Next week marks the 2014 Eating Disorder Awareness Week, with activities and events planned to increase understanding of eating disorders.
In Ireland, the Department of Health estimates that up to 200,000 people are affected by eating disorders. However, this statistic is dated and many Irish health professionals believe the number may be a great deal higher.
Much publicised in the news last week was the results of a study in the latest edition of the Irish Medical Journal, which found the average age of admission for children with anorexia to Temple Street Children’s Hospital had dropped to 13.5 years. Looking to admissions in other care facilities, HRB data from 2008 on child and adolescent psychiatric admissions in Ireland showed that eating disorders represented the second highest level of diagnosis at 18%.
Eating disorders are serious and complex mental health conditions with the highest mortality rate of all psychiatric disorders. Despite this, they are frequently misunderstood, and there are many misconceptions about what an eating disorder is.
The main categories of eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. Anorexia is characterised by a refusal to maintain body weight at or above a minimally normal weight for age and height. Intense fear of gaining weight and disturbance in how body shape is experienced are also features.
Bulimia is characterised by repeated episodes of binge eating followed by behaviour aimed at compensating for this (e.g. fasting, self-induced vomiting, use of laxatives and diuretics, or excessive exercising).
Most people are aware of anorexia and bulimia. Fewer know that binge eating disorder is also diagnostically classified as an eating disorder. Binge eating disorder is characterised by periods of binge eating or overeating (at least once a week for three months) without compensatory behaviours, although phases of dieting are common.
A major misconception is that only young, westernised women are affected by eating disorders. Firstly, an eating disorder is by no means a gendered disorder. A nationally representative Harvard study published in 2007 estimated that 25% of bulimia and anorexia cases in the US are male, alongside almost 40% of binge eating disorder cases.
The consequence of eating disorders being tagged as a “woman’s disorder” can be twofold, in that the stigma this brings can be an obstacle for a male acknowledging that they are experiencing an eating disorder both to themselves, and to others. In addition, men with eating disorders could fail to be diagnosed, have a delayed diagnosis, or receive a misdiagnosis (e.g. suffering depression with associated appetite changes).
Secondly, eating disorders are not something that only young people experience. While some cases of eating disorders in older populations had an initial onset in adolescence, a 2001 study found that eating disorders can also have an initial onset after the age of 40.
Finally, eating disorders are not unique to western culture. A 2001 study in the International Journal of Eating Disorders compared a group of female Iranian students living in Tehran to students of Iranian descent living in Los Angeles. There was no difference in disordered eating between groups. The researchers concluded that exposure to western media and acculturation to western norms does not necessarily predict the development of an eating disorder.
However, evidence does suggest that increased body dissatisfaction is linked to the unhealthy portrayal of the female body in the media. Research shows that even three minutes spent looking at models in a fashion magazine can cause up to 70% of women to feel depressed, guilty, and shameful. Just last year, MEP Nessa Childers called for mandatory labeling of airbrushed photographs in magazines for young people.
Undoubtedly, being constantly bombarded with photoshopped and digitally manipulated images of beautiful people doesn’t do much to serve our self-esteem, but preoccupation with media blaming can allow us to overlook that many other factors contribute to the actual development of an eating disorder.
An eating disorder develops from a combination of factors (biological, socio-cultural, familial and psychological) that are particular to each individual. Certain people can pinpoint a time or event after which the behaviours began, but others cannot.
Arguably, more pressing than the question “why did it start?” is the question “why does it continue?” What function do these seemingly self-destructive behaviours play in a person’s life?
The crucial thing to understand about eating disorders is that controlling food or engaging in disordered eating behaviours (skipping meals, repeated dieting, restricting food intake, vomiting, bingeing, over exercising) provides the person with a sense that they can cope with something they are experiencing as overwhelming or distressing. For a variety of complex reasons, the eating disorder helps the person to feel safe and secure.
It is the ethos of Bodywhys (The Eating Disorder Association of Ireland) that eating disorders should be seen as a way of coping with emotional distress, and as a symptom of underlying issues. Therefore eating disorders are not primarily about food and weight.
According to Jacinta Hastings, CEO of Bodywhys, “Nobody just wakes up one day with an eating disorder. These are conditions that develop over time, sometimes over years and often at a point when life changes bring fear and insecurity.”
Understanding that an eating disorder is a person’s coping mechanism helps those around the person to realise how frightening and difficult it is for the person to let it go as they recover.
That leads to the final and most important point. People with eating disorders can, and do, recover. It is a gradual process and recovery has a very individual meaning for each person.
Like recovery from many illnesses, it is a learning process involving steps forward and steps backward. Alongside appropriate treatment, sensitivity, compassion, respect, and patience, are needed from family and friends if a person is to be successfully encouraged and supported on their journey towards recovery.
For more information on eating disorders, support services, and treatment options, visit www.bodywhys.ie