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.
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.
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.
Good health is a balance between social, spiritual, mental and physical wellbeing. Mental and emotional health depend upon good physical health and nutrition, along with rest and exercise, is a basic foundation of physical health. If the nutritional needs of your body are not met, sleep patterns can become disturbed, the capacity to do physical exercise can become impaired, mental concentration and decision-making can suffer and unwanted changes in mood can occur.
So what are our bodies nutritional needs?
Major health organizations agree that there are six main principles and recommendations for good nutrition:
In practical terms these recommendations translate to;
Regular meals and snacks are important in keeping our bodies energy levels constant. Three meals and two – three snacks per day are recommended. Eating regular meals also stimulates the muscles of the gut (digestive system) to work well. Bowel movements become regular and constipation is prevented. For some individuals recovering from an eating disorder, it may be easier to begin working towards a more normal food intake by eating six smaller meals, rather than three bigger meals. It is very important to eat breakfast since it can help prevent the desire to binge or overeat later in the day. Breakfast is the meal which break(s) the fast of the night’s sleep. It stimulates the body’s metabolic rate and gets you going in the morning.
The body needs a continuous supply of energy in order to survive. Food and drink provide us with energy in the form of carbohydrates, proteins and fats; Vitamins and minerals do not supply energy. However some are needed to help the body utilize energy from food. The energy in food is measured in calories or kilojoules. The amount of energy that each woman needs is affected by a wide range of factors. However, we know that it is difficult to meet your required intake of nutrients if your energy intake is less than 1200 kcal (5040 kJ) per day. Most women need approximately 2000 kcal (8400 kJ) daily.
Two main types of carbohydrates exist in food. The complex carbohydrates include starch and fiber-containing foods such as breads, pasta, potatoes, kumara, corn, legumes, rice and cereals. Foods containing simple carbohydrates include fruits, honey, sugar and sugar-containing foods (desserts, cakes etc). The major function of carbohydrates is to provide a steady supply of energy to all cells in the body. Complex carbohydrates are also crucial for the healthy functioning of the digestive tract and contribute to feeling full after a meal. Ideally approximately 50 to 55% of an individual’s total energy intake will come from carbohydrates. Included in this will be 25-30 grams of fiber per day. This can be met by eating at least six servings of food from the bread and cereal group, plus five servings or more from the fruit and vegetable group each day.
Foods supplying high quality protein include meats, eggs, dairy products and seafood. Proteins of a lesser quality and concentration are found in nuts, legumes, grains and other vegetables. The major function of protein is to build and repair the body and to maintain an effective immune system so that you can fight off infections and stay healthy. Ideally, about 12 to 20% of total energy intake will be derived from protein. This can be met by eating at least two servings of food from the milk, milk products group, plus one or more servings from the meat, fish, chicken, dried beans, nuts or eggs group daily.
The most common sources of fat are butter, margarine, oil, fatty meats, high fat dairy products and rich desserts and cakes. Fat is an essential part of meals.
Fat in food contains important fat soluble vitamins, such as A, D, E & K.
Vitamin A is needed for vision in dim light. It is also put in skincare products as it keeps skin strong and elastic, and helps resist infection.
Vitamin D is essential for strong bones. It protects the skeleton from fractures.
Vitamin E is protective against aging. It has also been proven to reduce the risk of cancer.
Vitamin K is needed for blood clotting.
Fat also contains essential fatty acids. Essential fatty acids are the building blocks of many hormones and of the substances in the body that help fight infection. All body cell membranes contain fat to give them elasticity. Women store more fat in their bodies than men. Body fat gives us the curves which make us female. A healthy body fat percentage is approximately 25% for women. This fat insulates the body and prevents excessive loss of body heat. It also cushions our bones and decreases the risk of bone fractures. Current New Zealand recommendations are for people to cut down on fat intake. This does not mean “cut out”. A target of 30 – 33% of total energy in food coming from fat has been set. This means having a moderate amount of fat with each meal.
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:
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.
A panic attack involves a sudden rush of intense psychological and physical symptoms. The symptoms of panic can be frightening and can happen very suddenly, often for no clear reason. Panic attacks usually last between five and 20 minutes, and although it may feel as though you are in serious trouble, they aren’t dangerous and don’t cause any physical harm.
The psychological symptoms of a panic attack may include an overwhelming sense of fear or a sense of unreality, as if you’re detached from the world around you. The physical symptoms of a panic attack can include heart palpitations, sweating, nausea, trembling or shaking, shortness of breath or difficulties breathing, dizziness and chest pain. The symptoms of a panic attack are often very unpleasant and distressing, and the anxiety caused by these sensation can often end up making the symptoms worse.
If you think you are experiencing panic attacks it is very important that you seek help from a professional who will be able to help you reduce and eventually stop these attacks. However below are a few helpful tips on how to gain more control over you panic.
1. Reassure yourself that you are not in danger and that what you are experiencing is not dangerous
A panic attack is your body going into ‘fight or flight’ mode. It is what happens to the body when adrenalin is released, which happens in response to a perceived threat. Often people aren’t aware of what the perceived threat is, meaning that the panic attack seems to occur for no reason at all.
Often when people experience a panic attack the perceived threat is external i.e.) a social situation, a meeting at work. It is also possible to bring on a panic attack by thinking about (being worried about) having a panic attack or thinking about (being worried about) what might happen during a panic attack. For example you may be worried about people noticing you having a panic attack, about fainting or being sick during a panic attack, or about the panic attack never ending an descending you mad.
