Anorexia - leading the way

Groundbreaking therapy and practical techniques have turned St George’s, University of London’s Eating Disorders Unit day service into a world model.

Anorexia is the biggest killer of any psychiatric disorder — 15 per cent of patients die before the age of 40. It is most common among young women.

St George’s Eating Disorders Unit treats 2,000 patients a year — many of whom have had unsuccessful treatment elsewhere.

Providing day services for anorexics has seen widespread failure across the UK, with many projects failing as patients’ symptoms proved ‘severe and enduring’.

But St George’s, University of London is bucking the trend. On its day programme, patients gain weight at the same rate as the in-patients — an average of 0.8kg a day — despite only attending from 8am to 4.30pm five days a week.

Professor Hubert Lacey, head of the unit, puts St George’s success down to expert preparation work before patients come in, very strict rules, clear aims and award-winning multidisciplinary methods.

‘We work as a multidisciplinary team, with psychiatry, psychology, psychiatric nursing psychotherapy, occupational therapy, drama therapy, art therapy, exercise and nutrition working together.

‘No one knows exactly what gets anorexics better, so by all those professionals having an equal input, we have developed treatment programmes that are stunningly successful.’

The day service has become so successful that primary care trusts in Surrey are now contracting into it. Based at Springfield Hospital, the unit’s award-winning therapies include body image classes in which patients examine their bodies in the mirror under the supervision of therapists to try to address the distorted view they have of their weight.

‘Anorexia is a fear of normal body weight, but also an extreme disparagement of the body,’ explains Professor Lacey.

‘So while most women have concerns about their bum and thighs and suchlike, these patients will be horrified by the sight of any body fat — some of the more disturbed ones will even try to stab the fat out. So this therapy seeks to address that.’

Art therapy helps those who find it difficult to express their feelings by talking.

This is particularly successful with youngsters and older people who have been unable to talk about their body issues for many years.

Other classes that the patients are required to take as part of a timetabled routine include group therapy for anger and anxiety management and low self-esteem issues, plus family therapy.

‘There’s a lot of practical stuff, too — going out to the shops, buying food, cooking it, eating it with others,’ says Professor Lacey. ‘Also, they tackle things that they find difficult, or even terrify them, such as going into a canteen.

‘They learn how to deal with restaurants, bars, pubs, even men.’

Anorexics often suffer extreme social anxiety, becoming withdrawn and even losing interest in the outside world altogether.

If their condition is left untreated, their social and emotional skills can be severely affected. Part of St George’s, University of Londono’s day programme concentrates on teaching patients how to cope with social situations from making friends to dating.

‘Their minds are emotionally immature,’ says Professor Lacey. ‘So you may have a 22-year-old whose body changes from emaciation to that of a normal woman during the treatment, while the mind has not yet caught up.

‘They don’t have the emotional or social skills to be able to handle relations with men. The therapy concentrates on helping them to develop the mature skills to deal with people who they haven’t engaged with up until then.’

The success of the day service won plaudits at the last year’s three day London International Conference on Eating Disorders, co-organised by Professor Bryan Lask, Emeritus Professor of Child and Adolescent Psychiatry at St George’s.