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Dublin: 12 °C Monday 20 May, 2013

Column: Dying to be thin – what you should know about eating disorders

As part of Eating Disorder Awareness Week, psychologist Deirdre Ryan removes the misconceptions surrounding this group of devastating illnesses – and explains how to approach a loved one in pain.

Deirdre Ryan

DURING THE 20th century, a relatively unheard of and very serious form of anxiety began to emerge; this new behaviour is now recognised universally as ‘eating disorders’. The prevalence of eating disorders began to occur rapidly in the late 1960s and they currently rank among the 10 leading causes of disability among young women and adolescents.

It has been reported that as many as 80 per cent of women display symptoms at some point during their lifetime, with the UK reporting a 67 per cent increase in the number of men treated for an eating disorder in the last five years. Individuals with an eating disorder have the highest levels of inpatient hospitalisation, suicide attempts and mortality of the most common psychiatric syndromes, as well as an increased risk of the onset of obesity, depression, and substance abuse.

In Ireland, the Department of Health estimates that up to 200,000 people may be affected by eating disorders, with 400 new cases emerging each year, representing 80 deaths annually. The demographic is also getting younger, with children as young as five presenting with eating disorder symptoms.

Worrying trend on the rise

“Western” culture’s beauty ideal, which glorifies extreme thinness and objectifies the body, is a key risk factor for the development of an eating disorder. Thinness has come to symbolise certain concepts within western culture, such as self-discipline, control, sexual liberation, assertiveness and competitiveness, as well as affiliation with higher socioeconomic classes.

Research has found that exposure to this ‘thin ideal’ produces depression, shame, guilt, body image dissatisfaction, and stress. One study reported that after only three minutes of viewing a fashion magazine, 70 per cent of the women who took part felt depressed, guilty and shameful. There is also a growing imbalance between what is realistic and what is ideal, with the gap between ‘us’ and ‘them’ widening. The average woman is now 5’ 4” and weighs 10 stone. In contrast, the average fashion model is 5’11” and weighs 8 stone. Twenty years ago, models weighed 8 per cent less than the average woman. Today, they weigh 23 per cent less.

However, while the media may have a role to play in the development of an eating disorder, there are a number of other risk factors, such as body dissatisfaction, dieting, low self-esteem, perfectionism, childhood sexual abuse and a family history of eating disorders.

About Eating Disorders

Eating disorders are characterised by severe disturbances in eating, emotional and psychological distress and physical consequences. They are complex and sometimes life-threatening, but people can – and do – get better. Often mistaken to be primarily about food, eating disorders are more related to a way of coping with feelings too uncomfortable to disclose. They are not a ‘lifestyle choice’, ‘just a teenage thing’, ‘a faddy diet’, ‘a phase’ or just ‘a women issue’.

People experiencing an eating disorder share many of the following features:

  • A history of dieting
  • Low self -esteem
  • An over-concern with body size
  • View thinness as a magical solution
  • Have a distorted body image
  • Problems around control
  • Find it hard to talk about feelings
  • Feel isolated
  • Experience mood swings

Types of Eating Disorders

Anorexia Nervosa

People with anorexia will continually starve themselves and may become underweight but will view themselves as overweight. They will be preoccupied with thoughts about food and the need to lose weight. They may exercise excessively and may vomit or take laxatives. Anorexia has the highest mortality rate of all mental disorders.

Bulimia Nervosa

A person with bulimia may binge eat and then try to get rid of food through dangerous behaviours such as vomiting, excessive exercising, laxatives, diuretics and other medications. People with bulimia often maintain a body weight within the normal range for their age, sex and height, so it may go unnoticed for a long time.

Binge Eating Disorder (also known as compulsive eating)

A person with Binge Eating Disorder may eat large amounts of food but does not try to get rid of it. They may gain considerable amounts of weight over time and are trapped in a lonely cycle of dieting, bingeing, self- recrimination and self- loathing.

Approaching Someone

If you are worried that someone you care about may be suffering from an eating disorder, it can seem very difficult to start that first conversation about such a sensitive issue.

You should remember that by asking someone how they are feeling you are showing them that they have a support network around them – your concern will not make anything bad happen. The first step towards recovery is being able to acknowledge that there’s a problem; by approaching someone you are giving them the opportunity to take that first step.

Choose an appropriate time and place and gently let the person know you are concerned. Let them know you care for them and describe specifically what you have observed that has made you concerned. Don’t be discouraged if your approach is met by resistance and don’t be surprised if they deny there is a problem.

Do ask the person what they need from you to help reduce the stresses they are experiencing, but be honest with them about your own limits. Don’t put pressure on the person to make immediate changes to their behaviour but let the person know that you are there for them to discuss the issue further if they want to do that.

For more information please see www.bodywhys.ie.

Deirdre Ryan is a psychologist at St Vincent’s Hospital, Fairview. She holds a B.Sc and Masters in psychology and is currently in the final stages of completing a Doctorate in Clinical Psychology at the NUI, Galway. She recently worked in partnership with Bodywhys to investigate a prevention programme for eating disorders in adolescents and has expanded this research into primary schools. Her children’s book ‘The Magnificent Toby Plum’, written in collaboration Dr Deirdre Cowman, aims to promote a healthy body image in children. To contact Deirdre please e-mail: d.ryan31@nuigalway.ie.

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Comments (22 Comments)

  • My mum died just over a month ago from anorexia. She was 58. She was 24 kilos when last weighed. By that time she couldn’t walk and could barely talk. ( which ironically, were the 2 things she was most fondly remebered for: walking and talking) The hospital did what it could but she fell between 2 stools. She was shunted from medical to psychiatric and back again. The more people who realise that this disease is lethal the better which us why I post this.

