Eating Disorders Awareness Week

Next week (25^th February - 3^rd March) is Eating Disorder Awareness Week in the UK and this year’s theme is Breaking Down Barriers […to treatment], of which there are many. Research indicates that only 20-30% of people with eating disorders receive professional help [1-2], despite the fact that eating disorders are frequently chronic and intractable illnesses associated with numerous medical complications, psychosocial impairment, and the highest mortality rates of all psychiatric illnesses [3].

As well as the stigma linked to mental illness, eating disorders are often also subject to an additional layer of stigma whereby eating disorders are widely trivialised, even among healthcare professionals [4]. Depending on the exact presentation, eating disorders can be viewed as the result of either an over-investment in societal standards to be thin – ‘a diet gone too far’ OR the absence of care and respect for one’s body and self. This is reflected in the research and I have personally heard medical professionals make sweeping statements to this effect, which does not exactly inspire confidence that people will receive the care they need when seeking treatment. Significantly, studies show experiences and /or internationalisation of stigma are positively associated with severity of eating disorder symptoms and the duration of illness [5] and are a clear barrier to seeking help.

The DSM-V recognises three main eating disorder categories: Anorexia Nervosa, characterised by extreme dietary restriction, weight loss, and a fear of gaining weight; Bulimia Nervosa, characterised by recurrent episodes of binge eating in combination with some form of unhealthy compensatory behaviour (e.g., purging); and Binge Eating Disorder, characterised by regular binge eating episodes and an absence of compensatory behaviour. There is also a fourth group of eating disorder, Other Specified Feeding or Eating Disorders, which represents the feeding and eating disorders that are clinically severe but do not meet diagnostic criteria for another type of eating disorder. OSFED includes five specific disorders: atypical anorexia nervosa; bulimia nervosa of low frequency and/or limited duration; binge eating disorder of low frequency and/or limited duration; purging disorder; and night eating syndrome. Notably, despite the fact that anorexia nervosa is the least common eating disorder, it seemingly receives the most media representation and research attention.

Stereotypes surrounding who gets an eating disorder, (i.e., thin, white, young, middle class, straight, cis-gender, able-bodied women) are an important barrier to treatment for many people struggling. Studies indicate that people who do not fit the stereotype of what a person with an eating disorder looks like, often do not self-identify themselves as someone with an eating disorder, are reticent to seek help, and in addition are less likely receive a diagnosis and appropriate treatment from professional healthcare providers. For example, a recent study by Kendrin Sonneville and Sarah Lipson [6] found that among a group of people presenting with eating disorder symptoms, those who were bigger in size, were people of colour, or were male were less likely to receive treatment.  In a paper by Andrea LeMarre and Carla Rice published in Social Sciences [7], it was highlighted that many researchers have explicitly suggested or implied that people of colour, men, disabled people, LGBTQ + populations and others might be “immune” to disordered eating. Relatedly, it is often observed that many eating disorder treatment studies take place in residential, inpatient treatment where the majority of patients are emaciated, white, young, middle class, straight, cis-gender, able-bodied women, which serves to reinforce the stereotype of what a person with an eating disorder looks like, despite the fact that there are numerous barriers for others to seek treatment.

For Eating Disorder Awareness Week, BEAT is asking people who do not reflect the narrow eating disorder stereotype to share their story on social media to help break this stereotype which acts as a barrier of treatment to so many. This is valuable, as even on social media, there is a lack of diversity and presentation pertaining to who has an eating disorder [7]. Given all the stigma surrounding eating disorders, especially if you are not young, white, and female, and did not struggle with anorexia, I think it takes great courage to share your story for the benefit of others. My personal ask as someone focused on eating disorder prevention is to be mindful of inadvertently causing harm or sharing triggering content by talking about numbers (e.g., weight or calories), detailing behaviours, and posting before & after pictures that replicate aspects of eating disorder stereotypes (e.g., emaciated body). I think you can tell a valuable and empowering story without. Here are some questions (I’m sure there are many others) that (I think) can prompt a powerful eating disorder narrative. What do you wish people knew about eating disorders? What’s the best thing to say or not to say to someone currently struggling with an eating disorder or in recovery? What is helping you / has helped you through? What were your ‘breakthrough’ moments? What advice would you give to someone currently struggling? What does recovery feel like? What has recovery opened up for you?

If you want to know more about eating disorders, supporting others, and seeking help yourself in the UK, please see BEAT’s website: https://www.beateatingdisorders.org.uk

Nadia Craddock is a PhD Candidate at the Centre for Appearance Research(CAR), exploring whether big business can meaningfully foster and advocate for positive body image. She produces and co-hosts CAR's podcast, Appearance Matters, which covers all topics related to appearance and body image research. You can find her on Twitter @Nadia_Craddock 

References:

[1] Forrest, L. N., Smith, A. R., & Swanson, S. A. (2017). Characteristics of seeking treatment among US adolescents with eating disorders. International Journal of Eating Disorders, 50(7), 826-833.

[2] Hart, L. M., Granillo, M. T., Jorm, A. F., & Paxton, S. J. (2011). Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clinical psychology review, 31(5), 727-735.

[3] Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of general psychiatry, 68(7), 724-731.

[4] Doley, J. R., Hart, L. M., Stukas, A. A., Petrovic, K., Bouguettaya, A., & Paxton, S. J. (2017). Interventions to reduce the stigma of eating disorders: A systematic review and meta‐analysis. International Journal of Eating Disorders, 50(3), 210-230.

[5] Griffiths, S., Mond, J. M., Murray, S. B., & Touyz, S. (2015). The prevalence and adverse associations of stigmatization in people with eating disorders. International Journal of Eating Disorders, 48(6), 767-774.

[6] Sonneville, K. R., & Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders, 51(6), 518-526.

[7] Lamarre, A., & Rice, C. (2017). Hashtag recovery: # eating disorder recovery on Instagram. Social Sciences, 6(3), 68.