Anorexic Images – Who Needs Them?

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anorexia, competitiveness, denial, Eating Disorders, emaciation, images, media, misconceptions, symptoms, weight

Anorexic Images – Who Needs Them?

I recently spoke to a journalist who was interested in covering my row to London for Beat. Her first question, before she even asked about what I was doing or why, was “Do you have any images of yourself at a low weight?” As soon as I calmly explained Beat’s guidelines on the topic, which advise ambassadors not to provide these sorts of images, she launched into a heated speech about how she “simply couldn’t understand why that was necessary” because if I was “claiming to have been anorexic” I would “need to prove it”!

I thought to myself that that is precisely the problem with the current state of the media: too many people assume they understand eating disorders by sight alone, rather than stepping outside of their comfort zone to consider the reality that they run much deeper than skin level.

Given the recent controversy on Twitter surrounding the portrayal of eating disorders on popular TV programmes, it is important to recognise that their basis lies in the psychological symptoms, NOT the physical alone!

Displaying images of sufferers in their skin-and-bone state puts too much focus on weight loss, which is in fact just one of many symptoms of eating disorders – and actually only applies to anorexia which accounts for just 10% of cases under the umbrella term ‘eating disorders’.

As a result this feeds the common misconception that in order to have an eating disorder one must be drastically underweight. In fact, many people who are diagnosed as having an eating disorder never fall below a healthy weight!

In my own fight for treatment I was turned away because I was not underweight enough, even though I had already reached the stage of amenorrhoea. It seems so dismissive to believe that anorexia in particular is categorised by emaciation; in my last blog I explained how even after three years of maintaining a healthy weight – and therefore by the media’s definition being recovered – I can still encounter the distorted cognition associated with the illness. The weight is simply a by-product of the thoughts, and so the thoughts are just as much present once the weight has been gained, and take far longer to work through.

Another common justification is that seeing such graphic images of starvation will make an anorexic ‘think twice’ about ‘what they are doing to themselves’. Anorexia is NOT a lifestyle choice that can simply be opted out of! They are not doing anything to themselves, they are being dictated to by the malicious voice of a genuine illness.

Susan Ringwood, CEO of Beat, has said: “Eating disorders are more hard wired than was first known to be the case… people with anorexia can know they are at risk of dying and can find that less terrifying than gaining a few pounds in weight”.

The ‘shock factor’ which is experienced by the typical reader, and is exploited by the media, does not affect someone with an eating disorder. Susan continued: “These images do not shock them, they excite, encourage and motivate them to get as thin if not thinner than the person depicted”.

‘Triggering’ can sound like such a trivial word, but the truth is that presenting emaciation as a validation of anorexia not only promotes the denial of being ill because a sufferer will never feel like they look like the person in the picture – and so they can’t have the same illness – but also brings out the innately competitive side of the illness and drives the need to restrict food further because they take the image as evidence that they can (and in their mind should) be thinner!

It is understandably difficult to comprehend the danger of these graphic images when to most people they serve as a catalyst for disgust, but I would urge anyone viewing such an image to consider it from the point of view of a person who is caught in the deadly grasp of an eating disorder. To these people, opening that magazine in which they sought a momentary escape from their own reality only to be faced with a representation of the idol who they feel they can never replicate merely reinforces the feeling of inadequacy, self-hatred and depression.

What health professionals should know about eating disorders

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consequences, contact, counsellors, diagnosis, early intervention, Eating Disorders, family, friends, GPs, health professionals, health service, help, myths, nurses, psychiatrists, psychologists, recovery, sensitivity, social workers, support, symptoms, treatment, weight, young people

What health professionals should know about eating disorders

Over the course of two years, I have met with 40 young women and men who have shared on film honest details about their experiences of eating disorders. Their hope is that sharing their stories will help other people who are similarly affected to feel less alone and encourage them to seek help.

The research shows that common myths about the illness have prevented many young people from getting the treatment and support they needed, from family, friends and even the health service.

During the course of their eating disorder, young people came into contact with many different types of health professionals including GPs, nurses, counsellors, psychologists, psychiatrists, dieticians, social workers and other support workers.

There are some things that health professionals should know when dealing with a young person living with and recovering from an eating disorder.

Anyone can have an eating disorder

Anyone can become ill with an eating disorder. Eating disorders affect people of all ages, backgrounds, sexualities, both men and women. You can’t tell if a person has an eating disorder by just looking at them.

First point of contact is often critical

This first contact with services was often a huge step for a young person. People often found it very difficult to talk about what was going on, trying to hide their problems and it could take months, even years, to seek help. The way they were treated at this point could have a lasting, positive or negative, impact.

Young people hoped that the health professionals would realise just how hard asking for help was and to help nurture and support their confidence to stay in contact with services.

Early intervention is key

Young people often felt that people struggled to recognise the psychological symptoms of eating disorders as well as the range of different eating disorders.

If those who haven’t yet developed a full-blown eating disorder could be recognised, they can also be helped earlier. This is critical, as the longer eating disorders are left undiagnosed and untreated, the more serious and harder to treat they can become.

Effective, early intervention could be achieved when health practitioners were knowledgeable, well trained, sensitive and proactive.

Eating disorders are about emotions and behaviours, not just about weight

A common myth that many of the young people had come across was the thought that people with eating disorders were always very underweight. This idea had made it harder for some to get treatment and support or even to be taken seriously by their doctor.

In some cases, young people felt that the only way for them to be taken seriously and be able to access eating disorder services was to lose more weight. This could have serious consequences; the more weight they lost, the harder it was for them to be able to seek or accept help.

