Explaining tokophobia, the phobia of pregnancy and childbirth

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anxiety, birth, childbirth, distress, fear, hyperarousal, labour, media, negative birth experience, panic, positive birth experience, post-birth PTSD, pregnancy, PTSD, social media, symptoms, tokophobia, trauma, treatment

Explaining tokophobia, the phobia of pregnancy and childbirth

For expectant mothers, it’s very normal to approach birth with a feeling of trepidation, particularly for the first baby. From the moment a pregnancy is announced, the average pregnant woman is inundated with horror stories of pain and long labours by supposed well-meaning friends, and it can be hard to focus on a positive birth experience when you don’t know what to expect.

But for some women, the fear of childbirth goes beyond trepidation into full-blown anxiety, panic and fear. Known as tokophobia, this phobia of childbirth affects somewhere between 3-8 per cent of pregnant women.

Symptoms include worries specifically about the pregnancy and birth, a fear of harm or death related to the birth, poor sleep, and a sense of hyper-arousal (rapid heartbeat and breathing, difficulty winding down). The fear of childbirth is a common non-medical reason for requesting a caesarean section, and women with this fear have a much higher rate of both caesarean delivery and use of epidural anaesthesia.

There is no clear path to developing fear of childbirth, but there are some risk factors that we know about. A history of anxiety or depression is one risk factor, as is a history of childhood abuse, be it sexual, physical or emotional abuse.

Some studies have also identified patterns with age, suggesting younger mums are more vulnerable, as are those with less education, and mums without a strong social network.

However, a recent study found that one of the biggest influences women reported on their fear of childbirth was the media. Hospital-based reality television programs and medical dramas often feature storylines with dramatic emergency situations during childbirth and this may be all women know of giving birth prior to the event.

We also know that around 95 per cent of pregnant European women report searching for pregnancy and birth information online, and social media and blogs hold the potential for the circulation of misinformation that may heighten fears rather than allay them.

There is another group of women who may find pregnancy and childbirth frightening due to related fears. One of the most common phobias in adults is blood/injury phobia, often including a fear of injections. Pregnancy and childbirth is hence very confronting for these women, who may faint or experience extreme distress at even routine blood tests throughout their pregnancy.

Researchers have found that for first time mothers, a positive birth experience can often relieve the fear of childbirth so that it is no longer an issue for future pregnancies. However, whether or not women start with a fear of childbirth, a negative birth experience can make them up to five times more likely to develop tokophobia for future pregnancies.

A negative experience of birth may be due to complications, feeling out of control, dissatisfaction with care providers, or just not having the birth that was expected. Between 2-6 per cent of women report post-traumatic stress syndrome (PTSD) following a difficult birth experience. PTSD is the disorder once known as ‘shell shock’ for its affliction of soldiers following war, and is characterised by nightmares and re-experiencing of the birth trauma, avoidance of all reminders of the birth, and hyper-arousal. Without treatment, PTSD can limit family size and cause problems in women’s relationships with their partner and their child.

While we may not hear much about tokophobia and post-birth PTSD, their prevalence suggests we do need to look out for women who may be suffering both before and after birth. In addition to the distress at the time, stress and anxiety during pregnancy are linked to a higher rate of preterm birth and later behavioural problems in children.

The good news is that like all anxiety disorders, the fear of childbirth and PTSD can be addressed and treatments are available. One of the most vital elements of treatment is education on birth, whether through the obstetric care provider, midwives, or antenatal classes. Knowing what to expect and having an agreed plan with your care provider can assist to overcome some of the irrational fears.

Linked to this, a supportive and trusting relationship with the care providers who will manage the birth is essential. This is not always possible as some obstetric settings do not allow for repeated contact with the same provider, but a relationship of trust will be more likely to create a positive birth experience.

When problems do occur in pregnancy and birth, a post-birth debriefing can be useful and may help prevent the development of PTSD symptoms. Understanding what went wrong and why things happened the way they did can help with processing the events and accompanying trauma.

As with other anxiety disorders, relaxation, light exercise and slow breathing can help to calm the body and relieve the hyper-arousal that comes with the fear of childbirth. A psychologist can assist with other anxiety management techniques that can help to minimise fears.

For those who find the idea of pregnancy and birth overwhelming, it is important to know that help is available and such symptoms can be successfully treated. The first step is confiding your fears so that those around you can start to support you through what could be a wonderful journey.

Schizophrenia: the most misunderstood mental illness?

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diagnosis, discrimination, fear, help, media, mental health issues, paranoia, psychosis, recovery, schizophrenia, shame, silence, stereotypes, stigma

Schizophrenia: the most misunderstood mental illness?

Let’s face it, when most people think about schizophrenia, those thoughts don’t tend to be overly positive. That’s not just a hunch. When my charity, Rethink Mental Illness, Googled the phrase ‘schizophrenics should…’ when researching a potential campaign, we were so distressed by the results, we decided to drop the idea completely. I won’t go into details, but what we found confirmed our worst suspicions.

