More and more young people are presenting with complex disorders such as anorexia, bulimia and binge eating. The experts explain how to spot the signs and what parents can do to support their child’s recovery
Last year saw a dramatic increase in the number of children presenting with eating disorders (ED). Up to four times as many young people presented at the children’s hospital in Crumlin with ED in 2020, compared to 2019. There has been a 40pc increase across Sligo/Leitrim Mental Health Services and admissions for eating disorders in the Galway region rose from two to nine cases after February 2020.
Bodywhys, The Eating Disorders Association of Ireland, has seen a 350pc increase in website traffic and 133 users accessed its online support groups in 2020, compared to just 57 the previous year.
The isolation and stress of Covid-19 has undoubtedly contributed to the rise in cases, but it’s not a simple case of saying the pandemic has caused eating disorders. In fact, there’s even some evidence to suggest the pandemic may have had a positive impact, with parents noticing concerning behaviours faster and some young people finding the absence of school removed a huge stressor in their lives.
The fact is that anorexia, bulimia, binge eating and the whole range of ED are complex disorders and there is never just one factor at play — understanding this is crucial to support and recovery.
“Eating disorders are what’s called ‘multi-factoral’ or ‘biopsychosocial’ conditions,” explains Dr Kielty Oberlin, Counselling Psychologist, Eating Disorder Treatment Specialist and author of Working with People Affected by Eating Disorders: Developing Skills and Facilitating Recovery.
First and foremost there is a genetic element. Some 15pc of children are born with a more anxious disposition, with tendencies towards perfectionism and sensitivity. When other factors, the environmental and stressors, come into play, the child born with the anxious disposition is more at risk. Other children might be able to listen to a class in school on ‘healthy eating’ or take on board the pandemic mantra of self-improvement with moderation, but these children are more susceptible to taking it to the extreme.
With or without a global pandemic, the majority of ED develop in teenage years. According to Oberlin, this is because it’s a time of existential crisis, where young people are dealing with big questions around personal identity and values. But interestingly she also reports seeing an increase in onset of middle-age. “It’s another peak moment for those ‘who am I?’ questions,” she explains. “They’re times of stress and crisis.”
Today’s teens have to contend with an increasingly image-based society, bombarded with notions of the ‘perfect’ body on social media. “But I would never make the direct link that social media or photo-altering apps are causing eating disorders,” says Dr Malie Coyne, Clinical Psychologist and author of Love in, Love out: A Compassionate Approach To Parenting Your Anxious Child. “In fact, what I would say is that eating disorders should really be called ‘eating and other disorders’, because it’s never just about the eating, there’s always something underlying it. The eating is the coping mechanism and that’s why it’s so important for parents to focus on the rest of it.”
There are key signs to watch for: physical things like weight loss, being cold, bloating of the stomach, constipation and abdominal pain, restlessness, inability to settle, dry hair and dry, discoloured skin.
“But you’re also looking for a significant impact on their overall well-being,” explains Coyne. “When a person has an eating disorder, they begin to construct their lives according to a very strict routine and thinking becomes very black and white. They’re likely to become socially isolated, experience irritability, mood swings, low self-esteem and low moods. You’re looking to see how much it’s impacting on their daily lives.”
However, it’s often the behaviour around food that’s most likely to be noticed. In April last year, Laura* noticed her then 15-year-old daughter was avoiding eating with the family at meal times. “She’d lost quite a bit of weight and every time I’d offer her food she’d say, ‘I’m not hungry, I’ll have something later.’ Then she’d come down to the kitchen when I was out the back and lift maybe a rice cracker and three or four grapes and I’d be saying to her, ‘that’s nowhere near enough to eat’.”
Emer* ended up having to be admitted for treatment on multiple occasions. In conversations with healthcare workers, she said she hated herself, her body, everything about her. She wrote a letter expressing a desire not to live. “That is the worst thing in the world for a parent to have to read, a letter from their child saying goodbye,” says Laura.
She feels that Covid contributed. “Being completely cut off from everybody and tied to the home definitely had a detrimental effect,” she says. But the biggest factor was a difficult family situation resulting in a toxic home environment that Emer clearly struggled with. It’s only since moving away from that environment that Laura feels her daughter’s health has improved.
She also worries that in small ways her own issues around body image may have played a part. “I’ve struggled with weight for the majority of my adult life, until a year ago when I managed to lose six stone. I had been trying to look after my health and make myself fitter and healthier for my children. I feel so guilty thinking that it could have indirectly impacted on my daughter and how she viewed being overweight and eating.”
Oberlin says parents do need to be mindful of the ‘throwaway’ comments they make around weight and the values that could impart to a sensitive child. But she maintains the crucial thing is to recognise there’s never one reason for an ED and that blame, frustration and fear — although perfectly understandable emotions — are not helpful in moving forward.
“When we’re scared, we can sound like we’re angry, and the child who is supersensitive will pick up on that and think the anger is directed at them,” explains Oberlin. “It just adds more stress, and when they’re stressed they’re using their eating behaviours to cope. The key is to talk with the child, not at the child. You need to be with them and their emotions, because when kids sense that their parents are with them on their journey, and not blaming them for it, that’s the greatest asset.”
The child struggling with self-worth is looking for validation, not to feel like they are a problem to be solved. “Steer clear of being accusatory, overly emotional or threatening in any way,” recommends Coyne. “Use ‘I’ statements, like ‘I’ve noticed you’ve been less happy’ and tread carefully, because imagine your only coping mechanism was restricting food and over-exercise and the next thing is, somebody tells you that you have to stop that, then you’re completely lost.”
To parents, she adds “be kind to yourself”. “Blame and shame aren’t going to help anybody. It’s not your fault that your child has this issue and it’s no good to your child you blaming and berating yourself for this — get the support that you need so you can support your child.”
Bodywhys has a family support programme, PiLaR. And know that recovery is a real, achievable outcome. “It takes time,” says Oberlin.
“Getting the eating sorted is very hard, but the real recovery is looking at all the relationships, building resilience and addressing the need for perfection. But recovery is 100pc possible and it is a beautiful thing.”
Recovery is an ongoing process for Laura’s daughter. “Emer’s eating disorder, or ‘Evie’ as I call her, has had a profound impact on the family,” she says. “She’s like an unwelcome monster, toxic and manipulative and we’re battling daily to banish her.
“Most days her voice is stifled by normality, but every so often you can tell her whisper is back and these are the days we long to see the last of.”
*Names have been changed.
For help and support, log on to BodyWhys.ie