See the whole person, not just the eating disorder

Once in contact with health services, above all else, young people wanted not just to be seen “as an eating disorder” but to be treated as a whole person. It was important that they felt treated as individuals and for health professionals to realise that everyone responded differently.

A good health professional also tried to engage young people on other things than just the eating disorder, hobbies or interests.

Respect the young person

Feeling respected, listened to and being given the space to explain things from their perspective was important for young people during treatment and recovery.

Professionals should take their time and find out what was going on for that particular person, not act on assumptions. Health professionals shouldn’t patronise or dismiss issues that were important to the person in front of them.

This research, funded by Comic Relief, has now been published on online at Youthhealthtalk.org.

Ulla Räisänen is a senior researcher with the health experiences research group at University of Oxford, and was responsible for conducting the study published on Youthhealthtalk.org

Can you tell if a friend has an eating disorder?

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"ednos", anorexia, binge eating, bulimia, Eating Disorders, low self-esteem, mental health issues, support

Can you tell if a friend has an eating disorder?

I found out during sixth form that three of my friends had had an eating disorder in their GCSE years. Each time, my immediate reaction – for which I now chide myself – was one of surprise: they’d always looked so healthy.

As someone who has since come through an eating disorder myself, and as a volunteer for Beat – the UK’s leading eating disorder charity – I’ve spent years encouraging people to look beyond the visual to recognise the disease.

Only 10% of eating disorders sufferers are anorexic – and easily identified by severe weight loss. Around 40% suffer from bulimia (binge eating and purging) and the remaining 50% from “ednos” (eating disorder not otherwise specified, a category into which binge eating falls).

Though some people struggling with bulimia or ednos are underweight, the majority have a normal BMI, while some are overweight. When I heard my friends’ admissions, I instantly fell into the trap of equating “eating disorder” with “emaciation”, forming a host of regrettable assumptions about their experiences.

It’s often assumed that anorexia is fuelled by vanity and a desire to emulate skinny celebrities. In reality, eating disorders, including anorexia, are serious mental health problems, triggered by a complex interplay of low self-worth, difficulties in coping with problems and – possibly – genetics.

To recognise and understand these conditions, we need to look for behavioural signs as well as weight changes. For example, a friend with an eating disorder may become more withdrawn, preferring to spend time alone rather than engage in social situations they used to enjoy.

They may become extremely anxious at meal times and try to get out of events that revolve around food – you may notice they have taken to eating alone.

An obsession with calories and fat content can be an indicator, as can strict avoidance of certain food groups.

Some people with eating disorders – particularly anorexia – choose to engage in lengthy discussions about food, sometimes as a way of indulging through conversation, and sometimes to find out more about others’ eating habits against which they can measure their own.

Look out for physical and emotional symptoms: side-effects can include fatigue, difficulty concentrating, insomnia, frequent illness and mood swings.

If you suspect a friend has an eating disorder and you want to help, you’ll need to raise the subject gently. Reading through these dos and don’ts before broaching the topic will help, but don’t beat yourself up if the conversation doesn’t go as well as you’d hoped: your friend will appreciate your concern.

Offering to go with your friend to a GP appointment can be a helpful first step, as GPs refer people on to services that can help them.

Peer-to-peer support can be a really valuable way of complementing professional services. Student Run Self Help (SRSH) is a network of groups run by trained students in many universities across the UK. It aims to provide a safe, confidential space for students with eating disorders to share their experiences; attendance does not require a diagnosis. Going to groups for the first time can be daunting, so offering to accompany your friend might give them the confidence to turn up.

“When students face mental health problems, they are most likely to turn to their friends for support,” says SRSH founding director Nicola Byrom. “The problems faced by young people with eating disorders are often wrapped around issues of low self-esteem, so knowing that you have friends there to support you can make the world of difference.”

Recovery can be a slow process – you’ll need patience as well as understanding to help rescue your friend from the turmoil they are going through

a helpful first step, as GPs refer people on to services that can help them.

Peer-to-peer support can be a really valuable way of complementing professional services. Student Run Self Help (SRSH) is a network of groups run by trained students in many universities across the UK. It aims to provide a safe, confidential space for students with eating disorders to share their experiences; attendance does not require a diagnosis. Going to groups for the first time can be daunting, so offering to accompany your friend might give them the confidence to turn up.

“When students face mental health problems, they are most likely to turn to their friends for support,” says SRSH founding director Nicola Byrom. “The problems faced by young people with eating disorders are often wrapped around issues of low self-esteem, so knowing that you have friends there to support you can make the world of difference.”

Recovery can be a slow process – you’ll need patience as well as understanding to help rescue your friend from the turmoil they are going through.

Waging war on web ‘thinspiration’

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'thinspiration', anorexia, bulimia, Eating Disorders, recovery

Waging war on web ‘thinspiration’

Do a quick search on Instagram and you will find reams of “thinspiration” material, usually in the form of pictures that glamorises the extreme skinniness of various models and celebrities.

Hashtags such as #thynspo, #ana (for anorexia), #mia (for bulimia) and #blithe (code for self-harm) abound. From there you can find thousands of pictures of bloody wrists and thighs, messages of despair and cries for help, and photos of underweight women that mostly focus on apparent ribs, concave stomachs, thigh gaps, and prominent hip and collar bones.

