Eating Disorders

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’.

 

 

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.

Why does bingeing happen in bulimia nervosa?

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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.

The Unspoken Effects of Dieting

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The Unspoken Effects of Dieting

It seems that dieting has almost become a ‘normal’ activity amongst individuals in the UK.  Every magazine we open shares diet details, every celebrity seems to endorse a different one, and it seems almost a rarity amongst certain groups not to discuss dieting.  Of course, dieting can be done in a healthy way when it involves a balance of food groups, regular healthy eating and combined exercise to achieve weight loss goals.  However many of the ‘fad’ diets that we read about do not seem to work on these principles.  Very few women who diet realize that dieting itself causes severe psychological and physical changes. Dieting, even in women without eating disorders, often causes depression and irritability. When you diet, your metabolism slows down in order to conserve the small amount of food available. This is an intelligent move on your body’s part, and probably has helped people to survive in times of famine. The problem is that when you stop dieting, since your metabolism has slowed down, it becomes easier than ever to gain weight and you put weight on faster and more easily. Each time you go through another diet, this cycle continues. The only way to speed up your metabolism again is to eat.

Your body is like a wood-burning stove. It needs fuel to keep warm. The fuel intake needs to be regular through the day. The fire inside the stove is like your metabolic rate. It will burn the hottest when it has plenty of fuel.  When we limit the amount of energy or ‘fuel’ we are giving our body, we will undoubtedly experience a number of physical consequences:

Problems related to dieting and severe weight loss

  • intense hunger (this is likely to lead to overeating or bingeing in about 25% of dieters)
  • low energy
  • tiredness
  • poor sleep/insomnia
  • dizziness
  • headaches
  • visual problems including slightly blurred vision
  • edema (swelling due to excess body fluid)
  • gastrointestinal problems (tummy aches or cramps)
  • lowered body temperature leading to feeling cold
  • overall lowering of body’s metabolic rate
  • lowered heart rate
  • irregular menstruation or loss of periods (usually only seen in extreme dieting)
  • dry, pasty skin
  • muscle loss
  • moodiness
  • irritability
  • difficulty making decisions
  • difficulty concentrating

In women who are dieting healthily these effects may be mild and short-lived. When dieting is extreme however, as in anorexia nervosa, a state of chronic starvation is evoked meaning that these effects are likely to be ongoing, potentially causing serious longer term consequences.

Eleven Common Thinking Traps

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Thinking traps may also be referred to as ‘thinking errors’ or ‘cognitive distortions’.  Most people use thinking traps from time to time, however they tend to be more common in people who experience psychological distress such as anxiety or depression.  They are also very common in people with disordered eating.  Often people will use these thinking traps so often they they will not be aware that they are using them.  However, awareness of these thinking styles can be an important stop in understanding and changing unwanted moods and behaviours.

Here are eleven of the most common thinking traps that you might have experienced:

1. Mental Filter

Mental filtering is when we focus exclusively on the most negative and upsetting features of a situation, filtering out all of the more positive aspects.

Example: You undertake a performance review at work which is ninety-five percent positive and complimentary – but you dwell and focus exclusively on the five percent of the review that mentioned ways in which you could have performed better.  This leaves you feeling that you are a failure, that you haven’t done well enough and that your boss sees you in a negative way.  The impact of this mental filter may be that you not only don’t recognise the praise that you were given but that you start to feel anxious or low when thinking about your job.

2. Disqualifying the Positive

Disqualifying the positive is when we continually discount and dismiss the positive experiences we encounter, by deciding they are unimportant or ‘don’t count’. Positive information or experiences may be seen as a fluke.

Example 1: A friend compliments you on a dinner you made, but you decide that “they are just saying that to be nice” or “they are trying to get something out of me”.

Example 2: “I know I wear a size 10-12, but my thighs are too big”, “He only asked me out because he was lonely or feels sorry for me, he doesn’t really like me”.

3. ‘Black and White’ or ‘All or Nothing’ Thinking

This involves thinking in extremes, with no middle ground. These types of thoughts are characterised by terms such as or ‘every’, ‘always’, or ‘never’ .  Everything is seen as good or bad or a success or failure. It is generally the negative perspective that is endorsed, discounting all the shades of grey that lie in between the two focussed on choices.

Example 1: If you get eighty per cent on a test, you feel like a failure that you didn’t get a perfect score.

Example 2: People with eating disorders often believe that if they can’t be ultra-thin, they will be obese, and that they must be completely in control of their eating or there will be chaos. You may believe that if you begin eating normally you will lose all control and end up extremely overweight. When you think this way you are thinking in extremes; ultra thinness and obesity are not the only alternatives, in fact your body functions best within a natural weight range, which is somewhere between these two extremes.

To avoid black and white thinking it is often helpful to look for the grey area in between. Look for all the possible alternatives. For example “Getting a mix of As, Bs and Cs for my exams is fine and does not mean I am a failure” or “Obesity is not the only alternative to thinness, it is more likely that I will be in a healthy weight range”.

