How 'selfie' culture and changing food trends are fuelling a new age of eating disorders
It's not just the young who succumb to eating disorders, according to a new study. Tanya Sweeney reports on how stresses associated with age, along with changing food trends and the rise of 'selfie' culture, are fuelling an increase in diet-related illnesses
When Fiona Fitzgerald-McHugh was a teenager in 1980s Ireland, there was a dearth of information about calorie restriction and dieting. Yet it didn't stop her from obsessing about both, going so far as to order books from the US.
"I became an avid researcher, determined to be a perfect person, to be loved and to feel worthy to be on earth," she says. "At one point, I was getting up at 5am to run, and would eat only protein and no carbs. I cut down my calories to 1,000 a day. I'd even run on the spot at home, and would never eat after 4pm. After six months, I'd lost around four stone."
Fiona's quest for love and acceptance is an evergreen one; a simple-sounding goal that several youngsters now have in their crosshairs. And depending on where you look on social media sites such as Instagram or Twitter, McHugh's regime doesn't read entirely dissimilar to that of a number of people following today's health trends, #Fitspo or #cleaneating - many of whom are seen as paragons of aspirational living.
Yet Fiona wasn't a forerunner of today's clean-living craze; in fact, the Galway-based mature student endured a 35-year battle with anorexia. And where Fiona once had to search to seek out information on calorie-restricting diets which fuelled her anorexia, today we are faced with a tsunami of information, across all types of media.
In many ways, the complex face of anorexia hasn't changed down the years. At its heart isn't vanity, or even a desire to look like a supermodel: it's a way for many to claw back control in their lives.
Often suffered by those who are desperately unhappy, eating disorders such as anorexia are a last resort for those unable to express themselves vocally.
"We attribute eating disorders to multi-factorial conditions," explains Kielty Oberlin, a counselling psychologist specialising in eating disorder recovery. "As is sometimes the case with cancer, some people may be predisposed to having an eating disorder, but it can be triggered by environmental factors."
That's as true now as it ever has been, yet a host of modern-day environmental triggers have seen a jump in statistics.
According to new research conducted by Bodywhys, the Eating Disorders Association of Ireland, there's been a 10pc increase of usage of its support services since 2014. Not only has there been a 48pc increase in support emails, there's also been a 19pc in attendance in face-to-face support groups.
Bodywhys also reported a 19pc increase in email contact from those aged 36-55. Meanwhile, 46pc of helpline callers had lived with their eating disorder for over 10 years. It is thought that around 200,000 Irish people are affected by eating disorders, with an estimated 400 new cases emerging each year.
"There is more awareness around the issue generally, and about the idea that it's a mental health problem and not a food thing," says Harriet Parsons, services manager of Bodywhys. "This has resulted in people looking for information and support more."
Bodywhys' findings readily debunk the myth that eating disorders like anorexia, bulimia and binge eating are the preserve of young teenagers: "There is a huge portion of people who have had an eating disorder for over 10 years," says Parsons. "A percentage of those people are developing a problem at a later age. What I would say about causes is that there are transitions and huge stresses in people's lives at any age."
Adds Oberlin: "We're expected to stay younger for longer, so people in their 20s and 30s often developmentally experience a mid-life crisis. Others go back to work after kids, are going through divorces or struggling financially. All of these stressors are identity issues. The world we live in is stressful, yet there's an expectation to achieve more."
As to the murky area of orthorexia (a term being used in some circles to denote an unhealthy obsession with healthy eating), Parson says that although she is not hearing about clean eating directly from callers, she "hears a lot about it in the wider conversation around eating disorders".
"At one end of the spectrum is 'normal disordered' eating that we all engage in, and on the other end is a full-blown eating disorder, where compulsion comes in. This might be someone who is obsessed with a particular type of eating that it comes first above all else. If they don't eat in a certain way, their day is ruined. For many, it's no longer a conscious choice - something in them thinks, 'You have to do this or else'."
Adding insult to injury is the idea that, thanks to social media, now more than ever, people equate their bodies with their sense of self. "When some people post selfies, they're asking the world, 'Am I okay the way I am?'" says Parsons. "They're looking for external affirmation, yet if they get a negative comment or not enough likes, it can reinforce insecurities that may be there already."
In spite of these new concerns, the external factors that usually trigger eating disorders have changed little down the years.
"In a way, we're all kind of vulnerable to picking up on the distress around food," says psychologist Kielty Oberlin.
"Those who are predisposed to an eating disorder may be perfectionists. They want things to go well for them.