Perhaps most distressing are the pro-anorexic quotes interspersed between pictures, such as “Do it for the thigh gap”, “Skip dinner, weigh up thinner,” “1 like = 10 squats,” “Do not reward yourself with food, you’re not a dog” and the most frequently posted shibboleth, Kate Moss’s infamous quote: “Nothing tastes as good as skinny feels.”

Community support for these self-destructive illnesses is not unlike the first wave of pro-ana virtual communities of the late 1990s, though the nature of an image-based social networking service means that random friendships occur more easily thanks to hashtags, and an emphasis on imagery that dangerously ratifies the erroneous assumption that only skinny women are beautiful. There, thinstagrammers photo-blog their daily frustrations and struggles, and comment on each other’s pictures to encourage fasting. Recovery accounts sometimes pop up too, usually gently advising people to get help.

When I first scrolled through those pictures, my kneejerk reaction was disgust. The idea that Instagram users are tagging photos that promote the obsession with thinness as a lifestyle, rather than a mental illness, infuriated me. I’ve never had an eating disorder, but I know that while illnesses such as anorexia nervosa are widely accepted as containing a genetic component, many studies have also indicated the impact of sociocultural factors (peer pressure, troubled relationships, sexual abuse and the ideal beauty type prevailing in western culture) that trigger people into becoming eating-disordered.

Instagram’s policing measures have been thus far unsuccessful. The company added a pop-up disclaimer for #ana and #mia with a link to theAmerican National Eating Disorders website and in April 2012 the company publicly banned #thin, #thinspiration and #thinspo, which prompted Thinstagrammers to spell new hashtags differently – for example #thynspo or #thinspoooo. As such, Instagram’s policies might come off as more a perfunctory PR gesture (and a cover-your-ass move) than a committed strategy to police graphic content, though admittedly the problem feels like an unstoppable plague.

I wanted to try something different. Upon finding a number of pro-recovery Instagram accounts tagged with words such as #edrecovery, I decided to make one myself (@lovethighself) in order to use pro-ana hashtags in an attempt to subvert and effectively spam pro-ana communities. I posted hundreds of quotes that promoted recovery and body acceptance, as well as attractive pictures of average and plus-sized models. I also photoshopped some of the common pro-ana images to refute their harmful messaging.

These attempts were not intended to be dismissive of a mental illness I do not have, nor to raise the ire of people with anorexia or bulimia, but rather to enable users looking up these hashtags to reconsider their scrolling habits. I figured that not everyone looking at thinspiration has an eating disorder. Some who do may be on the verge of relapse from recovery, while others who don’t (yet) might be slowly becoming obsessed with their weight and curious about thinspiration and dieting tips, putting themselves at risk.

“Thinspo” has overwhelmingly been proven to cause negative effects even in the non-eating-disordered. One study published by the European Eating Disorders Review found that college women without a history of eating disorders who looked at pro-ana websites reduced their calorie intake in the following weeks, half of them unconscious they were doing so. By posting a reactionary wave of images promoting body acceptance while negating the beliefs of ana advocates, I hoped to make a difference.

I soon received tons of comments thanking me and urging me to keep posting. “Please always keep this account. I’m going through an eating disorder and I’m fighting so hard but it pulls me down a lot and I just am still trying to overcome it. My screen saver is one of your pictures and it helps me so much,” wrote one follower. Many users who self-identified as having ana or mia in their bios began to follow me, and I started following some of them, too, providing support when I could. But sadly, because of the sheer mass of thinspiration pictures posted on Instagram every day, it’s been impossible for me to truly dent the thinstagram subculture.

The degree to which western society’s ideal body type has diminished our sense of self-worth is unmeasurable, but unmistakably and dangerously high. Young girls are crying out for help, using Instagram as an emotional outlet and banding together around a service to commiserate. It’s understandable that such communities form, given the isolating effects of eating disorders. But while they can be somewhat helpful in allowing the eating-disordered to have a voice, #ana and #mia are also likely to further fuel their disorders.

As it is, thinspiration is an unstoppable movement. Until our society stops telling young girls they can only be accepted if they are thin, pro-ana users will likely always find a place to unify on the web.

Bringing up daughters: The new battlefield for parents

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advertising, alcohol, anorexia, anxiety, bulimia, daughters, Depression, Eating Disorders, family, media, mental health issues, parents, pressure, self-harm, social media, Teens

Bringing up daughters: The new battlefield for parents

It’s a freezing night in Bristol, and snow is forecast – but every seat at Colston Hall in the city centre was sold out weeks ago, and not only for Ronan Keating who’s playing in the main auditorium. Also packing them in is a 59-year-old, softly spoken Australian psychotherapist, who will take to the stage for 90 minutes with just a whiteboard and some ideas that will keep his audience on the edge of their seats.

The psychotherapist is Steve Biddulph, and most of the people queuing up to hear him are the mothers of teenage girls. A few years ago Biddulph toured Britain warning of a crisis facing boyhood: now he is back with a similar message about girlhood. And if the audience here is anything to go by, he’s definitely touched a nerve. “Parents of girls are seriously worried about their daughters,” says Saffia Farr, editor of Juno magazine and the organiser of the Bristol part of Biddulph’s country-wide tour. “They feel there’s this overwhelming tide of advertising that’s targeting their daughters, of inappropriate clothing being sold in the shops, of media messages that encourage their girls to grow up way, way before their time. And they want to know what they can do about it.”

