Eating disorders – on a day for eating
I really can’t complain about getting a job interview…especially for an assistant psychologist job working on a topic which I am very interested in and passionate about! However, it has meant postponing my Thanksgiving feast, as I have spent the day on the train traveling down to London for an interview. This is four trips to London in 15 days for me – two in the car, two on the train!
Perhaps ironically, on this American holiday which is nearly synonymous with feasting and gluttonous eating, this interview was for a job working as part of an eating disorders team, helping to assess the outcomes of interventions for eating disorders in children. This is a topic which I am very interested in, in terms of the theories involved and the importance of the work, and also because of my personal experiences.
I grew up in a family where healthy eating was always a priority. My mom made us delicious, healthy foods from scratch for every meal (to the point of really spoiling me with things like fresh home-made whole grain muffins and smoothies before school). In fact, I didn’t know you could make a cake from a mix until I was in my teens, and the emphasis at home was always on eating plenty of fresh whole foods, eating the sugary and fatty foods in moderation, and being active in daily life. However, like many young girls/women, and plenty of boys/men, I struggled with body image issues, and I went through a period of very restrictive eating. For a shorter period of time after this, I found myself feeling out of control when I would eat (this occurred as I started eating more) and then I would feel so guilty that I would try to make myself sick. When this didn’t work, and even when it did, I would feel miserable and guilty and would often find myself in the bathroom in tears. It felt like I was spinning in a vicious cycle and I couldn’t get out. I was never actually over-weight, but when I wasn’t eating enough, I was getting compliments on the weight I was losing and this fed my self-esteem. However, I felt exhausted, irritable, and unable to think or function normally when I wasn’t eating enough. When I ate more, I felt sick and guilty. I tried to diet by eating limited portions of healthy foods, but the more I focused on this, the more junk food I wanted to eat. I tried eating lots of low-fat and fat-free foods, but they never filled me up. I was obsessed with thinking about food, craving it but then feeling out of control, then guilty. To be entirely honest, I am not certain what broke this cycle for me, but some of the obsessive thoughts and feelings haunted me for several years (although thankfully the actions of severely limiting my food intake and making myself sick became incredibly infrequent).
In terms of my recovery, I am very lucky to have wonderful friends who I was eventually able to talk to about my eating issues, and an incredible family who are always loving and supportive, and are wonderful role models when it comes to eating healthy food and to understanding what is important in life. Perhaps counter-intuitively, especially given my wonderful family and their healthy outlook on food, it also helped me when I moved away from home. For the first time, I had total control over what I was eating and I had to be aware of what I was buying, what I was cooking, and what I was eating. In hindsight, I think this may have given me the control I was seeking, but perhaps much more importantly, it gave me a new focus for my thoughts about food. My thoughts about food changed to thinking about what was healthy, what combinations of things would taste good, how different meals were prepared, etc., and in time, this developed into a love of healthy food and cooking!
My knowledge of research on eating disorders is relatively scarce, and it is important to note that each person’s culture, family situation, and life events can impact upon their thoughts and attitudes toward food, but I have been fascinated by what I have learned about eating disorders in preparing for my interview. The studies I have read have been carried out in the UK, so the findings may or may not be generalizable to other countries and cultures, but the some of the results of the studies I have read are staggering and highlight the seriousness of eating disorders. Just to give you a taste of some of the them:
1) Eating disorders are deadly. Anorexia nervosa has the highest mortality rate of any psychiatric disorder (NICE guidelines). To put this into context, the mortality rate for childhood eating disorders is similar to the mortality rate for some forms of leukaemia (Nicholls, Lynn, and Viner, 2011). This is probably because eating disorders, perhaps particularly anorexia, can cause physical complications including weakening of the muscles including the heart, delayed or permanently stunted growth, osteoporosis, endocrine disorders, and possibly reduced brain volume and/or permanent damage to the grey matter of the brain (Eating Disorders Treatment leaflet from GOSH; NICE guidelines).
2) Effective treatment is complicated and takes time. If inpatient treatment for an eating disorder is required, it usually lasts for four to six months, at least in the UK (Great Ormond Street Hospital guidance – reference below). One study (Nichols, Lynn, and Viner, 2011), which looked at short-term outcomes in for eating disorders in five to thirteen year-olds found that one year after the study began, 16% of the patients were worse or unchanged, and although the majority of patients improved, the majority of patients were still receiving treatment (with some having been hospitalised for most of the preceding year).
3) Comorbid mental health problems are common. Comorbid mental health problems (anxiety, depression, OCD) were reported as possible or definite in more than 40% of the children with eating disorders (Nicholls, Lynn, and Viner, 2011). In other words, more than four out of every ten children in the study who had an eating disorder also had at least a suspected additional mental health problem. I found this particularly staggering since the study was looking at children ages just five to thirteen. The study authors also note that some of the people in the study with eating disorders also had autism, other developmental disorders, attention-deficit hyperactivity disorder, or tic disorders.
4) There are several surprising (at least to me) predictive and protective factors. Perhaps most interestingly, at least one study (Nicholls & Viner, 2009) found that the only independent factors which predicted people at age 30 reporting lifetime (lasting for most of their lives so far) anorexia nervosa were: being female, infant feeding problems, maternal depression symptoms in early childhood, and a history of under-eating during early childhood. Protective factors – in other words, factors which seemed to make people less likely to report lifetime eating disorders – were higher maternal body mass index and high self-esteem in late childhood.
This may seem like a random collection of facts, and quite gloomy facts for a holiday (in the US) but hopefully at least some of them caught your attention as much as they caught mine. In fact, my new knowledge of eating disorders makes me feel even more thankful for my health than I already felt! In addition, I feel like I have a far better understanding of eating disorders as a mental illness from the reading that I have done, so perhaps it was worth postponing the feast to go to the interview. 😉
While I would never wish to simplify eating disorders, or their treatment, I know that part of what keeps me from slipping back into my former negative thoughts about food is the fact that I make healthy, interesting food a priority in my life and I take pleasure in planning meals, cooking them, and eating them, preferably with family and friends around me. Perhaps most importantly, I don’t let myself feel the slightest bit guilty if I over-indulge once in a while, and that is what Thanksgiving is really about for me – cooking and enjoying lots of wonderful food surrounded by loved ones and being thankful for all that I have.
Happy Thanksgiving everyone!
Nicholls, D.E., Lynn, R., & Viner, R.M. (2011). Childhood eating disorders: British national surveillance study. The British Journal of Psychiatry. 198: 295-301.
Nicholls, D.E., and Viner, R.M. (2009). Childhood risk factors for lifetime anorexia nervosa by age 30 years in in a national birth cohort. J Am Acad Child Adolesc Psychiatry. 48: 791-799
National Institute for Health and Clinical Excellence. Eating Disorders: Core Interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. NICE, 2004.