First Episode and Rapid Early Intervention in Eating Disorders (FREED) is a new early intervention service for young people with eating disorders. FREED was evaluated by the South London and Maudsley Foundation Trust and King’s College London.
This evaluation showed FREED cuts long wait times. Cutting wait times meant that patients were more engaged in their treatment and were less likely to drop out.
Patients and their families said that they were very happy with the service. They felt strongly about the benefits of getting help early.
Research shows that when left untreated the symptoms of an eating disorder can have lasting effects on a young persons’ brain, body and behaviour. So when it comes to treatment, is it really the earlier the better?
Research in other areas of mental health suggests there is a lot to gain from early intervention. The benefits of early intervention for eating disorders were discussed 10 years ago. However, these benefits have not yet been proven by research. So, there is an urgent need to put the question to rest: does early intervention for eating disorders really work? Enter the FREED project!
The First Episode and Rapid Early Intervention in Eating Disorders (FREED) service was developed specifically for emerging adults and emphasises the importance of early intervention. FREED aims to give young people who have recently (within the last three years) developed an eating disorder rapid access assessment and care. As such, FREED reduces the amount of time that passes before an eating disorder is finally treated.
FREED has been tested by the South London and Maudsley NHS Foundation Trust (SLaM) with great success. FREED cut long wait-times. With FREED patients were also much more likely to engage with their treatment and less likely to drop out. FREED patients also recovered much more quickly. Finally, patients and their parents were very happy with FREED.
So the sooner a person with a recent eating disorder can get support, the better the outcomes may be.
Following this success, the team are now looking to explore the impact of FREED on a larger scale. The next steps include rolling FREED out to other eating disorder services so that we can look at implementation, patient outcomes and cost effectiveness.
Brown, A., McClelland, J., Boysen, E., Mountford, V., Glennon, D., & Schmidt, U. (2016). The FREED Project (first episode and rapid early intervention in eating disorders): Service model, feasibility and acceptability. Early Intervention in Psychiatry. doi:10.1111/eip.12382
Schmidt U, Brown A, McClelland J, Glennon D, Mountford VA. Will a comprehensive, person-centered, team-based early intervention approach to first episode illness improve outcomes in eating disorders? Int J Eat Disord. 2016 Apr;49(4):374-7.
Everybody thinks about things in different ways. Each way of thinking has strengths and weaknesses. Some people with eating disorders prefer to zoom in on details and stick to rules and routines. This way of thinking may not always be helpful.
Research suggests that this way of thinking may be related to eating disorder symptoms. This is because people who have recovered from an eating disorder only show some of these thinking behaviours.
This is good news! It means that unhelpful ways of thinking are not fixed. People may start using a more helpful thinking style when they get better!
Different people think in different ways. Some people prefer to zoom in on details. Others zoom out and think about the bigger picture. Some prefer to follow rules and routines. Others ‘go with the flow’. Different thinking styles have their pro and cons. For example, being very good at zooming in on details is helpful when proof reading coursework. However, it may be unhelpful when you need to think about the bigger picture. In the same way, being able to think flexibly is helpful when you need to change your routine or behaviour. However, being too flexible may lead to problems with not being able to follow rules.
So what about eating disorders and thinking? A recent study looked at the way people without an eating disorder think after they have fasted for a day. It was shown that after fasting people had more difficulty thinking flexibly than usual. They also became focused on details rather than the ‘bigger picture’. This suggests that even going without food for a short amount of time messes with your thinking. Actually, it makes you more rigid and focused on the ‘small-print’. A review of many studies found that people with eating disorders tend to prefer to zoom in on details than to zoom out and think about the ‘bigger picture’. Research has suggested that some do this so much that it becomes unhelpful.
Another review found that individuals with eating disorders are less flexible in their thinking than those without an eating disorder.
This finding is also backed up by new research. This showed that children and teens with anorexia also tend to zoom in and have trouble thinking flexibly. However, this is not to the same extent as in adults with AN. This difference between young people and adults with anorexia may be explained by the amount of time that they have spent being unwell.
Overall, these studies suggest that thinking styles are not stable. They are changeable with recovery. The earlier we tackle eating disorder symptoms the more likely it is that a person will have a more helpful thinking style.