Telling them what they can do about it is Biddulph’s mission. “A few years ago, boys were a disaster area – there was an epidemic of ADHD, they were underperforming in exams, they were drinking too much and getting involved in wild behaviour,” he says. “Back then, girls seemed to be doing just fine. But, about five years ago, that all changed – suddenly, girls’ mental health started to plummet. Everyone knew a girl, or had a girl themselves, who had an eating disorder or who was depressed or was self-harming. It was a huge change in a very short period; I started to investigate why this was happening.”

Biddulph lives and works in Australia, but the crisis he sees brewing for young girls seems to be echoed across the Western world – and, in Britain, the figures suggest it’s worse than in other countries. A few weeks ago, the charity Childline announced a 68 per cent increase in youngsters contacting them about self-harming, and said most of the increase was among girls. The problem also seemed to be affecting teenagers at a younger age, with 14-year-olds now likely to be among callers.

Anxiety and depression in teenage girls is also on the rise: research from the Nuffield Foundation last year found that the proportion of 15- and 16-year-olds reporting feeling frequently anxious or depressed has doubled in the last 30 years, and is more common in girls: it has jumped from one in 30 to two in 30 for boys, and from one in 10 to two in 10 for girls. Meanwhile, a report from the Department of Health found teenage girls in Britain are more likely to binge drink than teenage girls anywhere else in Europe; more than half of 15- and 16-year-olds admit they drink to excess at least once a month. A separate report in 2011 found that one in five girls in this age bracket who drink at least once a week have drunken sex and later regret it.

Anorexia and bulimia are also dramatically on the increase: official figures for hospital admissions released last October pinpointed a 16 per cent rise in hospital admissions for eating disorders, and showed that one in every 10 of these admissions was a 15-year-old girl.

“There’s plenty to be concerned about,” Biddulph says. “Everyone who has a teenage daughter right now sees this, in their child and among their child’s friends.” The people they blame, he says, are the advertising industry and the media. “They are driving girls’ sensibilities and making them miserable. The corporate world has identified them as a new market for products, and is preying on them.” During his talk, Biddulph describes teenage girls as being out in the wilderness, surrounded by hyenas: it’s starting to get dark, he tells his audience, but they are all alone out there.

His message, though, is one of empowerment: he encourages parents to get together, to challenge the advertising industry and to lobby the Government to impose more restrictions on advertisers.

“Take the drinks industry – about 30 per cent of the market is sales to underage drinkers,” he says. “Alcohol companies are extremely powerful – but parents are powerful, too, and they have to stand against this and stop the marketing of alcopops and push for a higher drinking age.”

But the battle needs to be fought on a domestic as well as a policy front. “What we need to do is re-evaluate how we think of teenage girls: the current philosophy is that they’re growing older, so they need us less. But I believe that teenage girls go through a kind of second babyhood, and they in fact need their parents more than ever. We have to spend time with our daughters at this age: talk to them, listen to them, keep in touch with them. Staying connected to their parents makes all the difference to how they cope with the pressures they’re up against.”

Case study

Lindsay Julian, 51, lives in Salisbury. She has three daughters: Emily is 24, Olivia is 14, and Amelia is 11. She also has a son, Alexander, 28

“Emily got into drinking when she was about 15, and she started taking drugs fairly soon after that. It was a real roller-coaster time for all of us: sometimes she’d drink a lot and run off, and we’d have no idea where she was. One time, she didn’t come back all night, and we ended up calling the police. They were difficult times.

“There are so many pressures on young girls today – you’re very aware of that as a mother of daughters. So when my younger girls got close to the age where things got difficult with Emily, I thought: we’re going to do things differently this time round. I sent them to a Steiner school, where I think the pressures are lessened: the philosophy is holistic, it’s not all about exam results, which I think can be very stressful for young girls.

“Some of my daughters’ friends spend a lot of time on social media, texting and on Facebook – but I’m careful to limit those things for my girls, and it does make a difference. They watch TV but I monitor it – in some homes, TV seems like a third parent, and I don’t want it to be like that in our house. A lot of teenage girls never switch off, they’re constantly connected, and that puts them under pressure from one another as well as from advertisers.

“We’ve got friends where you can see that their 14-year-olds are more like adults; the wanting to drink, to go to parties all the time.

“Emily is fine now: things turned around for her eventually, and she now works as a researcher and has written a book. She’s a rock for her younger sisters and I’m very proud of her. I know you could say that she was OK in the end, but I don’t think it’s an experience I’d want to go through with my younger daughters. I think their adolescence could be happier, and less fraught, than Emily’s was.”

Pro-Ana Sites Encourage Extreme Dieting And Eating Disorders In Girls

Tags

anorexia, Eating Disorders, internet, young people

Pro-Ana Sites Encourage Extreme Dieting And Eating Disorders In Girls

Thousands of young girls are using dangerous pro-ana websites that encourage users to ‘starve for perfection’.

According to a new report, Virtually Anorexic – Where’s The Harm?, funded by eating disorder charity beat and internet safety organisation Childnet International, hundreds of websites that encourage extreme dieting and eating disorders are being used with alarming regularity.

The research by University Campus Suffolk notes how ‘pro-ana’ sites, which promote the eating disorder anorexia nervosa, encourage weight loss via dieting competitions, advocate diets of just 400-500 calories per day and champion “thinspiration” (where images of celebrities such as Victoria Beckham and Keira Knightley are used to idealise a certain look).

According to the report, these websites are extremely influential. Many boast communities of thousands of members, with forums and chat rooms available to share tips to hide eating disorders and find an “anabuddy” for support.

