Eating disorders are serious mental illnesses that involve extreme concern about eating, weight or shape plus disordered eating. They are not a lifestyle choice or “phase”.
Eating disorders have the highest mortality rate of any mental health disorder. One in seven women will experience an eating disorder over their lifetime. Peak onset is in adolescence and young adulthood, but eating disorders can develop before and after this too. They affect boys and girls, men and women, young and old, rich and poor, and people of all cultures.
There are four main categories of eating disorder: anorexia nervosa, bulimia nervosa, binge eating disorder, and “other specified feeding or eating disorder” (OSFED). OSFED is no less serious than the other categories and just means that symptoms don’t exactly match those for anorexia nervosa, bulimia nervosa or binge eating disorder.
Eating disorders aren’t all about food. People with eating disorders often feel a lot of pain, sadness and worry. The eating disorder can be a way to cope.
‘Disordered eating’ can include limiting food intake, binge eating (eating a very large amount of food at once and feeling out of control of eating) and/or purging (making yourself sick or misusing laxatives). People may also exercise a lot, or exercise in rigid ways.
Some of the symptoms associated with eating disorders include:
Usually at least a few of these symptoms are present in someone with an eating disorder.
“An eating disorder is never the solution to a person’s distress or difficulties. It is always the problem.”
Ulrike Schmidt, Psychiatrist and Professor of Eating Disorders
Early intervention means providing treatment as soon as possible when someone needs it. Research tells us that we should try and reach someone with an eating disorder within the first three years of the illness. People with eating disorders experience changes to their brain, body and behaviour. In early stages these changes are more easily reversed.
After three years, eating disorder symptoms tend to become “hard wired” in the brain. Symptoms can still be changed, but it gets harder to make changes and there may be long-lasting consequences.
There are two key things that stop early intervention for eating disorders: difficulties spotting the illness early, and difficulties getting help. FREED aims to address both sets of difficulties.
Services using FREED aim to provide rapid, specialised, evidence-based treatment for young people with a recent onset eating disorder (anorexia nervosa, bulimia nervosa, binge eating disorder or another eating disorder). This means that treatment is more likely to be effective and young people are less likely to miss out on study, relationships and other opportunities because of their illness.
FREED was developed for 16 to 25-year-olds with an eating disorder of up to 3 years duration. Eventually, we hope that everyone with an eating disorder will be able to access tailored, specialist treatment quickly. FREED is one step towards this goal.
“FREED has really saved my life. Early intervention is crucial and without this I probably would not be where I am now - I am sustaining a job, have moved out to a new home, and able to love myself. I still have eating issues and anxieties but I have come so far in my wellbeing and quality of life.”
FREED service user
FREED is First Episode Rapid Early Intervention for Eating Disorders. It is a service model and care package for 16 to 25-year-olds who have had an eating disorder for three years or less (anorexia nervosa, bulimia nervosa, binge eating disorder, or another eating disorder).
FREED helps young people to access specialised evidence-based treatment quickly. The goal is for treatment to start within 4 weeks of referral to an eating disorder service.
FREED also attends to the specific needs of young people in the early stages of an eating disorder. It emphasises early, pro-active engagement; early symptom change; family involvement; attention to the effects of eating disorders on the brain; attention to social media use; and attention to transitions (out of school, to university, into work) and ‘emerging adulthood’.
FREED operates as a ‘service within a service’. It complements, rather than replaces, existing eating disorder services and treatments.
“Without FREED I am not sure I would be here today, getting early intervention was such a positive thing to happen to me when I was in a really dark place, and it gave me lots of hope for the future.”
FREED service user
The FREED service was developed and tested by the South London and Maudsley NHS Foundation Trust’s Eating Disorders Unit and King’s College London. The initial trial took place across 2014-2015. Compared to treatment-as-usual, FREED reduced the amount of time an eating disorder was left untreated and improved treatment outcomes.
Key benefits included:
Introducing FREED did not result in non-FREED patients waiting longer for treatment.
FREED confirmed that treating people as early as possible leads to better results for eating disorder treatment.
In 2016, FREED was introduced to three new eating disorder services in the UK. In 2018, FREED was introduced to eight new services. By 2020, we hope that at least 20 services will be using FREED. Work is also being done to establish FREED in Australia. Services that use FREED form part of the FREED Network. FREED is also being used in South Australia under the term EmergED.
We have an online training package and implementation toolkit for services interested in adopting FREED. This covers the why, what and how of delivering FREED and working effectively with young people and their families. There is currently no charge for this material but we ask that you register to access this part of the site.
We also have guides for healthcare professionals to use and guides and tools you can share with patients and carers. You don’t need to register to use these.
Professor of Eating Disorders, Consultant Psychiatrist and FREED Evaluation Lead (Kings College London)
Clinical Lead/Principal Psychotherapist and FREED Service Lead (Maudsley)
Principal Clinical Psychologist and FREED Network Lead (Maudsley)
FREED Champion (Maudsley)
Clinical Psychologist & FREED Champion (Maudsley)
FREED PhD Student (Kings College London)
FREED Creative Lead (Maudsley) and FREED Service Lead (Leeds)
Consultant Psychiatrist (Leeds)
Clinical Nurse Specialist and FREED Champion (Leeds)
Clinical Nurse Specialist and FREED Champion (Vincent Square)
FREED therapy lead (Vincent Square)
Consultant Psychiatrist (Vincent Square)
Consultant Psychiatrist (Vincent Square)
Psychological Therapies Lead and FREED lead (Birmingham)
Clinical Pathway Lead (Birmingham)
Clinical Team Manager (Birmingham)
Principal Clinical Psychologist (Somerset)
FREED Lead (Somerset)
Eating Disorder Service Lead & Consultant Family Psychotherapist (West Essex)
FREED Champion & Occupational Therapist (West Essex)
FREED Psychotherapist (West Essex)
Clinical Team Manager (Leicestershire)
FREED Champion and Eating Disorders Therapist (Leicestershire)
Psychological Therapist and FREED Champion (Manchester)
Counselling Psychologist and FREED Champion (Manchester)
Clinical Psychologist (Manchester)
Psychological Therapist and FREED Champion (Black Country)
Counselling Psychologist in Training (Black Country)
Specialist CAMHS Practitioner (Black Country)
FREED Champion and Specialist Mental Health Nurse (Nottinghamshire)
Clinical Psychologist (Nottinghamshire)
Specialist Mental Health Practitioner (Nottinghamshire)
Eating Disorder Service Lead / Consultant Clinical Psychologist (Liverpool)
FREED Champion / Clinical Psychologist (Liverpool)
FREED Champion / Specialist Nurse (Liverpool)
Clinical Psychologist (Sussex)
Consultant Clinical Psychologist
Consultant Clinical Psychologist (Sussex)
Clinical Psychologist/Acting Clinical Lead (Greater Manchester)
Clinical Psychologist/FREED Champion (Greater Manchester/Salford)
FREED Champion and Occupational Therapist (Cornwall)
Lead Specialist Dietician and Interim Service Manager (Cornwall)
Access helpful guides for GPs and other health professionals (no registration required) or register for our online training platform if you are interested in using FREED in your service.
Help & Support
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