Pictures of the brain (brain scans) show that when someone is unwell with anorexia nervosa some areas of the brain shrink.
However, pictures of brains also show that once someone has recovered from there is an increase in their brain size. The longer they are recovered the more improvement in brain size there is!
The brain is made up of white and gray matter. White matter connects different parts of the brain with one another. It also sends messages between the parts. Gray matter is responsible for all the brain’s most important jobs like memory and planning.
Technology has allowed us take detailed pictures of the brain. This has allowed us to look at how the brain is influenced or changed by illnesses like anorexia nervosa. Studies have collected brain images from people with eating disorders and compared them to those of people who have never had anorexia. These studies have shown that adults with anorexia have a less white and grey matter in the brain than people who have never had anorexia. This means that their brains are smaller in size. In fact, the brain of someone with anorexia can look similar to the brain of someone with dementia, a very serious disease of the brain!
We do not know exactly why the brain shrinks in anorexia. It may be due to damage caused by starvation. As the brains of young people are still developing up until the mid-20’s, their brains may be particularly affected by anorexia symptoms. In fact, we may see even more brain shrinkage in these younger people.
The answer seems to be YES! A review of a number of studies showed that once people had returned to a healthy weight, there was an increase in the amount of white matter in the brain. Moreover, after staying at a healthy weight for a few years there was also improvements to grey matter. In fact, there was so much improvement that there were no longer any differences in brain size between those with anorexia and those without.
Although these finding are positive and encouraging, we still have a lot to learn. We still don’t exactly know how eating disorders may affect brain shrinkage. We also don’t know if there are areas of the brain that are more affected than others. Or if some damage cannot be reversed. One thing we can be certain of however is that the earlier we can provide help the better! The sooner you combat an eating disorder the better the outcome for the brain is likely to be!
Seitz, J., Herpertz-Dahlmann, B., & Konrad, K. (2016). Brain morphological changes in adolescent and adult patients with anorexia nervosa. Journal of Neural Transmission, 1-11.
Understanding and communicating with others is an important part of life.
Research tells us that people with eating disorders have difficulty with social interactions. They also seem to have trouble reading and expressing emotions.
Research suggests that these difficulties are made worse by starvation and improve in recovery.
Social situations are full of information. For example, a person uses words to share their point of view. They also use the rest of their body to send messages about what they are thinking and feeling. When we interact with others our brains try to use all the information available to help us understand and respond.
Research shows that even short-term fasting messes with our ability to make sense of all this information. So what happens if you have an eating disorder?
A recent review showed that people with eating disorders have trouble making sense of social and emotional information. This was most true for people with anorexia nervosa. When we compare people with anorexia to people who have never had an eating disorder we see differences. For example, people with anorexia have difficulty recognising facial emotion. They also have trouble reading the emotions people express using their voice or body. People with AN also show less emotion in their face when looking at emotional images.
A second review also showed that people with eating disorders have trouble making judgements about what another person is thinking or feeling. This means they also struggle to predict what action another person might take. These difficulties are seen in all eating disorders, but most of all in anorexia. The longer the illness goes on, the greater the difficulties. This may be because eating disorders are very isolating. This means that people don’t get enough practice reading and interacting with others.
These sorts of difficulties have a big impact on our relationships. They also stop us from having rewarding interactions with other people. Fortunately, it seems that things get better with recovery! This is very encouraging. The sooner you get help, the shorter the journey back may be.
Bora, E., & Köse, S. (2016). Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: A specific impairment of cognitive perspective taking in anorexia nervosa? International Journal of Eating Disorders, 49(8), 739-740. doi:10.1002/eat.22572
Caglar-Nazali, H. P., Corfield, F., Cardi, V., Ambwani, S., Leppanen, J., Olabintan, O., . . . Treasure, J. (2014). A systematic review and meta-analysis of ‘systems for social processes’ in eating disorders. Neuroscience & Biobehavioral Reviews, 42, 55-92. doi:10.1016/j.neubiorev.2013.12.002
Davies H, Wolz I, Leppanen J, Fernandez-Aranda F, Schmidt U, Tchanturia K. (2016) Facial expression to emotional stimuli in non-psychotic disorders: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 64, 252-71.
Oldershaw A, Lavender T, Sallis H, Stahl D, Schmidt U. Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev. 2015 Jul;39:83-95.