Natasha Devon, co-founder of Body Gossip, a campaign that promotes natural, healthy and realistic beauty, said that although the intentions of sites are not always intended to be damaging, the emotional state and vulnerability of users often leads to mutual encouragement.

She told HuffPost UK Lifestyle: “People assume they would automatically know if they were on a pro-anorexia or pro-bulimia website. The press often portrays them as being quite obvious in their intention.

“The reality is that quite often they are just support groups set up on social networking sites by people with the best intentions, but they attract users who are unwell and are completely unregulated.

“It’s important to remember that eating disorders are a mental illness. Even if you’re on an ‘extreme diet’ or training regime you’re not in the best frame of mind. People who still struggle are certainly not in a position to be giving advice to others. Often users of these support groups simply egg each other on.”

In a statement, Dr Emma Bond, author of the report and senior lecturer in Childhood and Youth Studies at University Campus Suffolk (UCS) outlined her recommendations for change:

“People, especially parents and teachers need to increase their awareness so that young people can be helped. We need to encourage young people to develop critical media literacy skills and the media should be more responsible in not publishing pictures of very thin models and celebrities because young people wish to emulate them.

“Eating disorders are not going away, if anything they are becoming more common. We need to alert people to the dangers of harmful content on the Internet. Everyone needs to understand better the risks online and the harm that eating disorders can do to young people”

The report was funded by social investor Nominet Trust.

More children have anorexia than previously thought, study finds

Tags

anorexia, bulimia, Children, Eating Disorders, hospitalisation, treatment

2011:

More children have anorexia than previously thought, study finds

More than two and a half times as many children under 10 have anorexia nervosa as previously thought, according to the first study into eating disorders among British children.

On average, 1.5 in every 200,000 British children under 10 have anorexia, according to experts from the UCL (University College London) Institute of Child Health, who carried out the research.

Direct comparison with previous UK data is limited but a general practice registry study in the early 1990s found an incidence estimate of 0.6 per 200,000 for anorexia among children aged up to nine.

The findings have shocked experts, who called for “urgent action” to help save young lives. There are no national paediatric guidelines for the care of individuals with eating disorders.

“Recognition of eating disorders in children by GPs can be poor and, unfortunately, many eating disorder services are aimed specifically at adolescents,” said Dr Dasha Nicholls, a consultant child and adolescent psychiatrist at the UCL Institute of Child Health and the study’s lead researcher.

“Childhood eating disorders are not quick or easy to treat. For a minority of children it may be the start of a severe and enduring illness, with death rates comparable to some forms of leukaemia.

“Early-onset eating disorders – defined as those starting before 13 years of age – represent a significant clinical burden to paediatric and mental health services. Efforts to improve early detection are needed but our study also shows there is an urgent need to consider the needs of children with eating disorders separately – and not simply lower the age range of existing adolescent services,” said Nicholls.

Most of the 208 patients in Nicholls’s study were girls – 82% – but boys accounted for almost one in five cases.

More than 80% of the children in the study, to be published in the British Journal of Psychiatry, had an anorexia-like illness: 37% had diagnosable symptoms while 43% were classified as having an “unspecified eating disorder” because although they showed symptoms of anorexia they were not underweight. Only 4% had bulimia.

An additional one in five children had symptoms of disordered eating, such as food avoidance and being underweight, but did not have a preoccupation with their weight or shape.

Half were admitted to hospital, over 70% of whom had anorexia. After a year, almost two thirds were still receiving treatment. 73% had improved but 6% were worse and 10% unchanged.

Almost 44% of the children had a close family member with a history of mental illness, most commonly anxiety or depression. Another fifth had a history of early feeding problems, particularly fussy or picky eating.

Studies suggest that although the incidence of eating disorders has been fairly static over the past few decades, anorexia is being diagnosed among children in increasingly younger age groups.

Data on the rate and outcome of early-onset eating disorders is sparse. The National Inpatient Child & Adolescent Psychiatric Survey found that eating disorders were the most common diagnosis among child and adolescent psychiatric in-patients in England and Wales, 9.2% of whom were under 13.

The survey, however, did not include children on paediatric wards. “Ours are the first published data on the scale of paediatric resource used by this patient group in the British Isles,” said Nicholls.

Previous research from the NHS Information Centre has found that children aged 14 to 16 account for one in every three patients treated in hospital for an eating disorder, an 11% rise on the 2,316 cases recorded for the previous 12 months.

The centre’s data, however, found only a “small number” of 10-year-olds diagnosed with conditions including anorexia and bulimia.

A 1999 Office for National Statistics study found 0.3% of 11- to 15-year-olds had an eating disorder, with no one in the five- to 10-year-old age group.

The new study found wide variation in confidence among paediatricians over how to treat children. “This study provides the baseline figures needed to determine whether increases in hospitalisation rates are real or perceived, and can aid planning of age-appropriate services,” said Nicholls.

Because the new study gives the first estimate of the incidence of early-onset eating disorders, Nicholls said she was unable to say if there has been a rise in this group. “But we hope our research can be used as a baseline from which to monitor future trends,” she added.

The findings have galvanised concern that society’s obsession with physical appearance is making children become body-conscious at an increasingly early age. Blame has been placed on everything from poor parenting to the media and websites such as Facebook.

 Miranda

When Miranda turned eight, her parents took her to a pizza parlour to celebrate. For any other child, it would have been a common enough treat. But for Miranda, the trip was nothing short of momentous – as it signified a return to health.

Now 11, Miranda finds it hard to remember why, at seven, she developed an eating disorder so severe that she stopped eating and drinking and ended up almost 10kg underweight, with a body mass index (BMI) of 12.5. (A BMI of under 18.5 is officially underweight.)

