We need to talk about anorexia
As a new series puts the focus back on the eating disorder, Tanya Sweeney asks the experts how parents can approach the issue with their children
The name Eva O'Connor might not be readily familiar now, but given the actress/playwright's searing and emotional writing, it's likely you'll be hearing plenty of her in the coming weeks.
O'Connor is already receiving rave reviews for penning the BBC3 drama Overshadowed. The series, about a teenage girl with anorexia, is loosely based on O'Connor's own experiences with eating disorders. At 14, she was an avid ballet enthusiast and notes that this may have been the root of the anorexia that took over her life for over eight years.
"I'd had a wonderful childhood. Nothing traumatic happened that triggered anorexia. I was dancing a lot and I felt the pressure to look more like a ballerina than I thought I did," she said in an interview recently. "It's this thing of looking in a mirror and deciding you are not good enough for whatever reason and resolving to fix it. That's why they say anorexics have very high expectations of themselves and they are willing to go to extreme lengths to change what they see.
"For me, it was such a dark time and so many of my teenage years were coloured by having an eating disorder," she adds. "I look at family photos from holidays, graduation, pictures with my friends and remember instantly how sad I was feeling," she adds.
"People see someone who is extremely quiet, who is not eating their food, not socialising and being difficult. And you have this internal monologue all the time telling you that you are worthless and not thin enough."
Overshadowed comes three months after Netflix released To The Bone, a film starring Lily Collins that generated plenty of buzz among teens and tweens. The film tells the story of a woman with anorexia who finds herself in an in-patient programme. Many criticised director Marti Noxon for creating what they called a 'how to be anorexic' guide for youngsters, but Noxon defended her work, saying on Twitter and in a press release that her goal is "not to glamorise eating disorders, but to serve as a conversation starter about an issue that is too often clouded by secrecy and misconceptions".
In many ways, the complex face of anorexia hasn't changed down the years. Yet according to new research conducted by Bodywhys, the Eating Disorders Association of Ireland, there's been a 10pc increase of usage of their support services since 2014. Not only has there been a 48pc increase in support emails, there's also been a 19pc increase in attendance in face-to-face support groups.
While Overshadowed looks set to cast a greater spotlight on eating disorders, O'Connor's words are likely to remind us of the insidious nature of anorexia. Hers is a valuable insight into the mindset of the teenage victim: tortured, helpless, hell-bent on exerting a sense of control, and yet unable to seek help or articulate their difficulties. And for parents too, eating disorders can present something of an emotional minefield. It's a discussion that many parents would rather not invite into their home at all, figuring that it's better if it doesn't show up on their child's radar in the first place.
But according to Colman Noctor, Child and Adolescent Psychologist at St Patrick's Hospital, parents who leave the conversation on the long finger do so at their peril.
"The age of onset is becoming earlier, around nine or 10 as opposed to 13 or 14," he explains. "We have kids coming into us from fifth or sixth class. They're exposed to body conversations around weight and desiring thinner bodies at an early age."
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 are a resort for those unable to express themselves vocally.
"A child thinks, 'if my life is consumed with thinking about friendships, social media, exams, and expectations 90pc of the time and I can't control any of it, the anorexic person's brain says, 'let's swap it out and spend 90pc thinking about the stuff you can control'. It allows the child to preoccupy themselves with food."
And far from being the angsty, rebellious type, teenagers susceptible to eating disorders are often perfectionists, obsessed with being the ideal child.
"Be vigilant of the child who never causes you a problem," warns Noctor. "To be expressive and difficult as a teen is normative. They battle for control and influence. If you have a child who likes to do their lunches, who goes to study without being told to, or who is overly compliant, that's something to keep an eye on."
"We attribute eating disorders to multi-factorial conditions," explains Kielty Oberlin, a counselling psychologist specialising in eating disorder recovery.
"Some people may be predisposed to having an eating disorder, but it can be triggered by environmental factors."
Certainly, the clean-eating craze has reached fever pitch in recent years. It may not necessarily trigger the condition, but a preoccupation with eating the 'right' foods can certainly complicate things for parents at meal times.
"What you're looking for, essentially, is the child who becomes more controlling and develops a pervasive desire for perfectionism in all aspects of their lives.
"A child might start getting into healthy eating and they cut down sweet foods," says Noctor. "Next thing, they're cutting down portions and cutting out whole food groups.
"Food isn't the central issue, rather it's the signpost towards what is really wrong," he adds. "Conversations around food tend to be unhelpful, and I take particular issue with the idea of 'good' and 'bad' foods. If you are bringing this up with a child, rather than making everything about food and body shape, ask them about where they are finding meaning. What you're trying to do is bolster their self-esteem and remind them that they are multi-faceted people that are worth more than what they see on the scales. Allow them to talk about stuff that's not perfect in their lives."
Harriet Parsons, Services Manager with Bodywhys, offers the following advice for parents: "If you're concerned about eating disorders, the first thing to do is have an understanding of what an eating disorder is. It's never a good idea to say 'why aren't you eating enough?'. Instead, be concrete with your child about why you're having the conversation with them. Tell them in a concrete way why you are concerned.
"Say, 'I'm worried about how you are in yourself'. If you try and go head-on with the topic of anorexia, a child's defence mechanisms will go straight up and people often feel threatened and ashamed when the issue arises. You want them to feel like they can talk to you, without you coming in and making them change all of a sudden.
"On a practical note, sometimes the best conversations can be had in the car, when two people aren't looking directly at each other" she adds. "You'd be surprised at how effective a way of talking to someone this can be."
Adds Oberlin: "To parents and loved ones, I say 'get help yourself'," she adds. "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."
For more information on Kielty Oberlin, see www.kieltyoberlin.com. For more information on Bodywhys, call 1800 902 406 or see www.bodywhys.ie.