Eating disorders

Overview

An eating disorder is about more than just food. It is a type of mental illness that involves unhealthy thoughts and behaviours towards food, weight, and body shape.

Eating disorders can affect people of any age, race, gender or sexual orientation. If you have an eating disorder, you might worry so much about food that it makes it difficult to work, go to school, or enjoy time with friends.

The Provincial Adult Tertiary & Specialized Eating Disorders (PATSED) Program at St. Paul’s Hospital treats patients 17 years of age or older with a variety of eating disorders. This includes anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorders.

Our philosophy of care is: ‘Right patient, right treatment, right time.’

We work with patients to match them up with the right treatment at the right time. The team believes that each person’s journey is unique. Treatment planning will be different for each patient.

It is important for patients to think about their level of readiness for treatment. This helps them get the most benefit possible from the program. Our team uses a holistic approach, and is guided by research-and evidence-based practice.

Contact

St. Paul’s Hospital
4 North, Burrard Building
1081 Burrard Street
Vancouver, BC V6Z 1Y6

Eating Disorders Program Intake Coordinator

Email arauh@providencehealth.bc.ca

Two doctors are seated talking with a patient who is also seated

Diagnosis & assessment

Eating disorders are diagnosed based on symptoms and a review of eating habits and behaviours. If you think you might have an eating disorder, the first step is to contact your family doctor. They can confirm a diagnosis and provide a referral to the PATSED program at Providence, or an eating disorder program in your area. Learn more about how to find a family doctor if you don't have one.

If you are referred to the program, the following assessments will help determine the recommended care.

The Intake Coordinator manages received referrals. If you are eligible, they call you with details about our program and to schedule intake assessments. If the program isn't a fit, we will suggest other resources.

If you meet the admission criteria for the program, we will schedule a three-part assessment: medical, psychiatric, and research.
- An internal medicine doctor will conduct the medical assessment.
- A program psychiatrist will conduct the psychiatric assessment.
- A research coordinator will conduct the research assessment.
Together, these assessments will determine medical and psychological status, treatment needs, and identify the most appropriate services. Patients will be invited to participate in ongoing clinical and program evaluation research.
If you are a youth or young adult, take the FoundryBC Body Image, Disordered Eating & Eating Disorders Self-Check Quiz. If you are an adult, we suggest the NEDA Online Eating Disorder Screening Questionnaire.

It is important that if you are unsure if you have an eating disorder that you get a professional assessment.

Treatment & management

For people with eating disorders, recovery can be scary. It isn’t easy to ask for help and finding the best treatment may take time. Treatment recommendations will vary depending on your individual needs.

Watch this video to learn more about what happens once you enter our program.

Hospital (inpatient) treatment

If you sleep at the hospital during treatment for an eating disorder, it is called inpatient treatment. Our inpatient treatment program is recommended when someone needs intensive support from a team of care providers. The team will help them work toward their nutritional, medical and psychological goals.

Our inpatient program is called 4 Northwest (4NW). It is located on the 4th floor of the Burrard Building at St. Paul’s Hospital.

The 4NW program has 2 phases or stages. Both phases help patients explore treatment in a structured and supportive environment.

Upon admission to 4NW there is a 2 to 3 day introduction period to help patients get settled and oriented. During this time patients attend some groups but not all. Patients meet team members, have their individual assessments, and have time for rest.
During Phase 1, patients have their medical and psychiatric needs addressed, and start to learn some new skills. Treatment during this time includes group and individual therapy, focusing on nutrition, education, coping skills, and leisure, in a structured supportive environment. During Phase 1 you will work with the team to decide if Phase 2 is right for you at this time.
Similar to Phase 1, Phase 2 consists of group and individual therapy focusing on similar goals, with the addition of planned therapeutic passes of increasing length to practice and experiment with recovery goals.
Before starting Phase 2, all patients move through an application process with the 4NW care team in order to clarify treatment goals, review progress, and ensure that this treatment path is appropriate for them. Some criteria must be met prior to moving to Phase 2. This will be reviewed with patients prior to their admission.
The length of a person’s stay in the 4NW program is individually based, and evaluated regularly by the patient and care team. Patients journey through program by different paths, but some aspects of these paths remain consistent for all patients:

Phase 1 - maximum length of stay is 4 weeks.

Phase 2 - maximum length of stay is 7 weeks (including time in phase 1).

If patients need 4 weeks (or longer) in Phase 1, they will not move to Phase 2 during their current admission. The care team may recommend a future admission, which could include Phase 2 when the time is right.

Patients can prepare for their admission by reviewing our handbook.

Intensive day program (outpatient) treatment

Some individuals will be recommended to participate in our intensive day treatment program. Our intensive day program is called Discovery/Vista. The daily programming takes place at St. Paul’s Hospital. Participants live at Vista House, a housing facility located in Vancouver.