“I remember living in a clinic with other children. None of us could eat normally,” she said. “I was there for five months. They said I had food avoidance emotional disorder. I don’t know where it came from but in my diary, I said it was like having a pixie in my tummy. The pixie was like the devil. When I wanted to eat, the pixie would fight me. At the beginning, in my diary, I said the pixie was stronger than me. But then I got stronger than him. I remember it being like he got smaller and I got bigger. The pixie’s not in my tummy any more. I hope he never comes back.”

Hospital admissions for eating disorders jump 16 per cent

Tags

anorexia, binge eating, bulimia, Children, control, diagnosis, Eating Disorders, GPs, hospitalisation, low self-esteem, osteoporosis, suicide, treatment, young people

Hospital admissions for eating disorders jump 16 per cent

Hospital admissions for eating disorders,  which carry the highest death rate of any psychiatric condition, have leapt 16 per cent in the last year and are up by almost 50 per cent in a decade.

Experts blamed the rise on a failure by doctors to diagnose those affected early in the course of their illness, before it takes hold. There has been no increase in eating disorders overall  for 20 years.

The Health and Social Care Information Centre (HSCIC) said there were 2,290 admissions of adults and children with eating disorders, including anorexia, bulimia and related conditions in the year leading to June 2012.

That is a 48 per cent increase on the 1,533 admissions a decade ago  in 2002-3. More than nine out of ten patients were female and over half were young people aged from 10 to 19. The ages ranged from under 5 to over 60.

The small number of very young children hospitalised (under age 10)   are thought to have had mechanical problems with eating, distinct from the psychiatric condition, a spokesperson for the HSCIC said.

The eating disorders anorexia and bulimia are associated with low self esteem and a desire for control which becomes linked with body shape, size and weight. They carry a high risk of death by suicide or starvation, rising to 20 per cent after 20 years.

The US singer Karen Carpenter,  Scottish child star and TV host Lena Zavaroni and  Brazilian model Ana Carolina Reston are among celebrities who have died from anorexia.

The eating disorders charity b-eat said a media and social culture which  focused on women’s weight and shape aggravated the condition, though it did not cause it. An estimated 1.6 million people suffer from eating disorders.

Susan Ringwood, chief executive of B-eat, said: “I spoke to a 12 year old girl who said: ‘ Why have I got to go to hospital when they [celebrities] are on the front of the magazine.’ It reinforces their view that they are not ill – trapping them in their illness.”

She added:  “We know that 40 per cent of callers to our helpline have not spoken to a health professional. Lots are not putting themselves forward. Studies show community treatment has better outcomes but it is very variable across the country. People are not getting early treatment. Hospital admission is a last resort.”

The longer the condition went “unchallenged” the more serious the consequences, she said, including osteoporosis (thinning of the bones) caused by poor diet.

“We see girls of 20 with the skeleton of 80 year olds,” she said.

Dr Lucy Serpell, a clinical psychologist at University College London and expert in eating disorders, said: “The problem is the lack of good out-patient treatment and the failure of GPs to pick up the disorder and refer. When the patients come to us they are so unwell we have to get them to hospital to be stabilised. We don’t like admitting 15 year olds to hospital.”

An outpatient service for eating disorders established three years ago in north east London had seen admissions fall in three of the four boroughs where it was available – but not in the remaining one.

“We can see the difference – patients get admitted to hospital more in the fourth borough because they are not being treated soon enough. All the evidence shows people are better off where there is a specialist service.”

In anorexia sufferers lose weight rapidly, becoming skeletal and ill. Bulimia typically starts with an effort to restrict the diet severely, but this cannot be sustained and ends with a binge, followed by vomiting and the cycle begins again. Eating is the one area of their lives that they feel they can control.

Case Study

“I think it is mainly the pressure to look a certain way in the media”

Charlie Crompton, 21, spent six months in hospital when she was 17 after an eating disorder led to her weight plummeting to five stone.

“It started when I was 15 but it wasn’t until I was 17 that I was admitted to hospital. At my worst I weighed five stone. My mum had been pressuring me to go to the doctors as I was just getting thinner and thinner, they kept weighing me and I kept losing weight so the next step was hospitalisation. I think my illness was due to lots of different reasons. Just growing up is hard sometimes. I was also under a lot of exam pressure and I felt under pressure from my friends and the media to look a certain way. I wanted to look good.

Looking back it now all seems very strange. I think that when you’re ill your brain isn’t working properly so you can’t really understand what’s happening or why you are acting the way you are acting. I didn’t realise I was ill. In hospital they put you on a feeding routine to get you back into eating. That restores your weight and as your weight comes back up your brain starts to work normally again. When you have gained enough weight they let you out of hospital and you start therapy to stop you doing it again.

“For me I had actually booked a holiday about a year before so I needed to get out of hospital to go to America. I don’t think they were convinced I was ready but I was really determined not to miss that trip. I was discharged on the Friday and went on holiday on the Monday on condition that I had lots of checkups and support as soon as I got back.

“I’ve now been recovered for almost four years. I can understand why the figures might show a big increase in teenage girls being admitted to hospital. I think it is mainly the pressure to look a certain way in the media. But there’s also a lot more awareness nowadays so perhaps it is also that more people are coming forward for help.”

