Social media and body image – What impact is it really having?

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Social media is now a hugely popular and pervasive tool among all age groups.  Facebook currently has over 1.3billion users worldwide, and instagram over 300 million.  Of these users around half are female and under the age of 25.  But what impact might this new obsession be having on its users?  There has been a lot of talk about the impact of social media on mood, body satisfaction and life satisfaction, but now for the first time there is some evidence as to the potential detrimental effects of what has become a new norm.

A number of correlational studies have previously made links between increased social media use and body image dissatisfaction, low mood, and a number of other psychological conditions.  These correlations have been found across various age groups from pre teenage to university age.  (see. Fardouly et al., 2015 for a summary).  What we dont know from correlational studies however is whether it is social media resulting in increased psychological distress, or whether increased psychological distress makes people turn more readily to social media.

For the first time researchers at The University of the West of England have shown that it is an individuals tendency to compare themselves to others that is likely to determine whether social media use has a positive or negative impact.   The tendency to compare yourself to others is known as social comparison.  Individuals can socially compare themselves to others on a number of dimensions including status, appearance, satisfaction and life experience. With 70 million photographs posted instagram every day, and over 10 million photographs added to Facebook per hour, there is a lot of material to which social media users can socially compare themselves.

Jasmine Fardouly and colleagues, in a paper published in Body Image, 2015, investigated the link between rates of social comparison, social media use and appearance related concerns.  They found that the impact of social media is not universal amongst all users.  Only those who have a tendency to compare themselves to others are likely to suffer from lower mood or poorer body image after viewing social media images. What this means is that, much as with magazine media images, social media cannot necessarily be tarnished with a universally negative brush.  For some individuals though, the impact of constant social media viewing is likely to be contributing to, or at least maintaining, psychological distress or dissatisfaction.

Dr. Bryony Bamford, of The London Centre says “The problem with social media is that it presents a very skewed version of real life – photos can be added with filters, experiences can be embellished, and life can be presented through a rose tinted lens.  What that means for individuals who have a tendency to compare themselves to others, is that they are likely to be comparing themselves to a skewed reality of real life’.

 

 

The myth of the ‘perfect’ body

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With Christmas over, and many people experiencing a lingering anxiety over  festive over-indulgence, now is the perfect time for us to be bombarded with messages about detoxing, new year exercise resolutions, fad diet tips and promises of achieving a ‘new year – new you’.  But are your New Year resolutions helpful or harmful?  And are the promises made by the many diets on ‘sale’ realistic?

There are hundreds of different diet options open to us – a quick search of google is all it takes to realise how many different diets are presented to us each year.  And each year there seems to be a different one.  Does anyone ever ask why?  Perhaps because there is no such thing as a ‘perfect’ diet.  Recently, a number of different articles have been published questioning the rigidity of many of the more popular diets.  Is it really healthy to completely cut out fats, or carbs, or solid food.  In short no – our bodies need a full balanced diet in order to be healthy, and cutting out foods only tend to make us crave them more.  Is it really possible to detox our bodies?  In short no – if there were really toxins that stayed in our digestive system for any period of time they would probably kill us, or at least make us very ill.  Is it really possible to achieve a ‘model’ body by attending a gym class – in short no.   Models have genetics, lighting, photography skills and photo shop on their side.

Eating disorder psychologists talk about the idea of ‘set point theory’ – the idea that we are genetically programmed to be a certain weight and shape.  Sure we can tweak it, but can we drastically alter it – not if we want to be healthy, and have a good quality of life.

So why are we presented with so may promises?  Well, in short because it makes money – In the US 6billion dollars are spent every year on the diet and beauty industry, and this sum is only increasing.

This isn’t meant to imply that new goals can’t be set – by all means, turn over that new leaf and set yourself goals, but make sure these goals are healthy, achievable and realistic for you and your life style.  Body image distress is a huge problem in the UK, and the unrealistic expectations that we are bombarded with every day only serve to increase our dissatisfaction and self criticism.  Focus on the behaviour you want to achieve, rather than the body, and your 2015 resolution are much more likely to last into February.

 

 

Are you a perfectionist?