"This sounds like most of us, but they are compulsive in wanting to keep their life in order. When things start to not go well, they can't handle it. And when their sense of worth is really down, people struggling with their sense of identity and worth are most likely to go on a diet that goes out of control.
Another thing that Oberlin's research highlights is that eating disorders are so externalised. If a person emotionally feels like they can't handle something, they'll control how they look. They need that external affirmation. The food mirrors their way of being in the world. And the smaller they get, the more they see those imperfections."
Oberlin herself knows eating disorders acutely from both sides; as someone who has suffered for 15 years, and someone who has healed others. "I was a sensitive child who wanted to fit in and belong," she says. "My father was in the US Air Force which meant we moved every few years. I felt if I looked prettier (which I translated into 'thinner'), it would make the transitions easier.
"I went on a 'diet' around the age of 10 and it spiralled into 15 years of symptoms that ranged from restricting, binging, purging, over-exercise and episodes of healthy-eating obsessions leading to my size varying from scary skinny to moderately overweight.
"Each bout of treatment stalled the progress of the disease for a time, but I wasn't ready to make the changes necessary to recover and accept that I had worth beyond my weight and shape and external achievements, until I was totally worn out from it all," she says.
Recovering, Oberlin says, can often take several years. Many sufferers believe that they have had disordered eating for too long to be able to make a full recovery.
"The recovery process is never smooth sailing, but we learn from the slips," says Oberlin. "Because people with eating disorders are perfectionists, they think, 'Okay, I'll go recover now'. But it goes way beyond weight restoration.
"To parents and loved ones, I say, 'Get help yourself,'" she says. "Children with eating disorders tend to do so much better when the parents are seeking their own help (around their feelings of having a child who is unwell). It's about creating the environment for recovery."
Parsons is in agreement: "What parents will notice is not changes in eating behaviour, but marked changes in their personality… mood swings, feeling isolated, not going out with friends."
She suggests that worried parents should read up on eating disorders in order to gain a better understanding of them, and so reduce the amount of resistance and denial that their child might have.
"They're likely to meet the mindset, 'I'm fine, leave me alone', but the parent needs to be concrete as to why they are concerned. It's best not to linger on the food or weight, but to say, 'I'm worried about how you're feeling,'" says Parsons. "We talk to people experiencing eating disorders about what it might be like to live in a way that's not like that," she adds. "Often those fears are really distorted and out of perspective."
She says that when seeking treatment, a good GP is the gateway into many public services (such as the Adult Mental Health Service or the Child and Adolescent Mental Health Service). The HSE is also developing a clinical programme to treat people with eating disorders using a consistent pathway.
For Fiona Fitzgerald, it took visits to many doctors, who dismissed her out of hand, and consultations with over 20 therapists in order to find the right therapist. This, along with the unconditional love of her now-husband, has helped her on the road to recovery.
"You have to learn to 'manage' the condition," she says. "Other people may say 'I'm completely recovered', but I like to lower the bar a bit for myself. It's important to learn that there is no perfection. You have to cut yourself a bit of slack.
"I have to tell myself that I'm okay every day. You have to be your own best friend. When I met my husband, it helped me feel I was capable of being loved. I recommend never giving up finding the right therapist. I had to learn to be assertive and find the person right for me."
For psychologists, food is the most complex addiction, not least because it's a form of sustenance for everyone. Even more confusing is a preoccupation with healthy eating. Colorado-based physician Dr Steven Bratman coined the term 'orthorexia' to describe the condition of those addicted to healthy eating.
Bratman himself is an orthorexia survivor: "I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong," he's quoted as saying. "My ability to carry on normal conversations was hindered by intrusive thoughts of food. I had been seduced by righteous eating."
"Orthorexia would really describe an unhealthy obsession with healthy eating," explains Dublin-based nutritionist Aveen Bannon (dnc.ie). "It can begin with a focus on healthy eating, herbal remedies, vitamin supplements and some food avoidance. Often, quality of life decreases as the quality of the diet increases."
Yet it can often be confused as being 'good', to be competitive with others bout dietary prowess, and sufferers often self-punish if 'temptation' wins out. Orthorexia is not yet recognised by the DSM05 (the directory of mental disorders), but several people struggle with symptoms. And much like other eating disorders, orthorexia is often motivated by a need for control and improving self-esteem, or using food to create an identity.
"It's all very amenable, but you then need to weigh up your eating habits with your emotional state," says Bannon. "If it affects your life, your relationships, your work performance or your happiness, and your eating has enduring effects, it's time to look at it in a different light."
- Tanya Sweeney
Health & Living