    Reply
    • That is heartbreaking Stiofan. May your mum rest in peace & I hope that you and family get all the support you need at this very difficult time.
      Thank you for sharing this and highlighting the fact that this isn’t just a young persons/teenage disease, and that its not a “fad” but a really serious illness.

      Reply
  • Great article, at 5″3.5 and 10 stone I am bang on average and am now going to stop feeling guilty when I see taller thinner women! I think it’s important to get that message across to Irish women, it’s ok to be 10 stone!!

    Reply
  • It’s disgraceful that the Department acknowledges that there’s 200,000 people with an eating disorder, yet as of 2009, was still only funding three public hospital beds to combat eating disorders. I’m guessing that hasn’t been increased since the article below was published.

    http://www.independent.ie/woman/diet-fitness/still-only-three-public-beds-to-cater-for-eating-disorders-26523130.html

    Reply
  • I know so many people who either ARE battling or HAVE battled eating disorders and they are truly awful disorders to deal with. The one shortcoming of this article is that it doesn’t mention that increasingly more guys are developing eating disorders too. Not as many, but they’re definitely there.

    Reply
    • Hi B, Thanks so much for reading the article and posting a comment. You are absolutely right about the increase in males presenting with an eating disorder and it is an area that receives little attention. The report above among mentions that there has been a 67% increase in males presenting with eating disorders in the UK in the last 5 years, however, Irish stats on this have yet to be released.

      Thanks again

      Deirdre Ryan

      Reply
    • Shona 13/02/13 #

      The increase in men with eating disorders is mentioned in paragraph 2.

      Reply
    • Doh. Didn’t spot that. That means no shortcomings so. I fully acknowledge my error and accept the Hat Of Comment Shame. *Facepalm*

      Reply
  • Great article, the more people learn about this area the better. I agree wholeheartedly with Caoimhe the best way to deal with these issues like this is to talk with qualified professional mental health professionals. Lets get Ireland talking and reduce the stigma across all mental health issues.

    Please visit organisations like Bodywhys for more information on this subject and also http://www.helplink.ie for information on health services (public and private) across Ireland including charities and support groups.

    Reply
  • i am ceoliac and have a young lady who cooks for me, she is anorexic. its very strange indeed, to be in this situation but i have told her i am concerned and i have discovered some of the whys for this young lady. i wish i could do more. i am not her mother, but i just want to reach out to her, i adore her, she is a lovely young lady and very young for her age. she is getting help and so far is maintaining her weight, she dropped down again for a while but i think has improved a bit at present. its so so worrying and i feel so bloody helpless. she is still far too thin indeed.

    Reply
  • fads to follow lead to it becoming a damaging behavioural response to needing and feeling bad about ones body. all start off on the dieting track, and then it becomes more than this.
    i believe its based in trauma. something makes a person begin and its about feeling bad inside i believe.

    Reply
  • This artical failed to mention that the number of cases of Children developing an eating disorder as young as age 5 is on the increase. Children are becoming much more boday aware and are following a very dangerous trend of not eating lunch in school and surviving on an apple and water for long periods of the day. Children as young as 5 know the calorie count of anything that goes into their mouth. How did they learn this? When did our children learn that being thin was so important? Who is to blame for sending messages out to such young children that it is normal to be so sickly thin…
    An article in the journal that covers eating disorders in children:
    http://www.thejournal.ie/children-as-young-as-five-years-old-suffering-from-eating-disorders-84001-Feb2011/

    Reply
    • Hi Julie Ann, Thanks do much for reading the article & thanks for the link to the article I did with journalist Jennifer Wade last year. It is a particular area of interest of mine & as mentioned myself & my colleague have written a children’s book aimed at promoting a healthy body image in kids. As well as that I have been visiting primary schools & piloting a prevention programme for eating disorders. You’ll notice in the third or fourth paragraphing the article above I mention that the demographic is getting younger with children as young as five presenting with eating disorder symptoms. It is a very worrying trend & one that certainly needs attention. Thanks again for the feedback.

      Deirdre Ryan

      Reply
    • Hi Deirdre, While I felt it was a very well written artical I felt it was a bit focused on woman’ with only one line mentioned to children and men. I felt that a lot of the advice would not be relevent in the area of children as we have to ask ourself how did our children develop their body image by age 5? I am glad to see more research into this area and look forward to seeing more reports on this topic.

      Reply
    • Hi Julie Ann,

      You are absolutely right and more articles directed towards men and children in this area would be really valuable. I will be writing an article addressing the issue of children and body image dissatisfaction over the next few weeks.
      Thanks again

      Reply
  • The best way to keep the weight off is to eat properly and keep fit, no need for any diets if you follow this.

    Reply
    • Its not really a weight issue. Its a mental illness.

      Reply
    • In my own experience, thinkning of anorexia as a mental illness makes recovery more difficult. Very few people with eating disorders have any kind of organic illness. The disorder mimics “sickness”; the sufferer can appear ill as she (usually) is thin in a food-rich environment but this thinness is totally a result of a restricted diet and resolves once normal eating resumes.
      Seeing eating disorders as illnesses can be unhelpful as contributes to a battle of wills where the sufferer is pitted against family and professionals who feel the first step to recovery is for her to “accept” that she is sick. It is fact much more shocking, and more challenging, to think that the people who are doing this to themselves are healthy.
      As for the obsession with food, cookbooks and dieting, these have been shown to be the result of calorie restriction rather than its cause. (I can’t rememebr the name of the study but it’s fairly well-known). Starving is a way of coping with life’s problems; its origins are developmental rather than pathological.

      Reply
  • I dont think its entirely a mental illness, for some yes it’s a serious issue but for others I believe its a fad to follow.

    Reply

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