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Perfectionism refers to the setting of excessively high standards. These can either be standards that we set for ourselves, or the standards that we expect others have of us. Clinical or ‘problematic’ perfectionism is accompanied by an overly critical view of the self and a fear of not meeting self imposed standards.

What makes perfectionism problematic?

Many people would describe themselves as setting high standards for themselves, and would see this as beneficial and a valued part of their personality. So what marks healthy perfectionism out from problematic perfectionism?

Perfectionism can be considered problematic if…

  • the standards we set have a negative impact on our self evaluation or self esteem ie) if we fail to meet the standards we set, we see ourselves in a negative way (e.g. as a failure or worthless).
  • we struggle to feel good about our achievements, or if any sense of achievement or satisfaction is very short lived before our standards are raised further.
  • the standards that are set, and the associated fear of failing to meet these standards has a negative impact on our productivity or on other areas of life. This may be because tasks are avoided for fear of not succeeding at them, or because the time taken to ensure standards are met is to the detriment of our emotions, social life and relationships.

Wile perfectionism is often seen as beneficial, a recent review showed that high levels of perfectionism actually predicted depression, anxiety, chronic fatigue, suicidal ideation and eating disorders (Hewitt & Flett (2002).

Am I a perfectionist?

  1. Do you continually try your hardest to achieve high standards?
  2. Do you focus on what you have NOT achieved rather than what you have?
  3. Do other people tell you that your standards are too high?
  4. Are you very afraid of failing to meet your standards?
  5. If you achieved your goal, do you tend to set the standard higher next time?
  6. Do you base your self esteem on striving and achievement?
  7. Do you keep trying to meet your standards, even if this means that you miss out on things or if it is causing problems?
  8. Do you tend to avoid or procrastinate on tasks in case you fail or because of the time it would take?

If you answered yes to many of these questions it is likely that you are a perfectionist and it might be important to consider whether the standards that you set for yourself are realistic or helpful.

Obsessive Compulsive Disorder: Do you know the facts?

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Most people have probably heard the of term ‘OCD’ and know that it stands for ‘obsessive compulsive disorder’.  But few people actually know what OCD is and even fewer recognise how debilitating it can really be.  In this weeks blog we look at the signs and symptoms of OCD and  explore how it can be linked to disordered eating.

What is obsessive-compulsive disorder?

OCD has two characteristic elements:

1. obsessions (undesirable, recurrent, intrusive, distressing thoughts and worries)

2. compulsions (repetitive or ritualized physical or mental behaviors).

Most people with OCD will experience both obsessions and compulsions.  A smaller number of people experience obsessions without compulsions and an even smaller number of people will perform compulsions without an awareness of their feared or obsessional thoughts.

OCD usually starts in childhood or teenage years.  At its most severe a person with OCD might spend all day performing ‘compulsions’ such that they are unable to leave the hose, hold down a job or maintain relationships.  OCD tends to get worse with time so it is always worth seeking help as early as possible and as soon as the OCD start to become a problem.

What is the link between obsessions and compulsions?

In OCD obsessions and compulsions do not happen independently.  The compulsions usually happen to stop the obsessions from happening, to reduce anxiety or distress resulting from the obsession, or to prevent an obsessional thought from becoming a reality. Examples of this might be someone who hand washes to prevent an obsessional fear of germs.

Obsessions and compulsions are in fact not uncommon among most people – almost all of us will experience an intrusive unwanted thought from time to time.  There are also many things that people do in a particular or repetitive way.  To meet criteria for OCD, obsessions and impulsions must evoke significant distress, must be time consuming, and must interfere with a persons normal functioning.