 

Not just a boy thing: how doctors are letting down girls with autism

Tags

aggression, anxiety, Depression, Eating Disorders, emotions, gender, mental health issues, misdiagnosis, OCD, relationships, social exclusion, stress, tics, vulnerability

Not just a boy thing: how doctors are letting down girls with autism

Annette Lewns has more experience than most of the different ways in which boys and girls with autism are treated. Her 14-year-old son, Ryan, was diagnosed when he was three and a half. But doctors refused to diagnose her 12-year-old daughter, Rachel, until she was nine.

“What angers me is that for years I was dismissed by doctors purely because Rachel was a girl. Ryan was spotted very quickly because the autism symptoms that doctors look for are so male-orientated,” said Lewns. “But Rachel’s autism was hidden unless you knew where to look for it.

“Rachel could express herself, she had a couple of friends and understood emotions if someone was at an extreme: really upset or really happy. But you didn’t really have to look too hard to see she didn’t genuinely understand emotions or relationships: she was just mimicking scripts and scenarios from TV.”

“The doctors failed time and time again to see through her coping strategies. I fought for years but I was confronted with a wall of disbelief and scepticism. They were simply unable to understand that a girl might present differently to a boy.”

While Ryan’s condition was acknowledged by their local authority, and he is now at a specialist school, Rachel continues to struggle at a mainstream school. “Ryan is being taught all sorts of tools and techniques to cope with his condition but Rachel is not,” said Lewns.

Estimates of the ratio of females to males diagnosed with Asperger’s syndrome or high-functioning autism varies from 1:4 to 1:10. No one understands this gender disparity: whether women really are less likely to be on the spectrum than men – or whether doctors are failing to spot the disorder in women.

Opinions are divided: Richard Mills, director of research at the National Autistic Society (NAS) says he “would not be surprised” if the true ratio was twice as high, with one woman on the spectrum for every two men. Dr Judith Gould, director of the NAS’s Lorna Wing Centre, thinks the ratio could be even narrower, with 1:1.5 female:male.

We may soon have an answer. Mills is leading the UK arm of a two-year international programme, Autism in Pink, which will look at the condition in women, focusing on the stress, social exclusion, vulnerability and misdiagnosis they suffer.

It follows concerns about reluctance to diagnose women. One recent survey by NAS found girls may wait longer than boys for a diagnosis and are more likely to be misdiagnosed: just one-fifth of girls with Asperger’s syndrome who responded to the survey were diagnosed by the age of 11, compared with half of boys.

The UK is leading the research side of the programme. Last week, Mills signed up the first two of the 12 women with Asperger’s he needs to work with researchers over a two-year period.

“I hope the programme will be the first step to ending the current trend for gender to be a barrier to diagnosis and post-diagnostic support,” he said. “Because research in the past has largely concentrated on males, the way we understand autism tends to be very much based on the experiences of men and boys with the condition. People are reluctant, for some reason, to make a diagnosis in girls and women.”

This reluctance is exacerbated by the fact that girls and women with Asperger’s or high-functioning autism can be more adaptive than boys: they are commonly better at hiding things or seeming more sociable, masking what doctors traditionally think of as the signs of autism.

But the strain of trying to appear “normal” can be immensely stressful. Gould said it results in “many of the girls we see having developed secondary problems such as anxiety, eating disorders or depression”.

This can also mean that misdiagnosis of girls and women is also a problem. The survey found 42% of females had been wrongly told they suffered psychiatric, personality or eating disorders, compared with 30% of males.

There is also the problem that the gender difference becomes a self-fulfilling prophecy: because more males are diagnosed than females, it is their symptoms and behaviours that experts have studied. The so-called screening tools, developed to help diagnosticians spot the syndrome, focus on culturally “male” interests, such as computers, trains and cars, rather than things more likely to appeal to a girl, such as animals, soap operas or fashion. Gould is rewriting the NAS’s diagnostic interview for social and communication disorders to include “gender-neutral” cues.

Even when an accurate assessment is given, however, it is no guarantee that the necessary support and help will materialise: the NAS survey found women continue to struggle after diagnosis, with half of females with Asperger’s or high-functioning autism – compared with 39% of males – saying it made no difference to the support they received.

Lucy Clapham, 25, spent years being turned away by doctors who insisted “girls don’t get autism” and told her to simply “act normal and read female magazines”. “I am certain that my diagnosis was delayed because of the fact that I am a girl,” she said. “My mum first noticed something when I was about six but our GP laughed at the suggestion. I’ve gone to counsellors, doctors and psychiatrists but all of them, including my teachers, refused to see I had classic autism even though I had casebook symptoms: almost no speech until I was five, no friends, hours spent staring at the washing machine, lining toys up and flicking my fingers in front of my eyes.”

When she was 12, Clapham became violent, aggressive and developed multiple tics, obsessions and compulsions. “I stopped talking outside of the house and sunk into an inner world,” she said.

After two more years and about eight counsellors, Clapham’s GP referred her to a child psychiatrist. “She was adamant that girls didn’t get autism, they just had ‘traits’,” said Clapham. “She claimed that I just needed to ‘act normal’ and that by buying nice clothes and reading women’s magazines I could learn to be ‘normal’. The only diagnosis I received from her was depression and anxiety.”

After leaving the children’s mental health service “none the wiser and possibly with more mental health problems than when I had arrived”, Clapham was sent to the adult mental health service and, after a long battle, to the Maudsley hospital in London, where she was finally diagnosed with autism, Tourette syndrome and obsessive-compulsive disorder.