Both elements of the program help patients explore treatment in a structured and supportive environment.

Discovery/Vista is an intensive, recovery-oriented treatment program that has two main components. Participants attend daily programming at St. Paul's Hospital and live at and engage in programming at Vista House, a facility located in Vancouver (operated in collaboration with Vancouver Coastal Health).

Discovery/Vista is for people with eating disorders, who want to work on:
- Giving up self-destructive coping strategies
- Identifying issues beneath the eating disorder
- Learning new methods of coping without the eating disorder
The Discovery Program is a 12 to 15 weeks-long intensive day hospital treatment program. Our team includes a dietitian, a social worker for family therapy, an occupational therapist, a psychiatrist, several psychologists, and a spiritual health practitioner. All individuals who enter the Discovery Program must first complete the Readiness Program.

Referral and wait/preparation time

Referral to the PATSED program is received through our intake coordinator. After completing the intake assessments, treatment recommendations are made and a referral to Discovery/Vista (D/V) may be the most appropriate treatment for you. Our team will continue to work with you to plan and prepare for this treatment. Generally there is little to no wait time for entering into the Discovery/Vista program. However, there is a preparatory component involved called “Readiness Program” which will be arranged with support of our care team.

Discovery Program FAQ

Transitional Services for Eating Disorders

Our program offers a variety of transitional services that support patients as they work to prepare for our program. These services are again available as patients transition back to their communities following their admission.

Outpatient, group-based program which provides support and assistance for individuals after completing the Discovery/Vista Program.
The Readiness Program provides support for individuals preparing for the intensive Discovery/Vista Program. To participate, you must be medically stable and motivated to make changes to your eating disorder symptoms. The Readiness Program occurs on Wednesdays from 10:30am-2pm via Telehealth and there are three major components:
- Goals and Victories Group
- Supported Lunch
- Exploration and Awareness Group.
In addition, you will have regular meetings with the psychiatrist, and with a dietitian for weekly nutritional counseling.
Connections is a closed, process and meal support group. This group helps individuals strengthen their ability to participate in groups, eat a balanced lunch, and explore various leisure activities or educational subjects during the post-meal support group.
Meals with Maude is a closed, low-barrier meal support group. This group helps individuals strengthen their ability to participate in groups, eat something for lunch, and explore participating in a leisure activity during the post-meal support period.
LEAP is an 8-week, closed group aiming to promote curiosity and awareness around exercise attitudes and beliefs, and explore how compulsive exercise is related to eating disorders.
We schedule individuals preparing for the program for regular appointments. The clinic is held by a psychiatrist and a care coordinator.

Sessions are for ongoing assessment, management and monitoring of eating disorders. This includes monitoring related psychiatric concerns and discussing treatment care planning. Individuals transitioning between the PATSED programs or back into their communities will also be referred to this service.

Medical Team Clinic is a weekly clinic held by a medical doctor and a dietitian. If required, we will schedule individuals for an appointment. Appointments are for the assessment, management, and monitoring of related physical health concerns.
Our Care Coordinator works with you to help with care planning. This is available for individuals transitioning into, out of, or between our programs.
The treatment plan for eating disorders often includes counselling on nutrition and meal planning. Part of recovery from an eating disorder is about improving nutrition and eating, and changing harmful eating behaviours.

Individuals connect with the program dietitian to talk about nutritional goals, and develop an individualized meal plan.
Individual support from an occupational therapist is available to work on self-care, leisure, or productivity-related goals.
Our program offers individual psychotherapy for patients who have a significant medical condition, are pregnant, are at acute risk for decompensation, or have specific psychological goals in preparation for treatment.
Individual support with resource-based service access (e.g., government applications), as well as family therapy.
Individual support from a Spiritual Health Practitioner to work on deepening spiritual and/or faith-based beliefs in line with the individual’s goals.

Support services

Providence Health Care offers a variety of services to support those we care for. The following services may be of use or benefit to you and your families.

To help with communicating with your health care team, we offer interpretation services 24-hours-a-day. Please ask your care team to place a request if you need an interpreter including a sign language interpreter.

Learn more
We strive to offer you the best and most compassionate care possible. If we succeed, please let us know. If we fall short of our goal “How you want to be treated,” please also let us know.

Learn more

A group of people are seated in chairs arranged in a circle

Support for Indigenous Peoples

The Indigenous Wellness Liaison Team is here to support your health journey. Team members offer cultural support and healthcare advocacy. Learn more below or call them at 604-682-2344,62937 or email IWL@providencehealth.bc.ca.

Indigenous wellness services

The Indigenous Wellness Team at Providence is available to support Indigenous patients and their families. We are here to coordinate culturally safe wellness supports and services.

Education & resources

Patient-centred help, resources, important phone numbers and education about eating disorders come from many sources.

Some resources listed here come from St. Paul's Hospital and Providence Health Care. Other useful resources about eating disorders are available from the community and from online supports.