Understanding obsessions

94% of the population will experience unwanted intrusive thoughts.  These are thoughts or images that seem to come from nowhere that people usually would not want to admit to having.  In OCD these intrusive thoughts or images  occur repeatedly (much more frequently than in someone without OCD) and are experienced as being outside of a persons control. The thoughts or images are unwanted and they evoke significant distress in the individual when they do occur.  Overtime, these obsessions start to occur more and more frequently such that they start to interfere with normal activities like socialising or working.  Common obsessional thoughts include:

  • Contamination (thoughts about germs and disease, dirt, chemical contamination, fear of getting a physical illness or disease)
  • Losing control (fear of acting on a urge to harm oneself or another person, fear of stealing things or yelling out insults)
  • Perfectionism (extreme desire for things to be even or exact, concern with a need to know or remember something important, inability to decide whether to keep or discard things)
  • Harm (fear of being responsible for something horrible happening or of not protecting others through not being careful enough)
  • Unwanted sexual thoughts (forbidden or unwanted sexual thoughts or images)
  • Religious obsessions (concern with offending god, superstitious ideas about lucky or unlucky numbers or colours)

We don’t really know why obsessions occur in some people more than others although a number of different theories have been proposed.  We will cover these theories in a separate blog post.

Understanding compulsions

An example of a ‘normal’ compulsion might be a bedtime or cleaning routine –  doing something in the ‘same’ way repetitively.  In OCD compulsions ‘have’ to be performed.  The thought of not performing the compulsion evokes extreme anxiety usually because the person fears that not performing it will result in a disastrous consequence.   Common compulsions in OCD might include:

  • Washing and cleaning (hand washing; excessive cleaning or washing to remove or prevent contamination)
  • Checking (checking that you didn’t harm someone, make a mistake, that nothing terrible has happened or checking a part of your body)
  • Repeating (rereading or rewriting; repeating routine activities; repeating body movements e.g. tapping, touching, blinking; repeating activities in multiples of the same number)
  • Mental compulsions (praying, counting, mentally reviewing events to ensure you did things ‘right’ or didn’t do wrong)
  • Avoiding (situations that may trigger obsessions or certain words or numbers that might be ‘unlucky’)
  • Order / symmetry (putting things in order or in a certain place so that it feel ‘right’)

Over time, both obsessions and compulsions usually occur more frequently as the person works harder either to stop themselves from having the intrusive thought, or to prevent the intrusive thought from becoming a feared reality.

OCD and Eating Disorders

Whilst OCD and eating disorders are different disorders, they can be related and often coexist.  Some of the ways in which OCD and eating disorders can be related include:

  • OCD may result in an ‘eating disorder’.  For example when a person becomes unable to eat either through fear of contamination by food or because their compulsions become so time consuming.  It might look as though someone is suffering from an eating disorder when actually they have a severe form of OCD.
  • OCD may be caused by low weight – as weight drops behaviours tend to become more obsessive and ritualised – this is a result of the brain being starved.  In these instances, OCD type behaviours tend to resolve with weight gain.
  • The OCD might overlap with an eating disorder – obsessions may be specifically about becoming fat or gaining weight, and compulsions may be about restrictive eating or exercise
  • An eating disorder may be used to ‘resolve’ OCD – occasionally low weight or a focus on food and weight may temporarily distract someone aware from their OCD obsessions.  This means that an eating disorder might be used as a way or reducing distress caused by the OCD.  In these circumstances, as the eating disorder is resolved, OCD behaviours may increase unless they are also effectively treated.

What treatment is available?

Treatment for OCD is highly effective in people who want to stop the compulsions.  CBT is the treatment with the best evidence base and this is often used in combination with education to reduce anxiety.  Around 75% of people will make a full recovery from OCD with appropriate and specialist treatment.

When does disordered eating become an eating disorder?

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‘Eating Disorder’ vs ‘Disordered eating’ – though these terms are often used interchangeably, where to draw the line can be a decision that is difficult to make. So when does ‘disordered eating’ become an eating disorder? And how do you distinguish disordered eating from normative dieting behaviours that seem to be so prevalent in todays society?

What do that sats. tell us?

Statistics from the National Institute of Mental Health suggest that 2.7 percent of adolescents suffer from an eating disorder. This number seems to be on the increase in younger children (age 8 – 11) and in males. However this is a relatively small percentage compared to suggested rates of disordered eating. It is thought that up to 50% of the population demonstrate a problematic or disordered relationship with food, exercise or their body image. In our culture there exists an increasingly prevalent obsession with size and weight, diet and exercise, meaning that many people may see their disordered relationship with food as ‘normal’. There remains a huge number of people with disordered eating who never seek help for their difficulties and the tendency to see these behaviours as ‘common, normal , or ‘healthy’ may contribute to this.

