So says a friend of mine who works at an eating disorder unit. And I’m inclined to agree. Whether you opt for professional care or the support of friends, church and family (and in my view you need both) – you can’t do it alone.
The nature of addiction is that you don’t always want to get help. In all likelihood, it’s one of the most terrifying steps you will ever take. But you need it.
In the next series of posts, I’m going to look at what you might expect if you seek medical help for an eating disorder: from going to the GP to inpatient care. A lot of it is obvious and some applies more widely to mental health. Many of you will know much more than me about this – so please share your wisdom.
Today: Going to the GP (Primary Care).
This is really, really important. Your GP is like the gateway to lots of other help – from counselling to inpatient care. I know it’s scary: but this is not out of your control. It’s taking it back: and getting other people on board to help you get healthier. So, if you’re not registered, then do it: it’s a coupla’ forms and maybe a blood test. Remember, no-one’s gonna lock you up or shout at you for being a ‘bad’ boy or girl. You’re an adult and this is ok. See www.nhs.uk for surgeries in your area.It’s also worth asking in advance (before or after registering), if anyone at the surgery specialises in mental health or EDs.
If you’ve already got a Dr, then you’re halfway there. Ask for a double appt (which will give you space to talk). Bring a friend, especially if you find it difficult to talk about the issues and talk through with them what you want to say. or maybe have someone on standby after, to say well done, talk it through and give you sweet tea and a hug. Think about making a list of questions and things you’d like to cover – that way if you dry up, you’ve got it in front of you.
Once you’re in there, there are different possibilities. They will ask you what you’re there for, but this is not a challenge or a statement about your worth! Tt’s ok to say ‘I’m very nervous or this is difficult’. GPs are human and they should put you at your ease. So have in mind a couple of sentences about your concerns, eg; ‘I’m worried about how I use food to cope with stress’. Or, think about printing out some of the symptoms of an ED – tick the ones that apply and hand it over…or write a note and give it to them. This is such a positive step, so keep breathing and remember you are in control and you are with someone who wants to help.
The Dr may ask to weigh you and calculate your body mass index (bmi) – you don’t have to, but at some stage this will be important. They may do blood tests (to rule out other disorders and see how your body salts etc are – if you’re not eating, overexercising, abusing laxatives or purging, it can really mess with your internals, even if you feel ok). For the same reason, they may also suggest an ECG to check out your heart. (Your heart is a muscle and if you starve it or put it under pressure, it can waste away or weaken). If they don’t suggest these things and you want them, then it’s worth asking. Your GP will probably ask you general qs about your mood, physical and emotional history etc. Again, this is to give the fullest picture of how you’re going; and consider issues like anxiety, substance abuse or depression which can co-exist with EDs. They will have heard it all before, so don’t worry about shocking them or being a drain on their resources etc. It’s their job and you need this.
If the doctor suggests medication, ask about the side-effects and what you should expect in terms of symptom relief, how long they take etc. Here’s a list of qs about antidepressants, which might be useful.
If you don’t agree with what your GP says, you can ask them to refer you to a colleague: if they won’t, then you can go to another GP for a second opinion. It’s worth getting someone you feel comfortable with – so if they don’t get it or don’t take you seriously, don’t give up. Go to someone else. If you have any questions or complaints about your NHS treatment, you can contact PALS: Patient Advice and Liaison Service: www.pals.nhs.uk – they can help you make complaints and seek help outside of the NHS.
Confidentiality: There’s part of the law called Gillick Competence, which means that if the medical professional believes you to be able to make informed decisions for yourself and that these decisions will not put you in any danger, they keep confidentiality. Before you talk to a professional you can ask under what grounds they would break this confidentiality.
Your GP may suggest some sort of counselling or refer you for secondary care, (usually as an outpatient to a clinic), eg; psychologist, psychiatrist, dietician, specialist nurse, counsellor etc. If they can’t get it in your area you can ask to be referred outside your area (but be aware there may be large waiting lists – up to 18 weeks). You should receive a follow-up letter – explaining what treatment involves, where, when and with whom. In the meantime, ask to see your GP regularly so they can keep track on you and you’re not left alone.
If other people are involved in your care as well as a GP, you should be given a written agreement which says whose responsibility it is to check you are ok. Ask for this if you don’t get it.
The most common therapy used for EDs is often cognitive behavioural therapy or CBT – in part, because those with EDs tend to have lots of distorted thinking. It looks at linking how you feel to how you behave and changing the way you respond to eg; stress. (See here for more thoughts on CBT and Christianity). This might involve 40-60mins a week for about 20 sessions; looking at eating habits, underlying emotions and ways of handling these. If you are a Christian and are concerned about how it will interact with what you believe, explain this at the outset and ask how you can work within what you believe.