Richard Hogan: It is terrible to see wonderful teenagers suffer with insidious anorexia

It is very important that we don’t suggest concepts of weight gain and weight loss to our children at a young age

Of all the disorders I work with, anorexia nervosa has to be one of the most complicated and difficult to resolve. It can so quickly envelop a person’s life, and consume it. What makes it so difficult to break is the fact that not eating makes the person feel good and eating makes them self-loathe and feel terrible.

It is one of the most complex positive feedback loops a person can get stuck in. The thing they use to make themselves feel good, food avoidance, is the thing that is bringing their life into chaos and potential destruction.

Of course, there is a complicated interplay between the person’s neurobiology, psychology, and environmental factors that make this a chronic disorder with frequent relapses and high treatment costs. What is so problematic, as a clinician, is the person's relentless drive to lose weight and avoid food.

Reward pathways in the brain are disrupted, and that can push the person towards a very terrible outcome. Because as I said, they feel good when they don’t eat. Chasing that feeling can result in very tragic outcomes. Overcoming this pathological fear of eating and weight gain is extremely difficult for teenagers or adults with anorexia.

The brain circuitry that drives food–seeking has been well-defined in basic science models. Research clearly outlining the disruption to the circuitry of this hunger signal has been difficult to prove because there are such strong psychological and social factors involved in anorexia, including anxiety traits and the tendency to worry — and in my experience, they are combined with peer pressure, general poor stress management, and social media. All of these factors combine to create illness behaviours. This is what makes it such a complicated illness to treat. The rhizomatic roots of this illness are many and often entangled together.

I have worked with many teenage girls who have struggled with their food intake. Some very severe cases, others dipping their toes into the murky dark waters of anorexia. They came to me because they saw what the waters held and got a fright. Any of our children can be pulled in by this brutal illness.

In many of the cases I’ve worked with there’s a common theme: They first came into contact with the idea of weight loss from a family member, so it is important that we don’t suggest concepts of weight gain and weight loss to our children when they are young.

Healthy eating should not be presented in the family in a negative way of too much talk about weight gain, weighing scales, targets, and calories counted on the fridge door.

All of this can infiltrate a child’s brain about what is desirable and what promotes social derision.

The child quickly learns that to be thin is good and that to put on weight is bad.

Many teenagers who sit in my clinic tell the same story: They listened to family members comment about the size or shape of people on TV and they then internalised that commentary, so that when they put the slightest bit of weight on, they spoke harshly to themselves.

Any internalised prejudice, coupled with reward disruption in the brain, anxiety, and social media can be a ‘perfect storm’ for a child to get pulled into a behaviour that can utterly consume everyone in the family. So be careful of what you say, because words matter and children are always listening.

Anorexia can destroy the family: watching someone you love struggle with food avoidance, becoming emaciated, and having their bodily functions collapsing, can result in terrifying feelings of powerlessness and fear. In fact, any talk about food can cause the teenager to become more anxious and more resistant to food. That is why prevention is so vitally important. Algorithms targeting our children are having devastating consequences on their mental health. They are bombarded with perfect images of perfect bodies that make them feel incredibly unhappy about their own appearance. Comparison is always going to end in a negative self-image. So, our teenage girls in particular need help with how they interpret and internalise the images they see on their social media and how they think about food and body image.

Talking with teenage girls, I have noticed a striking change in the last five years — they are consumed with the minutia of their appearance. Even their face is broken down into aspects that they like and dislike. They say things like, ‘I’m okay with my nose, it’s not awful but I hate my eyelashes and my ears’. It is really terrible to sit with such wonderful teenagers with their whole life ahead of them, and to hear them speak so negatively about their appearance. To hear the disruption in their cognition, their inability to celebrate the gift of their life and the true beauty they hold.

Anorexia is one of the most insidious illnesses people struggle with, and prevention is crucial. Helping our children to be body positive and enjoy their food is such an important part of preventing it from enveloping a child’s life and destroying the family.