 

4. Overgeneralisation

Thinking in an over-generalising way means we will often see a single unpleasant incident or event as evidence of everything being awful and negative, and a sign that now everything will go wrong.

Example 1: If you fail to get a job you interview for, you decide you are never going to get a job.

Example 2: If you go on one unsuccessful date, you decide you are never going to find a partner.

Example 3:  Believing that if something turns out badly once, then it will always happen that way. For example, failing your driving test and believing you are totally inadequate in all areas of your life.

For people with eating disorders a common generalisation is thinking that because I have put on some weight, I am just going to continue to put on weight forever. However, the facts show us that initial weight gain following re-introduction of regular eating is your body counteracting effects of past deprivation or starvation.

5. Jumping to Conclusions

This thinking trap involves making a negative interpretation or prediction even though there is no evidence to support this conclusion. This type of thinking is often made when thinking about how others feel towards us. It can show up as either ‘mind reading’ (assuming the thoughts and intentions of others) or ‘fortune-telling’ (anticipating the worse ad taking it as fact).assuming the worst even when there is no reason to.

Example 1: “People are staring at me because I am so fat” (mind reading).

Example 2: “My boss wants to speak to me – I must have made a massive mistake and I’ll get the sack” (fortune telling).

Example 3: “Sarah didn’t call – I must have done something to upset her” (mind reading).

Example 4: You are at a party and you don’t like what you are wearing and you decide ‘everyone is laughing at me’ (mind reading).

Example 5: You are going to take your drivers test and ‘know’ that you are going to fail (fortune-telling).

6. Magnifying or Minimising (Also referred to as “Catastrophisation”)

Thinking in a magnifying or minimising manner is when we exaggerate the importance of negative events and minimize or downplay the importance of positive events. In depressed individuals, it is often the positive characteristics of other people that are exaggerated and the negatives that are understated (and then when thinking of oneself, this is reversed).

Catastrophising is only paying attention to the negative side of things or overestimating the chances of disaster. When we think catastrophically we are unable to see any other outcome other than the worse one, however unlikely this result may turn out to be.

Example 1: “I had one binge – I am back to square 1 – I’m never going to get better”. “Nothing ever works for me – I may as well give up now”.

Example 2: You send out the wrong letter to a client at work, and this turns into “I will now lose my job, and then I won’t be able to pay my bills, and then I will lose my house.”

7.  Personalisation

A person engaging in personalisation will automatically assume responsibility and blame for negative events that are not under their control. This is also called ‘the mother of guilt’ because of the feelings of guilt, shame, and inadequacy it leads to.

Example: You feel it’s all your fault that your dog injured his foot even though you weren’t at home when it happened but were out shopping. Your thoughts might be ‘if only I didn’t go out’ or even ‘maybe when I came home I accidentally stepped on the dog and hurt him’ even though this is entirely unrealistic.

8. Shoulds and Oughts

Individuals thinking in ‘shoulds’, ‘oughts; or ‘musts’ have an ironclad view of how they and others ‘should’ and ‘ought’ to be. These rigid views or rules can generate feels of anger, frustration, resentment, disappointment and guilt if not followed.

Example: You don’t like playing tennis but take lessons as you feel you ‘should’, and that you ‘shouldn’t’ make so many mistakes on the court, and that your coach ‘ought to’ be stricter on you. You also feel that you ‘must’ please him by trying harder.

9. Emotional Reasoning

Emotional reasoning is when we assume feelings reflect fact, regardless of the evidence. The idea here is “I feel it, therefore it must be true”.  Such thinking can lead to self-fulfilling prophecies whereby our thoughts can end up eliciting the very behaviour we predicted, just because we changed our behaviour in accordance with that thought.

Example 1: if you think “I feel ugly and stupid, so then I must actually be ugly and stupid” you might then stop buying yourself new clothes and start doing poorly at the course you are taking at university, even though you look fine and were doing very well at school.

Example 2: Taking your emotions as an accurate reflection of what is happening. For example, “I feel fat therefore I am fat”, even when you are actually underweight.

10. Labelling

Labelling is an extreme form of ‘all or nothing’ thinking and overgeneralisation.  Rather than describing a specific behaviour, an individual instead assigns a negative and highly emotive label to themselves or others that leaves no room for change.

Example: You make a mistake on a form you filled out and it’s sent back to you in the post. So you decide “I’m such a loser” or “I’m so stupid” rather than thinking “I made a mistake as I had a busy day when I was filling this out”.

11. Expecting perfectionism and having double standards

These two often go together. People with eating disorders often expect themselves to be perfect and anything less than excellence equals failure. They judge themselves by what they achieve and expect others to judge them in the same way.

Additionally, they may have double standards, for example, thinking it is OK for other women to be a normal weight, but that they will only look good at X weight. It may be OK for other people to make mistakes but unacceptable for them.

 

Newsflash: Eating disorders and autoimmune disease linked in latest research

autoimmune diseases

In a recent study published in PLoS One, a number of autoimmune diseases were found to be linked to eating disorders.  The study researchers suggested that the autoimmune diseases may have played a role in the development of eating disorders.