 

Disordered Eating vs. Eating Disorders

The most recent version of The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) recognizes 4 different categories of eating disorder: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Eating Disorder Not Otherwise Specified (EDNoS). This last category was designed to describe behaviors that meet some but not all of the criteria for anorexia or bulimia. EDNoS is actually a far more prevalent eating disorder than either anorexia or bulimia and it is likely that a large number of people with ‘disordered eating’ would meet criteria for EDNoS. Falling into this category does not mean that a person has a less significant problem with food, or that their difficulties exist without physical or emotional risk.
So what are the symptoms of disordered eating?
Symptoms of disordered eating may include the kind of behaviours that are commonly associated with the other three categories of eating disorder:

  • rigid dieting or frequent limitation of the amount of food eaten
  • binge eating (frequent or occasional loss of control of eating that causes guilt shame or distress
  • purging (extreme attempts to get rid of calories e.g. via self induced vomiting, excessive exercise, or use of diet pills and/ or laxatives).

 

However, disordered eating might also include:

  • body weight and shape being central to self esteem or self worth.
  • A negative body image or disturbance in perception of body image (thinking that you look bigger than you really are)
  • A rigid exercise routine combined with extreme guilt or anxiety if this routine is not followed.
  • Obsessive calorie counting or ‘rules’ around calories e.g. ‘I can eat this only if Ive exercised first’
  • Anxiety about or avoidance of certain foods or food groups
  • A rigid approach to eating, such as only eating certain foods, inflexible meal times, refusal to eat in restaurants or outside of one’s own home
  • Rigid ‘rules’ around eating such as ‘I will eat that only if I know I can go to the gym later’

But is it an eating disorder?

What distinguishes disordered eating from a diagnosable eating disorder is mainly about degree, and the amount of distress that changes to eating, weight or behaviour evokes. If someone engages in ‘disordered eating behaviours’ on a majority of days, or experiences distress and anxiety either when they are unable to use these behaviours or when they have chosen not to, it is likely that they may be diagnosed with an eating disorder. In our experience it seems that many people with ‘disordered eating’ would not view themselves as having an eating disorder, and would rarely even consider themselves to have disordered eating. It is more likely that they will see themselves as ‘getting it right’ or ‘being healthy’. However when food choices are made due to anything other than hunger and appetite, when food preferences are held with more importance than other things like attending social events, and when eating has the ability to evoke strong negative emotions – we would very much argue that this is an eating disorder and should therefore be taken seriously.

So if its NOT an eating disorder, are there any risks to disordered eating

Many people see these behaviours as common, normal or healthy. However, whilst the behaviours might be increasinly prevalent in todays culture, they are certainly not healthy. Disorderd eating puts people at high risk of developing other physical and mental health conditions including more severe eating disorders. Other consequences may include:
• Concentration and ability to focus – people describe spending a huge amount of time thinking about or planning food and exercise – time that could (or should) often be spend focusing on other things.
• Social life – socializing is often limited due to anxiety about eating out in restaurants or prioritization of exercise.
• Coping skills – diet and exercise often starts to become a way of ‘coping’ with difficult life events. Whilst this may feel like an effective strategy in the short term, it actually prevents people from using healthy ways of coping with emotions meaning that stress can build up over time.
• Difficult emotions – thoughts about food and weight often start to become anxiety provoking, putting people at risk of depression or chronic anxiety

How do I know if I need help to address my disordered eating?

If your eating is causing you distress, or starting to have a negative impact on any areas of your life it is probably time to seek help. Many people avoid seeking help as they fear that their problem isn’t serious enough, or they feel anxious about what help will involve. If you want to, then it is never too soon to get help with what may become a significant problem the longer you allow it to continue.

My friend might have an eating disorder – how do I help them?

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Eating disorders can be very scary, confusing and anxiety provoking illnesses for everyone involved.  This includes friends and relatives.  It is unusual for a week to go by without us being asked for advice on how to help, support or confront a friend or relative who has or might have an eating disorder  For that reason we thought we’d make that the topic of our latest blog: how to help a friend.

