
Diagnostic criteria
| Anorexia Nervosa | Bulimia Nervosa |
| Body weight maintained 15% below expected for age and height/BMI<17.5kg/m2 | Bingeing, with preoccupation with food and craving of the same |
| Weight loss self-induced by: restriction of intakeself-induced vomitingexcessive exerciseuse of appetite suppressants or diuretics | Attempts to counteract excess calorie intake by: self-induced vomitingself-induced purgingalternative periods of starvation and bingeingUse of appetite suppressants diuretics, thyroid preparations or in diabetes, neglect of insulin treatmentMorbid dread of fatness |
| Self-set low weight threshold | self-set low weight threshold |
| Disturbance of endocrine function to produce amenorrhoea in women and loss of sexual interest and potency in men (in prepubertal onset there is delay of puberty and growth restriction) | Possible history of anorexia nervosa or atypical anorexia nervosa |
Many patients with an eating disorder do not have the full syndrome of either anorexia or bulimia e.g.
- May have features of anorexia and be underweight but may not be amenorrhoeic or not below BMI 17.5 threshold
- May binge but not attempt to counteract excess calorie intake (binge eating disorder)
In such cases follow protocol for closest approximation to symptom profile
Referral of patients
- Requiring emergency medical treatment linked to an eating disorder should be referred to acute medical services to be referred urgently to The Cullen Centre.The Cullen Centre offers Eating Disorder medical and/or dietetic liaison to acute medical services.(Urgent referrals will be offered an assessment appointment within 2 – 8 weeks by the Cullen Centre if they meet criteria for a primary Eating Disorder Diagnosis)
- Requiring urgent referral because of their psychiatric risk need to be referred to general adult psychiatry/crisis services. They will be offered a routine assessment appointment by the Cullen Centre (within 12 weeks) if they also meet criteria for Eating Disorder treatment.
- Simple obesity (see Dietetic Referral pathway)
- With a primary personality disorder or addiction or severe mental health problem with bulimia or binge eating disorder should be referred to general adult or addiction services for assessment.
How to refer:
Referrals are accepted from primary or secondary care medical practitioners and mental health professionals By completing the dictation checklist below
- Should be via SCI Gateway
- By letter if there is no access to SCI Gateway to The Cullen Centre, Tipperlinn House, Tipperlinn Road, Royal Edinburgh Hospital, EH10 5HF
PLEASE DO NOT EMAIL REFERRALS. Please note that incomplete referrals cannot be processed and will cause further delays.
Key Messages /Dictation Checklist
Referral Priority: If any of next 5 questions are answered yes, mark as URGENT
1 BMI 15or under Yes / No
2. If BMI under 15is patient losing weight > 1kg per week Yes / No
3. Pregnant Yes / No
4. Insulin-Dependent Diabetic Yes / No
5. Medical Complications as a result of eating disorder Yes / No
6. Psychiatric co-morbidities Yes / No
Please specify medical complications, if present
Fields for Height weight, BMI and bloods are mandatory:
(Please note height and weight must have been checked in last 1 – 2 weeks)
• Height (Metres)
• Weight (Kg)
• BMI
• Date taken
Baseline bloods taken within the last month
(Bloods to be taken: FBC/U&Es / Urea/TCO2/ LFTs / TFTs / Calcium / Phosphate / Magnesium/ Glucose)
• Current Mental Health Contacts or Active referrals
• Contact Details: Mobile Number
• Does the patient give permission for us to contact them by phone Yes / No
Please add any additional relevant information in Referral Text tab
For a preliminary discussion about the suitability of a referral please contact the referrals co-ordinator by phone on 0131 537 6655For medical liaison (referrers to use if they want advice about result / advice if the patient is ill but refuses referral), please e-mail CullenAdmin@nhslothian.scot.nhs.uk and your query will be directed to the relevant professional
Website: https://www.nhslothian.scot.nhs.uk/Services/A-Z/EatingDisordersServicesForAdults/Pages/default.aspx
Free downloadable self-help manual: The Bulimia self-help manual by Chris Freeman and Gillian Downey https://www.moodcafe.co.uk/media/11461/Self-HelpManualforBulimiaNervosa_1.pdf
Websites:
https://ithriveedinburgh.org.uk/ Edinburgh Mental Health Information This is a very useful website which provides mental health information and self help material. Under self help resources there is a link to a list of self help books including Getting Better Bit(e) by Bit(e) which is mentioned below.
http://www.seeds.scot.nhs.uk/Pages/Home.aspx South East Eating Disorders Scotland This site provides information for the public and professionals on Eating Disorders and services in Fife, Forth Valley, Lothian and the Borders
https://www.beateatingdisorders.org.uk/ BEAT – beating eating disorders website This site provides help on all aspects of eating disorders including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and related eating disorders. You can contact BEAT on their Helpline: 0845 634 1414 (Mon- Fri, 10:30-8.30pm, and Saturday 1.00- 4:30pm)
https://eating-disorders.org.uk/ National Centre for Eating Disorders This is an independent organisation set up to provide solutions for all eating problems, compulsive or “binge” eating, failed or “yo-yo” dieting, bulimia and anorexia.
https://www.anred.com/ Anorexia Nervosa and Related Eating Disorders Inc. This is a non-profit organisation that provides information about anorexia nervosa and related eating disorders.
http://www.eatingdisorderexpert.co.uk/ Eating Disorder Expert This website provides help and advice on all eating disorders.
Royal College of Psychiatrists – www.rcpsych.ac.uk (link not working) The Royal College of Psychiatrists provide information on eating disorders.
Self-help books:
Books on prescription for registered users from local libraries
- Getting Better Bit(e) by Bit(e) – Ulrike Schmidt + Janet Treasure (for bulimia)
- Overcoming Binge Eating – Christopher Fairburn (for bulimia and binge eating)
- Overcoming Anorexia Nervosa – Chris Freeman
- Anorexia nervosa: a survivor’s guide for families, friends and sufferers – Janet Treasure Skill-based Learning for Caring for a Loved One with an Eating Disorder. Professor Janet Treasure