The study comprised a large sample of more than 2,000 Finnish people with eating disorders.  Of these 2,000 people, a higher proportion that would otherwise be expected of a healthy sample, reported coexisting autoimmune diseases.

Autoimmune diseases, such as diabetes type 1, coeliac disease and IBS occur when the immune system incorrectly attacks and destroys healthy cells in your body.

The researchers said of their findings “The immune system appears to contribute to the start and continued problems of eating disorders, at least in this group of patients”.

Study Details

Over the course of about 16 years, the researchers examined 2,342 people currently in treatment for bulimia nervosa, anorexia nervosa and binge-eating disorder.

Each patient was then compared with four age- and sex-matched healthy people. Also, data on 30 autoimmune diseases from a hospital discharge register from 1969 to 2010 were analyzed.

Results showed that 8.9% of the people with eating disorders and 5.4% of healthy people had been diagnosed with at least one autoimmune disease by the end of follow-up.

Other related findings

The immune system has previously been recognized as playing a role in disorders including autism spectrum disorders, ADHD, obsessive-compulsive disorder, and post-traumatic stress disorder.  Additionally, previous research has reported autoimmune diseases and severe infections to be significant risk factors for mood disorders and schizophrenia.

Conclusions

Eating disorders are known to have a very strong psychological component, but this study provides evidence for their also being a possible biological component to eating disorders.

Orthorexia – is it an eating disorder?

ORTHOREXIA-21-300x279

Orthorexia nervosa has gained increasing attention in the press in recent years, but what is it?  Sometimes described as orthorexia nervosa, it describes those who may be seen as having “unhealthy obsessions” with otherwise healthy eating.  Orthorexia usually starts out as a harmless attempt to follow certain healthy eating rules.  However, in some cases, these rules start to become all consuming obsessions.  At this point, a person may be referred to as having orthorexia.  ‘Healthy’ dietary rules will be  followed to an extreme, and the person will become fixated on  food quality and purity.  Deviations or  ‘slip ups’ from these rigid food rules become highly distressing, and are often taken as evidence that the person is a failure, or has no will power. ‘Punishment’ is often used following any deviation from these very rigid rules, and may include fasting, increased dietary restriction or strict exercise.  Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake.

Is Orthorexia An Eating Disorder?

Orthorexia is a term coined by Steven Bratman, MD to describe his own experience with food and eating.  It is not an officially recognized disorder in the DSM-V, but is similar to other eating disorders – those with anorexia nervosa or bulimia nervosa obsess about calories and weight while orthorexics obsess about healthy eating (not about being “thin” and losing weight).

Why Does Someone Get Orthorexia?

Orthorexia appears to be motivated by health, but there are often additional underlying motivations, which can include safety from poor health, compulsion for complete control, escape from fears, wanting to be thin, improving self-esteem, searching for spirituality through food, and using food to create an identity.

Do I Have Orthorexia?

Consider the following questions.  The more questions you respond “yes” to, the more likely it is that you may be suffering from orthorexia:

  • Do you ever wish you could spend less time on food and more time living or doing things you enjoy?
  • Do you wish that occasionally you could just eat and not worry about food quality?
  • Does you find it very difficult or anxiety provoking to eat a meal that has been prepared by someone else and not to try to control what is served?
  • Are you constantly looking for ways foods are unhealthy for you?
  • Do you spend a lot of time thinking about food or planning what you can and can’t eat?
  • Do you feel guilt or self-loathing when you stray from your diet?
  • Do you feel in control when you stick to the “correct” diet?
  • Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?

Why is orthorexia unhealthy?

When food choices become so restrictive, in both variety and calories, health suffers.  The diet of orthorexics can actually be unhealthy, with nutritional deficits specific to the diet they have imposed upon themselves.  These nutritional issues may not always be apparent as a person may continue to ‘feel’ healthy.

Social problems are often more apparent.   A person with orthorexia can easily become socially isolated, often because they plan their life around food.  They may have little room in life for anything other than thinking about and planning food intake.  Orthorexics lose the ability to eat intuitively – to know when they are hungry, how much they need, and when they are full.   Instead of eating naturally they are destined to keep “falling off the wagon,” resulting in a feeling of failure familiar to followers of any diet.

In the long term, obsessions with healthy eating will start to crowd out other activities and interests, impair relationships, and become physically dangerous.

What does Recovery from orthorexia look like?

Recovered orthorexics will still eat healthily, but they will achieve a different understanding of what healthy eating is.  They will realize that food will not make them a better person and that basing their self-esteem on the quality of their diet is irrational.  Their identity will shift from “the person who eats health food” to a broader definition of who they are – a person who loves, who works, who is fun.  They will find that while food is important, it is one small aspect of life, and that often other things  are more important!

Orthorexia, being a relatively newly recognised condition, will rarely be diagnosed by a GP however, professional help is usually required. Psychologists at The London Centre are skilled in helping people overcome the limitations of orthorexia and CAN help you.