The first essential thing to remember when talking to or supporting a friend with an eating disorder is that it is pretty much impossible to always say the right thing.  Expect to get it wrong sometimes and don’t let this put you off trying to help.  At some point your friend will probably need to see a professional who is trained in supporting people to over come an eating disorder.  You should never try to take responsibility for helping your friend alone.

Below we have tried to offer some guidance about what to do and what not to do to best support a friend.

What to do…

  • Do talk to your friend about your worries:  The first conversation with a friend can often be very difficult.   Think about what you are going to say in advance and pick a moment when you have enough time and privacy to have an open conversation.   
  • Be prepared for your friends reaction: Your friend may not respond well to your concerns initially.  Be prepared for this and try not to let this put you off.  The most important thing is that your friend gets help, even if this means they get upset or angry at first.  If you really can’t talk to your friend about your worries, you may need to tell someone else.
  • Communicate in a helpful way: Try to remain concerned, understanding, open and honest.  Explain that you’re worried. Be as gentle as possible, and try to really listen to and be supportive of what your friend is going through. 
  • If your friend isn’t getting better or isn’t getting help, think about you else you can talk to.  This might be your parents, their parents, the school guidance counselor or nurse or a teacher that you trust. This can be very hard to do because it can feel like betraying your friend. But part of being a good friend is doing everything you can to help.
  • Ask your friend what they need from you:  Tell your friend you want to help him or her get healthy again. Ask them what you can do to help, or what they want you to do.
  • Give your friend a list of resources that might help:  There are so many books and websites now offering support and guidance to help people overcome eating disorders.  Do a bit of research and show your friend a few of the options that you have found.  A really good place to start is our national eating disorders charity (www.b-eat.co.uk  or www.mengetedstoo.co.uk).  Both have great websites and links to other sources of support.
  • Ask your friend if they want you to go with them to see a professional: It is so important that you dont try to help your friend alone, but offering to go with them to speak to a professional might be one way that you can really support them.  They may want you to wait in the waiting room for them, or even to go in to the room to speak to someone with them.  Offering to support them in this way can be a really important sign that you are there to support them.
  • Keep trying to include them:  When someone has an eating disorder they often stop doing the things they used to do.  Even if they do stop, keep invited them and suggesting things to do, just as you did before.
  • Remind them that you love and care about them: Make sure you friend knows that you are their for them and are heppy to listen to them or offer support when it is needed.  Remind them that their friendship is important to you and that you care about them getting better.
  • Get support for yourself: It can be very stressful and scary to watch someone you care about struggle with an eating disorder.  It is important that you also have help and support to cope with these emotions.  This might involve talking to your parents or friends or you might want to think about looking for some specialist support to help you cope, which you can access through B-eat or through most private eating disorders clinics.