“I was still refused services, however, partly because there were none available and partly because our local authority was not willing to fund an out-of-town, specialist autism service,” said Clapham. “I ended up getting sent to a college for the blind where I developed more mental health problems and became very aggressive because no one understood me or my autistic behaviour.

“When I was 20, I ended up in care because my mother couldn’t cope with my aggression and anxiety.”

Clapham stayed there for three years but still struggles. “Despite my diagnoses, some people still seem to believe that autism is a ‘boy thing’,” she said.

There is no clear understanding about how many girls and women are being missed – or wrongly diagnosed – and for how long. But that may soon change: the first neuroimaging analysis of women and men, with and without ASD, has been under way for the past two and a half years at King’s College’s Institute of Psychiatry (IoP) and the Autism Research Centre at the University of Cambridge. It’s hoped this research could provide the clues. The final stage of the project is about to begin, with results expected in months.

“It’s very exciting,” said Dr Michael Craig, a senior lecturer and honorary consultant at the IoP’s department of forensic and neurodevelopmental sciences. “We could well be looking at gender-specific treatments for Asperger’s being developed in quite a short period of time.”

What is autism?

First identified in the 1940s, autism is a developmental disability that lasts a lifetime and affects someone’s interaction with other people – how they communicate with and relate to them. It is a spectrum condition, affecting some more seriously than others. While some lead fairly independent lives, others suffer serious learning disabilities and need extensive support. Many who have an autism spectrum disorder can be badly affected because they have trouble processing sounds, sights and smells.

Around half a million people in the UK have autism, according to the National Autistic Society (NAS). What causes it is still unclear. “There is strong evidence to suggest that autism can be caused by a variety of physical factors, all of which affect brain development. It is not due to emotional deprivation or the way a person has been brought up,” the NAS says. Genetic factors are assumed to be responsible, and scientists are trying to pin down which genes are involved. Genetic testing to enable earlier diagnosis is therefore still a long way off.

Many people are not diagnosed until they reach adulthood. A recent NAS study of more than 8,000 people with autism, parents and carers found 52% were initially misdiagnosed. One in three adults with the condition say they have developed serious mental health problems because they have not received enough support to help them cope with the difficulties autism brings.

Girls petition for Teen Vogue to put an end to airbrushed photos

Tags

airbrush, Depression, Eating Disorders, magazines, photoshop, Self-esteem, sexualisation

Girls petition for Teen Vogue to put an end to airbrushed photos

Teenagers Carina Cruz and Emma Stydahar delivered a 28,000 signature petition to Teen Vogue today to express their distaste for the common magazine practice of airbrushing images.

A group of approximately 10 girls staged a protest fashion show outside the Condé Nast building in Times Square to deliver the petition. Smiling for the cameras, the teenagers walked up and down a makeshift runway (which consisted of a 15-foot long red carpet produced by one of the activists and rolled out on Broadway) holding placards like “Let’s get real – all girls are beautiful” and “Teen Vogue #KeepItReal.”

“I don’t think girls should grow up in a world where beauty magazines dictate they should have a low self-esteem,” said Emma Stydahar, 17, a high school senior from Croton-on-Hudson, New York.

According to Stydahar, 75% of girls get depressed within three minutes of shuffling through a beauty magazine’s pages because the beauty patterns they convey as ideal are unattainable.

“Images that have been photoshopped have a bad effect and can really hurt young girls. We’re looking for more diversity of girls and body types [in these publications],” added Stydahar, whose younger sister, Hanah, 14, was also at the protest and said she wants to follow in her older sister’s footsteps.

The girls were part of a similar fashion shoot outside the offices of Seventeen magazine in May, when a 15,000-signature petition requesting the magazine to promise one un-photoshopped spread a month was delivered to the magazine’s editor-in-chief Ann Shoket.

Julia Bluhm, 14, along with Stydahar and Cruz, is a member of Sparksummit, an activist movement demanding the end to the sexualization of girls and women in the media. Bluhm’s petition quickly gained support after the Seventeen magazine action and ended with more than 84,000 signatures.

In Seventeen’s August issue, the editor promised to limit photo-editing to things like stray hair and zits, but not bodies. She also said the magazine would post before and after pictures on the magazine’s Tumblr.

“We’re focusing on Teen Vogue now, and then we’ll see what happens,” said Stydahar.

To organize the action, Stydahar started a petition on Change.org, an online social action platform, with activist friend Carina Cruz, 16.

“They are one of the lead mags on teen fashion, and if we can accomplish something with them then hopefully we can keep going,” said Cruz.

Teen Vogue has an audience of more than 3.5 million readers, 93% of whom are female. Outside their offices on Wednesday, the makeshift photoshoot was meant to show the magazine what kind of girls they would want to see on the cover of the popular fashion magazine.

In an official statement, Teen Vogue said: “Teen Vogue makes a conscious and continuous effort to promote a positive body image among our readers. We feature healthy models on the pages of our magazine and shoot dozens of non-models and readers every year and do not retouch them to alter their body size. Teen Vogue pledges to continue this practice.”

The magazine’s adult-targeted inspiration, Vogue, announced in May that it would only use models who are aged over 16 years and who, based on the editor’s judgment, do not have eating disorders.

Stydahar’s mom, Sheila Kelly, 54, attended the protests and told the Guardian: “I think it’s wonderful what they’re doing. They’re constantly bombarded with images that are overly sexualized and unattainable, and that clearly don’t contribute to their self-esteem.”

Kelly was a feminist activist in the late 70s in Chicago, where she went to DePaul university.

“I think young women are very active again, and with social media you can get your message out much quicker,” said Kelly.