The recent tragic death of Nikki Grahame at the age of 38 has once again brought the serious issue of eating disorders back into public discourse. Working clinically with an eating disorder is one of the most difficult and problematic issues to treat as a psychotherapist. It is very hard to break a negative pattern of behaviour when the person has come to view that behaviour as something positive.
This is one of the reasons why anorexia nervosa has the highest mortality rate of any mental health disorder. In fact, the mortality rate associated with anorexia nervosa is 12 times higher than the death rate of all causes of death for females 15-24 years old. This should serve as a serious reminder to policymakers, clinicians, teachers and advertisers that we have a responsibility to protect our children and start to roll out collective initiatives that, once and for all, tackle this deadly issue and not merely pay lip service to it.
If Covid 19 has taught us anything when we are all impacted by something we can unite and tackle that issue effectively. Not all of our children will struggle with an eating disorder. But none of our children are immune to one, it can strike at any time, without discrimination. So, the sooner we tackle it, head-on, in a unified systemic way, the safer our children will be.
Recent research shows that Covid 19 has provoked a serious rise in the number of people presenting with an eating disorder. It is very easy to think that someone who suffers with anorexia has just lost control of their diet and they need to just stop dieting. But for many suffering from the illness, it is more about control than it is about losing weight. So, it is easy to understand why a global health crisis that forced teenagers to isolate and eroded all sense of concrete norms caused such a spike in this complicated disorder.
I spoke with Dr Padraic Gibson, clinical director of the OCD Clinic and he said that, "for the anorexic the pleasure is in the control, for the bulimic it’s in the food, for the girl who eats in order to vomit the pleasure is in the compulsive cycle of eating vomiting and sensation".
The word ‘pleasure’ might strike you as odd in Dr Gibson’s description of the phenomenon, but that is exactly why clinicians find it so difficult to treat. I have heard the same narratives for many years from young girls in my clinic. The sense of joy when they skip a meal. It usually follows the same pattern, an emotional disturbance is felt, as a result they punish themselves for those difficult feelings by deciding not to eat, this results in a change of mood. They feel better. This is why it can be so difficult to break, because you are asking a young person to change the behaviour that helps them regulate their emotional distress.
Of course, they have developed a maladaptive way of dealing with their emotions but they don’t see it that way, they only feel the good feelings when their stomach rumbles. I had one young girl tell me recently, "when my stomach rumbled, it was the best feeling of the day". That sense of emptiness in the stomach promotes a sense of pleasure and conversely when they eat they feel incredible guilt and shame. This is why prevention is so important. This is why we need to educate our children and legislate so they are protected from seeing negative reinforcing ideas about the ideal body weight. Because treating it is incredibly difficult. And, if the truth was told, most psychotherapists/counsellors have not been trained adequately to deal with this issue.
Of course, weight loss can be the reason why a young girl or boy decides to restrict their food intake. And it is very important, as parents, we do not promote an idea of the ideal body weight. I hear this so often in my clinic, a young girl recalling how she first came to think about weight and her own body image. It begins with watching TV and parents commenting negatively about the size of someone on a show. The child is listening and internalising these comments. The child is learning to speak to themselves in a negative way about their image, because if that person on TV is the subject of ridicule, they too will be laughed at if they don’t watch their body image. Such an insidious and slow envelopment of the child’s thought process takes place when they hear this type of negative commentary.
We have to be careful how we talk to our children about food and body image. We have to, as a society, restrict the negative images our children receive about the ideal body weight. So many of the issues I meet, started with what the parents believed was an interest in healthy eating and evolved into pathology. We have to be careful about what messages our children receive. Advertisers should no longer be allowed display images of sickly thin models on billboards or magazines, we need our government to step in and step up here and protect our children.
The death of another girl at the hands of this terribly complicated disorder should remind us all of the need for a collective and unified approach to this issue. Schools must educate more, psychotherapists/counsellors training must improve, the government must protect against destructive advertising. We have lost far too many children, complacency is not an option.