Useful resources

Important phone numbers

Online crisis chat support available Monday to Thursday 9:00 a.m. – 9:00 p.m. (est) & Fridays 9:00 a.m. – 5:00 pm (est). Click “Start Chat” to begin chatting with a volunteer.

nedic.ca
To start using the text service, text CONNECT to 686868

Texting service is free and available across Canada 24/7.

kidshelpphone.ca
Self Compassion by Dr. Kristin Neff
http://self-compassion.org/

TED talk: “The space between self-esteem and self compassion” by Kristin Neff
https://youtube/IvtZBUSplr4

Why did I develop an Eating Disorder? – The Biopsychosocial Model
https://youtu.be/EniL2DTySms

Podcast: Let Us Eat Cake
www.letuseatcakepodcast.com
A treatment program for male, female, trans, gender and culturally diverse youth and young adults 16-24 years of age. The Looking Glass Treatment Pathway includes in person and virtual components.

Looking Glass Handbook

Community & events

How can you help a loved one with an eating disorder?

Family/support persons are an important part of treatment. Families may attend an information meeting with members of the treatment team. This meeting is to clarify treatment goals and provide an opportunity for questions about the treatment. With the patient’s consent, families/support persons have ongoing involvement in the treatment. They may help plan for when the patient returns home. There may also be an opportunity for short term family therapy.

Eating Disorders Program - Guidelines for Families and Support Persons

Eating Disorders Program Patient/Family Advisory Committee

The Eating Disorders Patient and Family Advisory Committee started in 2013 to strengthen the partnership between patients and family members, and clinicians and administrators. PHC’s commitment to person- and family-centered care is to ensure patient and family voices, opinions, and viewpoints of the care experience are included, valued, respected, and understood. The committee works together to create positive change, and strengthen patient and family involvement. We have many shared learning opportunities and experiences. If you or a loved one is interested in being part of the committee, ask to speak with the manager of the program. They can give you more information.

PATIENT AND FAMILY ENGAGEMENT EATING DISORDERS PROGRAM

Events

Family and Friends webinars

These webinars provide education on eating disorders and the process of recovery work. They teach family and friends how they can offer support to their adult loved one.

Note: these webinars are for supporters of those with an eating disorder (including practitioners). They are not for clients.

Supporters of individuals with eating disorders can interact with a family therapist, occupational therapist, psychiatrist, and dietitian. They can also engage with former clients who received treatment from the PATSED Program. These webinars are open to professionals who want more information about eating disorders treatment for adults and their families. The webinar series is offered three times a year. Dates and registration details are sent to active clients and the secondary services around the province.

Topics covered in the webinar are:

What is an eating disorder and how do they develop
How eating disorders are treated with adult clients
Health (medical/psychiatric) implications
Nutrition considerations and meal support
Emotional and psychological connections to eating disorders
The recovery process
What family and friends can do to support their loved one’s recovery

Ask the treatment team for more information on upcoming Family and Friends webinars or register here.

Research

Staff and patient participation in teaching and research helps us provide the best care possible. Clinical and research staff provide regular training to staff working with individuals with eating disorders at Providence, and across the province.

Patients and families help us learn what works well about our care, and how we can improve it. The program research team runs grant-funded projects that seek to deepen our understanding of how to best meet the needs of our patients and families. The Director of Research in our program is Dr. Josie Geller.

Medical & professional referrals and consultation options

Referral infographic for eating disorder program

We require a referral for assessment and treatment. Referrals are received from a secondary eating disorder program within the province. If there is no secondary program available, mental health teams or community care providers can provide referrals. For referral inquiries, individuals can contact the Intake Coordinator at 604-806-8654.

The general referral criteria for the Eating Disorders Program are as follows:

A primary diagnosis of anorexia nervosa, bulimia nervosa or Other Specified Feeding or Eating Disorder (OSFED)
Followed by a primary care provider ie. family doctor/ nurse practitioner.
Followed by a secondary eating disorders program where available. In the absence of a secondary eating disorders program, individual is followed by mental health teams, and/or other secondary service community care providers.
Resident of BC (some exceptions may apply)
17 years of age (out of high school) or older

Provincial Specialized Eating Disorders Programs Guidelines and Referral Form

Consultation options

We provide interdisciplinary provincial consultation to health care professionals regardless of whether the patient is receiving tertiary level of care services. The purpose of clinical consultation is to provide clinical advice to health care providers caring for individuals with a diagnosis of an eating disorder (ages 17 years and older). This service supports individuals receiving care closer to home. It also promotes continuity of care between specialized services and regional/community health care providers.

Overview

An eating disorder is about more than just food. It is a type of mental illness that involves unhealthy thoughts and behaviours towards food, weight, and body shape.

Contact

Eating Disorders Program Intake Coordinator

Diagnosis & assessment