Provincial Specialized Eating Disorders Program

The BC Children’s Hospital Provincial Specialized Eating Disorders Program is the provincial resource for children and adolescents with eating disorders.

Our mandate is to offer leadership in providing clinical services, education, family-focused child and adolescent health promotion, and research and outreach activities.

The clinical responsibilities of the interdisciplinary team include assessment and treatment services for children and adolescents with anorexia nervosa, bulimia nervosa and related eating disorders. The outreach component of the program supports and integrates services together with locally-based treatment resources throughout the province.
 

Our philosophy

We provide a client-centred focus using an inter-professional approach that offers children and adolescents the tools to manage their recovery. These tools are based on treatment that includes psychological, medical, nutritional, cultural, social, and spiritual supports and guidance.

As health care professionals, we strive to create a supportive and safe environment that enables the children or adolescents and their families to empower themselves and to assist in a healing process in which they can make their own decisions about their recovery.

Client-centred practice

We believe our practice must be guided by the needs and feedback expressed by our clients. Clients are active participants in their care plan. We offer formal and informal ways for clients and their families to provide feedback about our services, so that we can continue to provide services that meet their needs. We strive to be clear about our mandate and to be accountable for services rendered.

Inter-professional approach

Treatment is best delivered by a group of diverse health care professionals with specific training, competence and experience with child and adolescent eating disorders. They work together towards a holistic understanding of an individual. The goal is to provide flexible, supportive, integrated and accountable interventions, drawing as much as possible from the established research about eating disorders. We use a cognitive behavioural approach in much of our therapy work but draw on other therapeutic modalities as needed. We provide family therapy to patients in the Intensive Treatment Service.
 

About eating disorders

Anorexia Nervosa

There are two types of anorexia nervosa:

1. The first type is a restricting form and is characterized by the following:

• These individuals are below normal weight and usually have increasing weight loss which is pursued through restriction of caloric intake.
  
• Many such individuals engage in marathon bouts of over-exercising in an attempt to burn off unwanted calories.
  
• Individuals typically become quite preoccupied with eating, food, and calories; or even with cooking for others.
  
• Often various rituals are developed around food, such as cutting food into tiny pieces and prolonging the time required to eat.
  
• There is frequently a body image disturbance such that the individual feels fat and may see herself as fat even though she may be very thin.
  
• Various types of unrealistic thinking patterns are often a strong feature of someone with anorexia nervosa or bulimia nervosa. For example, the individual may think that “Everything is okay if I am thin.” Perfectionistic thinking and all-or-nothing thinking are additional examples.
  

Diagnosis of anorexia nervosa

Official criteria for the diagnosis of anorexia nervosa require that the individual refuses to keep her weight at least at a minimally normal weight for her age and height. Not every thin person has this illness but it should be remembered that one does not have to be extremely skinny to suffer from anorexia nervosa.

Apart from weight loss itself, the person may have not gained weight appropriately during the adolescent period of growth. Risk factors, as outlined later, are sometimes present well before the actual weight loss occurs. It is recognized that use of adult criteria for diagnosis may not always be appropriate for the younger age group. In general, it is felt that the earlier anorexia nervosa is identified and treated, the better the outcome is likely to be.

Additional facts about anorexia nervosa

Bulimia has been reported to occur in up to half of individuals struggling with anorexia nervosa.

It is estimated that anorexia nervosa afflicts about 1 in 200 teenage females.

Anorexia nervosa typically develops during the adolescent years. This is likely in part due to the fact that the teenagers are very self-conscious of their bodies and there are many culturally-based demands to conform to society’s goals for young persons.

Over the past decade, there have been an increasing number of reports on the appearance of anorexia nervosa in the 8–14 year old age range, or before the individual has undergone the changes of puberty.

Males and anorexia

Although up to about 10% of individuals with anorexia nervosa are males, the remaining 90% are females, perhaps in part because the pressure to be thin in our society is aimed mainly at women. However, there has been increasing concern about the media’s representation of preferred body shapes for males and its influence on boys and young men.

Bulimia nervosa

Bulimia nervosa is an eating disorder whose main feature is episodic binge-eating followed by efforts to compensate for, or prevent, weight gain resulting from the binging.

• These individuals typically feel a sense of loss of control over their eating during the binge eating episodes, and are often fearful of not being able to stop a binge episode.
  
• Individuals may attempt to avoid weight gain through purging behaviours or through the pursuit of vigorous exercise, or fasting.
  
• Individuals struggling with bulimia nervosa are typically within an average weight range, although their weight may fluctuate widely at different times.
• The prevalence of bulimia nervosa is about 1–3% of female adolescents and young women.
  
• Bulimia nervosa is typically a disorder seen in mid- to late adolescence and in young adults. While there have been reports of bulimia nervosa in very early adolescents, it is generally rare in this age group.

For more information about eating disorders, read “What are Anorexia Nervosa and Bulimia Nervosa?” an information pamphlet by Dr. Ronald Manley. This booklet is also available in Chinese.