Schizophrenia affects over 220,000 people in England and is possibly the most stigmatised and misunderstood of all mental illnesses. While mental health stigma is decreasing overall, thanks in large part to the Time to Change anti stigma campaign which we run with Mind, people with schizophrenia are still feared and demonised.

Over 60 per cent of people with mental health problems say the stigma and discrimination they face is so bad, that it’s worse than the symptoms of the illness itself. Stigma ruins lives. It means people end up suffering alone, afraid to tell friends, family and colleagues about what they’re going through. This silence encourages feelings of shame and can ultimately deter people from getting help.

Someone who knows first hand how damaging this stigma can be is 33 year-old Erica Camus*, who was sacked from her job as a university lecturer, after her bosses found out about her schizophrenia diagnosis, which she’d kept hidden from them.

Erica was completely stunned. “It was an awful feeling. The dean said that if I’d been open about my illness at the start, I’d have still got the job. But I don’t believe him. To me, it was blatant discrimination.”

She says that since then, she’s become even more cautious about being open. “I’ve discussed it with lots of people who’re in a similar position, but I still don’t know what the best way is. My strategy now is to avoid telling people unless it’s comes up, although it can be very hard to keep under wraps.”

Dr Joseph Hayes, Clinical fellow in Psychiatry at UCL says negative perceptions of schizophrenia can have a direct impact on patients. “Some people definitely do internalise the shame associated with it. For someone already suffering from paranoia, to feel that people around you perceive you as strange or dangerous can compound things.

“I think part of the problem is that most people who have never experienced psychosis, find it hard to imagine what it’s like. Most of us can relate to depression and anxiety, but a lot of us struggle to empathise with people affected by schizophrenia.”

Another problem is that when schizophrenia is mentioned in the media or portrayed on screen, it’s almost always linked to violence. We see press headlines about ‘schizo’ murderers and fictional characters in film or on TV are often no better. Too often, characters with mental illness are the sinister baddies waiting in the shadows, they’re the ones you’re supposed to be frightened of, not empathise with. This is particularly worrying in light of research by Time to Change, which found that people develop their understanding of mental illness from films, more than any other type of media.

These skewed representations of mental illness have created a false association between schizophrenia and violence in the public imagination. In reality, violence is not a symptom of the illness and those affected are much more likely to be the victim of a crime than the perpetrator.

We never hear from the silent majority, who are quietly getting on with their lives and pose no threat to anyone. We also never hear about people who are able to manage their symptoms and live normal and happy lives.

That’s why working on the Finding Mike campaign, in which mental health campaigner Jonny Benjamin set up a nationwide search to find the stranger who talked him out of taking his own life on Waterloo bridge, was such an incredible experience. Jonny, who has schizophrenia, wanted to thank the man who had saved him and tell him how much his life had changed for the better since that day.

The search captured the public imagination in a way we never could have predicted. Soon #Findmike was trending all over the world and Jonny was making headlines. For me, the best thing about it was seeing a media story about someone with schizophrenia that wasn’t linked to violence and contained a message of hope and recovery. Jonny is living proof that things can get better, no matter how bleak they may seem. This is all too rare.

As the campaign grew bigger by the day, I accompanied Jonny on an endless trail of media interviews. What I found most fascinating about this process was how so many of the journalists and presenters we met, were visibly shocked that this young, handsome, articulate and all-round lovely man in front of them, could possibly have schizophrenia.

Several told Jonny that he ‘didn’t look like a schizophrenic’. One admitted that his mental image of someone with schizophrenia was ‘a man running about with an axe’. It was especially worrying to hear this from journalists, the very people who help shape public understanding of mental illness.

Many of the journalists also suggested that through the campaign, Jonny has become a kind of ‘poster boy’ for schizophrenia and in a way, I think he has.

Jonny has mixed feelings about the label. “I hope that by going public with my story, I’ve got the message out there that it is possible to live with schizophrenia and manage it. It’s not easy, it’s an ongoing battle, but it is possible. But I’m aware that I’m one of the lucky ones. I’ve been given access to the tools I need like CBT, but that’s not most people’s experience. Because of our underfunded mental health system, most people don’t get that kind of support. I can’t possibly represent everyone affected, but I hope I’ve challenged some stereotypes.”

As Jonny rightly says, one person cannot possibly represent such a diverse group of people. Schizophrenia is a very broad diagnosis and each individual experience of the illness is unique. Some people will have one or two episodes and go on make a full recovery, while others will live with the illness for the rest of their lives. Some people are able to work and be independent and others will need a lot of support. Some people reject the diagnosis altogether.

What we really need is a much more varied and nuanced depiction of mental illness in the media that reflects the true diversity of people’s experiences.

What I hope Jonny has managed to do is start a new conversation about schizophrenia. I hope he has made people think twice about their preconceptions of ‘schizophrenics’. And most importantly, I hope he has helped pave the way for many more ‘poster boys’ and girls to have their voices heard too.

For more information, visit Rethink Mental Illness

*Name has been changed

 

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.

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.”