What not to do…

  • Don’t take responsibility for your friend getting better:  Even people who have trained for over 10 years can still struggle with treating someone with an eating disorder.  It is essential to recognise your own limits and not to try and be a therapist for your friend.
  • Don’t avoid talking about what is going on:  Even though your friend may not like talking about what is going on for them, it is important not to ignore it or pretend that there isn’t a problem.  Try to find a way of talking honestly and openly to your friend about your worries, even if they dont seem to want you to.
  • Don’t let it become the only thing you talk about:  It is crucial to get the balance right – not ignoring the eating disorder, but also not letting it take over all of your conversations.  Keep talking about the same things you did before you became worried about them.
  • Don’t doubt yourself:  Many people with an eating disorder struggle to recognise their own difficulties, or are so afraid of treatment that they will try to persuade or convince everyone that they are fine.  It is important that you recognise that your friend may not be being honest with themselves, or with you.  Go with your gut instinct – if you think there is a problem then there usually is.
  • Don’t simplify what they need to do to get better:  Comments like ‘just eat’, ‘just stop exercising’ aren’t helpful.  It is incredibly hard to overcome an eating disorder and involves a lot more than ‘just eating’.  Recognise the battle that your friend is probably going through.
  • Don’t misunderstand what an eating disorder is:  People with eating disorders still feel hungry, they still like food, they dont always see themselves as fat, they dont just want attention – eating disorders are very complicated illnesses, you dont have to understand them, but it is important not to misunderstand them.
  • Try not to talk about food, weight or calories with them: Usually these topics are very difficult for people with eating disorders to tolerate.  If possibly try to limit how much you talk about these things in front of your friend.
  • Don’t gossip to others:  People with eating disorders can often feel very ashamed or embarrassed about their illness and will often be very anxious about how others will see them.  Try not to use your friends eating disorder as something to gossip about.  Only talk to others if you need their support or think they can help.
  • Don’t comment on their weight:  It is important to express your concerns to your friend but try to talk about the changes or the behaviours that you have noticed rather than about their weight.  Comments like ‘you look too thin’, ‘you look really healthy’ can be taken the wrong way by someone with an eating disorder and so are best not said.
  • Don’t try to force them to do something they don’t want to do:  People with eating disorders often feel very ambivalent about change.  Trying to force them to eat, to stop exercising, to seek help can backfire.  Try to be encouraging and understanding rather than forceful.
  • Don’t expect them to recover instantly:  On average it takes months if not years to overcome an eating disorder.  Be patient with your friend and dont expect them to recover straight away.
  • Don’t be overly watchful of your friend’s eating habits, food amounts, and choices. People can often be very anxious about being watched / judged / noticed but others.  It is fine to express your concern to a friend but not to watch every move they make as this can leave them feeling criticised or judged.
  • Try not to give advice or criticism. Give your time and listen to them. This can be hard when you don’t agree with what they say about themselves or with what they are eating but try just to listen, rather than to ‘correct’ or ‘fix’ what they are saying.

Remember, you don’t have to know all the answers. Just being there is what’s important. This is especially true when it feels like your friend or relative is rejecting your friendship, help and support.

Eating Disorders in men: Do you know the facts?

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Male eating disorders have been in the news today when a recent B-eat campaign was pulled after receiving a number of complaints from male sufferers.  Whilst the campaign may have been received badly, its aim – to increase awareness of male eating disorders and to encourage men to seek help – is spot on.

With this in mind we thought we’d cover a few of the known facts about eating disorders in men.

How many men are affected by eating disorders in the UK?

In 2004 a Department of Health survey suggested that there were around 180,000 men and boys with eating disorders in the UK.  This was just over 10% of the total cases of eating disorders in the UK which stood at around 1.6 million.  It is thought that only a quarter of men experiencing disordered eating will seek treatment.  Given that these DoH statistics were based mainly on the number of individuals receiving specialist treatment at that time, it is very likely that the number of people suffering from an eating disorder in the UK, and in turn the number of men suffering from an eating disorder, was actually considerably higher. 

These figures are now 10 years out of date.  Rates of eating disorders seem to be on the increase in the UK so it is likely that the number of men suffering from an eating disorder would  now be a lot higher.  Indeed, a 2007 NHS survey found that 6.4 per cent of adults reported having a problem with food.  A quarter of this figure were men.  The Royal College of Practitioners has also recently indicated a 66% rise of male hospital admissions of men with eating disorders.  These more recent studies suggest that the previously held ‘1 in 10′ figure should actually be around ‘1 in 4′.  This may be due to increasing rates of eating disorders in men, or due to more men starting to seek treatment for their eating difficulties.

What does this mean?

Whilst eating disorders may still be more common in women, there seems to be a much higher percentage of men with eating disorders than previously thought.  It is crucial that eating disorders are not seen as a female disorder – this view only contributes to the difficulties men may have in talking about their difficulties, accessing appropriate treatment and having their disorder recognised by others.

* The facts in this article are based on current available literature and research – given the absence of research in this area we  hope that continued research will continue to add to our knowledge.

Eating Disorders and Fertility

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There are a multitude of physical, emotional and psychological consequences of eating disorders.  One of the issues that we commonly get asked about is what impact eating disorders have on fertility – both short term and long term.

Concern about fertility is one of the most common reasons that women cite for seeking treatment for an eating disorder.  Whilst we still don’t feel that there is enough research in this area to be able to give a definite statement about the long term impact of either anorexia or bulimia on fertility, we do know that women with current eating disorders are more likely to experience fertility problems.  

