Around 1.25 million people in the UK are affected by an eating disorder. Eating disorder psychiatrist, Dr Dasha Nicholls, provides an insight into this group of complex disorders and the factors that influence them.
It’s common for people to be dismissive when I tell them I work in the eating disorders field. Unless you have suffered from or know someone who has suffered from an eating disorder, the public perception, and indeed the scientific and clinical one often too, is that eating disorders are not serious. Of course, everyone knows of a few high profile people who have suffered or died from an eating disorder, but they may be seen as rare casualties of a celebrity lifestyle.
What many people don’t know is that most people with an eating disorder are of normal or even higher weight, that boys and men are affected too and that eating disorders don’t discriminate by ethnicity or social class. For most people, eating disorders start in the teenage years or young adulthood, but children as young as seven and adults as old as 90 can suffer too. The incidence in children has increased significantly in the past 15 years, for reasons I will speculate on more below.
Not all eating disorders are visible to others
Like most mental health problems, eating disorders are defined by thoughts, feelings and behaviours and not by weight. Eating disorders are therefore often invisible, and sufferers may go for a long time without their problem being noticed. People with eating disorders are often slow to seek help – it takes on average five years for some types of eating disorder – because shame, guilt and self-blame are common.
Anorexia nervosa tends to be noticed before bulimia nervosa and binge eating disorder, because of weight loss. We know from previous studies that by the time help is sought from a health professional it is likely to mean that an eating disorder is emerging, which makes sense if you think about how bad things need to be before it becomes obvious or someone seeks help.
How can you tell if someone has an eating disorder?
One of our studies is looking at the responses given by parents of young people who were later diagnosed with an eating disorder to a question about the first thing they noticed. Surprisingly, this is not a question that has previously been studied much, and yet is crucial if we want to ensure everyone gets the earliest possible access to treatment – we know early intervention improves the prognosis. Doctors often talk about weight loss or weight gain as a key symptom, especially if it has been over a short period or to an extreme degree.
However, the early signs are often more subtle. The thoughts that drive eating disorders are typically a fear of being fat and either a belief that the person cannot control their eating, or that they need to control eating, to an extreme degree. That can look like setting rules around the types of food that can be eaten, the quantity of food or calories consumed, or a belief that for every mouthful eaten, something needs to be done to compensate for it.
Body size perceptions
This brings me to one of the factors that may be contributing to disordered eating behaviour. You will know that the portrayal of fashion models in the media and unrealistic body images seen on social media are thought to contribute to a culture of the thin ideal. Another facet of the culture of thin idealisation is weight stigma. We live in a world where about 60-80% of adults and 20-30% of children in most Western countries are classified as overweight or obese. However, some actions that are being recommended to tackle obesity may be having a negative impact on people with or at risk of eating disorders. We, along with others across the world, are calling for an approach to obesity that does not negatively impact on mental health and well-being, including promoting eating disorders. For example, labelling people as overweight increases the chances of them developing disordered eating, regardless of their actual weight.
Check your own beliefs
We are particularly concerned about how these issues are affecting younger children. Weight stigma (discrimination based on weight) can result in weight-related teasing, as well as driving people who are struggling with managing their weight to take extreme measures. Eating Disorders Awareness Week is a good opportunity to check in with your own beliefs about weight and eating, including whether you hold any negative beliefs about people who are over or underweight. If you find you need some facts to challenge those beliefs, see the Academy for Eating Disorders Nine More Truths about Eating Disorders: Weight and Weight Stigma that I wrote with my friend and colleague Professor Philippa Diedrichs at the Centre for Appearance Research.
There is no doubt that, as with other disease states, the risks of eating disorder psychopathology is individually determined to some extent, and not purely a result of social factors (including social media – that’s a whole other blog I could write). We know more each year about the genetic risks for example, which are both psychiatric and metabolic, and also about the differences in brains including responses to food and body image-related stimuli. We are investigating the reward-related neurocircuitry among those most extremely affected, using an approach that is being used for people who self-harm.
If you need more information or are worried about someone you know, BEAT the UK Eating Disorders Charity, can point you in the right direction.
Dr Dasha Nicholls leads the Child and Adolescent Mental Health research team in the Division of Psychiatry, Department of Brain Sciences. Dr Nicholls was chair of the Eating Disorders Faculty of the Royal College of Psychiatrists.