It is fairly well known that in restrictive eating disorders, where periods stop due to low weight, fertility issues are very likely.  However studies have also identified fertility difficulties in women with eating disorders who are at a healthy weight.

A research study done in 2013 (Int J Eat Disord 2013; 46:826–833) is the most recent study that we are aware of that investigated the impact of a current eating disorder on fertility.  The researchers compared 2,257 women with a current diagnosis of an eating disorder with 9,028 women without an eating disorder.  An advantage of this study is that it explored fertility issues in women across all eating disorder diagnoses: anorexia nervosa, bulimia nervosa, atypical eating disorder and binge eating disorder.

The researchers found that across all eating disorders, women were more likely to be childless.  Whilst this doesn’t necessarily point to fertility problems in itself, it does support previous research in highlighting the presence of increased fertility difficulties in women with eating disorders.  This research also found that women with bulimia nervosa or binge eating disorder were at increased risk of miscarriage.

Previous research has also found that in restrictive eating disorders with resulting low weight, up to 1/4 of patient may never regain normal menstruation cycles, suggesting that fertility may be affected even following successful treatment.  In women that do become pregnant there is a known increased risk of  complications like miscarriage, birth defects and low birth weight babies, Cesarean section, and postpartum depression.

We would reinforce that we don’t feel there is enough research at present to know what the long term fertility implications for people in recovery from an eating disorder are.  There is some evidence though that fertility may not always return to normal once a person has fully recovered from an eating disorder.  We would suggest that this is more likely if the eating disorder has been severe and long term.

I you are concerned about the impact of an eating disorder on your fertility, we would encourage you both to seek professional help and to be open about your eating disorder history with your GP or any other professional involved in your fertility care.

Body Dysmorphic Disorder: What is it and how to recognise it

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Body Dysmorphic Disorder (BDD) affects nearly 1 in every 100 people in the UK.  BDD is an anxiety disorder involving extreme anxiety over and preoccupation with an imagined or slight defect in physical appearance.

Body dissatisfaction is a common occurrence for most people at some point in their lives, however ‘normal’ body dissatisfaction involves thoughts and feeling that come and go, can be easily forgotten, and do not interfere with a persons self esteem and daily life.  For someone with BDD the thoughts they have about perceived defects become very distressing and do not go away.

BDD has been likened to Obsessive Compulsive Disorder (OCD) where people experience obsessions (reoccurring intrusive thoughts or images) and compulsions (behaviours that are carried out to try and reduce the obsessions or their resulting anxiety).  In BDD the obsessions are either excessive, disproportionate concerns about a minor flaw, or recurrent, anxiety-provoking thoughts about a completely imagined defect.  The compulsions are acts that people do to reassure themselves or to hide the perceived defect.  These can include mirror gazing or avoiding all mirrors, frequent reassurance seeking, skin picking, excessive makeup use, reoccurring cosmetic surgery…

In BDD perceived defects may be about any part of the body.  That said, it is most common for people with BDD to focus on their face or head.  Skin ‘bumps’, a lack of symmetry to the face or body, features being ‘out of proportion’ or an ‘unusual colour’ are common fears in BDD.

In severe cases of BDD, the perceived defect in appearance can become so distressing to the individual that they start to avoid situations in which the defect may be noticed.  This may include avoiding social situations, avoiding eye contact with others, an inability to leave the house without having first performed certain acts or rituals (e.g. without makeup or without mirror checking).  Relationship problems are very common among people with BDD.  Overtime, anxiety over the perceived defect is likely to increase, with the thoughts about and behaviours around the perceived defect starting to take up more and more time.

BDD is a serious condition. Depression, extreme anxiety and suicidal thoughts are common.   Relationships, friendships and quality of life will usually start to suffer, and the fact that few people understand BDD will often only make things harder.

We still don’t really know what causes BDD, although like other psychological conditions it is likely to be a result of a combination of biological, psychological and socio-cultural factors.  People with BDD may have experienced bullying or teasing about their appearance.

If you think you are suffering from BDD it is important to seek help as early as possible.  Even though the thought of talking about your appearance may well evoke anxiety, there are professionals who understand and can help you to overcome the distress of BDD.

4 ways to spot BDD in others:

1. They constantly seek reassurance about their appearance but your reassurance doesn’t seem to help them to feel better.

2. They seem to avoid certain situation and you suspect this may be related to their appearance concerns.

3. They spend a long time trying to hide or cover up a certain part of their body or face – this might be with clothing, makeup or in extreme cases continual cosmetic surgery.

4. Their mood and self esteem is negatively affected by their appearance concerns, over and above how most people respond to dissatisfaction with their appearance.

Why does bingeing happen in bulimia nervosa?

bulimia nervosa binge eating
In the past it was believed that people with bulimia nervosa had a binge-eating disorder and that they dieted in order to counteract the effects of a binge. Although it is true that people sometimes restrict their eating after binging, we now know that dieting in fact precedes, and is the major cause of binge-eating.

Dieting causes binge-eating primarily because it results in a state of deprivation in the body. The body can only tolerate being deprived of essential nutrients for so long and then it rebels and overeats to compensate for what it hasn’t been getting. In the same way that people who become extremely thirsty tend to drink more than usual, people who’s bodies are extremely hungry, will tend to binge. How long it takes to develop binge-eating varies. Some people manage to maintain extreme restriction for a long time without bingeing, however for the vast majority of people, and for 50% of people with anorexia, restriction will at some point result in binge-eating. This is often taken as a sign of failure or weakness, however it is actually near impossible to override a physiological urge to binge

The body makes significant adaptations in response to both restriction and bingeing, meaning that the effect of bingeing on the body can change over time. Firstly, if the body learns that it has to exist on a small amount of energy (as it does in those who chronically diet), it slows its metabolic rate down in order to use food more efficiently. Dieting actually reduces the metabolic rate by around 15-30% and reduces the amount of energy expended during activity. This compensation is found irrespective of the body size of the individual. The longer a person diets for the more the metabolic rate is slowed, and the longer it takes for the metabolic rate to recover.

This has important implications for understanding the effects of binge-eating cycles. It is likely that weight loss becomes increasingly difficult each time a person tries to restrict their food intake, and that the calories taken in during binges are less likely to be burned as fuel and are stored more readily by the body as fat. This is one of the reasons why people with bulimia nervosa tend to gain weight over time, even if their eating doesn’t seem to have changed. This weight gain (or increased difficulty in losing weight) makes it more likely that people will try and diet. However this only serves to increase the frequency and intensity of being eating. Thus a vicious cycle begins.

Vomiting and using laxatives often begin as ways of regaining control after “over-eating.” These practices soon result in even greater breakdown in control since they “legitimize” binging (“It’s all right to binge, because I can get rid of it all afterwards”). They may also contribute to a physical relief after the fullness of binging or eating, and the person may eventually feel she must vomit or use laxatives after every meal or at the end of every day to try to get back the sense of relief. Although the individual may initially lose weight through purging, this is most often temporary as the effectiveness of vomiting becomes limited over time (see blog post: the ineffectiveness of purging). Although vomiting “solves” the short-term problem of getting rid of unwanted food that may lead to weight gain, in fact it only gets rise of around 30% of calories consumed during a binge, and actually makes it more likely that a person will binge as it increases hunger and urges to binge. Thus over time, people who purge after bingeing are also more likely to see an increase in bingeing and resulting weight gain.

Taking laxatives can also be part of this cycle. Regular laxative use can result in a physiological reliance on the laxatives. This may be because the bowel’s normal muscle contracting ability is impaired by repeated laxative use due to damage to intestinal nerves. Severe constipation or water retention can result when laxatives are not used, so that it seems that continuing to take the laxatives is the only way to continue “regular” bowel movements. Besides being extremely dangerous, laxatives are a completely ineffective method of trying to prevent the absorption of calories. In fact all laxatives get rid of is water, thus removing essential hydration from the body.

Occasionally bingeing eating occurs solely because of these physiological effects, however in bulimia nervosa there can often be emotional triggers to bingeing as well. In these circumstances bingeing tends to be triggered by intense emotions or as a desire to escape from strong emotions. This means that when bingeing stops, strong emotions may start to reveal themselves. For these people, it can be very important to seek support from a professional to help them to identify, understand and cope with these strong emotions.