It can be very helpful to reassure yourself that you are not in any danger and that the symptoms you are experiencing are not dangerous. Try reminding yourself of the following:
Fainting is a response to a drop in blood pressure. When you are experiencing a panic attack your blood pressure will be high (as the body is trying to get blood / oxygen to all of the muscles in your body). When you feel dizzy this is because there is extra adrenalin in your blood steam, not because you are experiencing low blood pressure. Therefore unless you are holding your breath during a panic attack it would be physically impossible for you to faint. Similarly, it is highly unlikely that you will be sick during a panic attack as the nausea you experience again is a result of the adrenalin in your system and not the result of an illness or sickness.
Remember that the symptoms you are experiencing will be much more obvious to you than they will be to anyone else. People are internally focused, meaning that they are far more concerned about themselves than other noticing other people. This means that you would need to do something quite dramatic for others to notice you. Whilst it might feel as thought your anxiety is obvious to everyone else, it probably isn’t even noticeable to others and if it were they are much more liley to feel concern and care than to judge you negatively or laugh at you.
When we experience a panic attack our sympathetic nervous system is activated and is operating. when we are relaxed our parasympathetic nervous system is active. It is only possible for one nervous system to be active at one time – we can’t be both relaxed and panicked at the same time. It is therefore possible to stop a panic attack from happening if we are able to activate our parasympathetic nervous system,. This can be done using simple breathing exercises.
The most effective breathing for this purpose is diaphragmatic breathing, a pattern of slow deep breathing that engages the diaphragm. When practiced regularly diaphragmatic breathing can bring a panic attack to a end in minutes. Essentially this breathing is the opposite of the breathing that happens during a panic attack which tends to be quick and very shallow. the more you practice diaphragmatic breathing the easier it becomes so it is important to practice it when you are not experiencing panic rather than only during a panic attack.
3. Remind yourself that the panic will end
Panic attacks tend to be very short lived – only a few minutes long. The body actually can’t stay in a heightened state of anxiety for very long. It can often feel as though the sensations will last forever getting worse and worse. This though can often make the panic worse and even elongate the panic attack. It can be useful therefore to remind yourself that the panic will subside and you just need to ride it out.
3. Behave as if you are fine
The mind and body are very closely linked meaning that what we do with our body affects how we think and how we feel and vice versa. Behaving ‘as if’ we are relaxed, calm and confident can have a surprisingly strong effect on anxiety levels. If effect we are able to ‘trick’ ourselves into thinking that everything is ok, which can have a dramatic effect on reducing anxiety.
Over time, using these approaches will help you to start feeling some control over your panic attacks. The more you feel able to cope with a panic attack if it were to occur, the less likely you are to actually have a panic attack.
Remember that these strategies, though they may sound simple, are actually quite difficult to implement, especially when you are panicking. It is always worth seeking professional help to guide you through these strategies.
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”.
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.”
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.
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.
In a previous blog post this week we discussed how pregnancy can be a challenging time for many women, in particular for their relationship with their bodies. Below we list a few tips on keeping a healthy body image during pregnancy.
1. Anticipate the changes that your body will go through. Try to embrace rather than fear these changes. Try not to focus on weight but instead focus on the new role that your body is taking on. Each and every body change is necessary for the health and protection of your baby. Embrace these changes where possible and value the role your body has in protecting your growing baby.
2. Focus on your babies needs rather than on your own. Recognise the importance of your own nutritional and emotional health in meeting the needs of your baby and try to make these your focus.
3. View the changes your body is going through as an essential part of pregnancy. Focus on the life changes that you are looking forward to rather than the changes that you are more anxious about.
4. Treat and care for your body. Pamper it, do things that make you feel good, allow yourself to buy new clothes, get your nails done, pamper your body with a pregnancy massage. All of these things can make you feel better and can help you achieve a healthier relationship with your body.
5. Focus on the things you can do rather than the things you can’t. Hobbies or interests may have to change slightly during pregnancy but they don’t have to change dramatically. Exercise, socialising, ‘dating’ your partner, are all important during pregnancy and do not have to stop.
6. Recognise the hormonal changes that your body is going through and how these might be making you feel. Acknowledge that your emotions may be more intense or may change quickly. Ensure that you are looking after yourself by eating regularly and getting enough sleep to help you deal as best you can with these hormonal changes.
7. Talk to others. One of the biggest fears pregnant women have is that they shouldn’t be feeling how they are. Many women struggle with the changes their bodies go through during this time in their lives. You don’t have to love every second of pregnancy. Share how you are feeling with others and keep talking to those who understand or can relate to your own struggles.
8. Take weight out of the equation if necessary. Though it is likely that the majority of your doctor and midwife appointments will involve weighing, you do not always have to know what your weight is doing. If you know that it is likely to cause distress or trigger unhealthy behaviours or obsessions, request that you are not told exactly what you weigh but rather whether your baby is growing healthily.
9. Reduce unhelpful behaviours. Body checking, body comparisons, focussing on the areas you are unhappy with are all likely to make you feel worse. Try to resist these behaviours and instead focus on things that you feel good or positive about.
10. Seek help. Pregnancy is a challenging time, especially for those who have pre existing body image or eating difficulties. Recognise the importance of seeking help when you need it and don’t feel ashamed to tell people that you are struggling.
This week on the blog we will be thinking about body image and pregnancy – an issue that we know is a growing concern for a number of mums to be. In this post we discuss the greatest body image concerns and issues faced by pregnant women.
1. Gaining Weight: Weight gain is a very natural and absolutely essential part of pregnancy however seeing weight go on can be very challenging for a lot of mums. A common fear can be whether you are gaining the ‘right’ amount of weight during pregnancy and whether this weight will come off easily after the baby is born. A recent survey suggested that fear of weight gain may be the number 1 reason why women opt not to have children.
2. Eating disorders in pregnancy: It is not uncommon for women to either develop an eating disorder during pregnancy or shortly after giving birth, or for women who have previously recovered from an eating disorder to experience a relapse of symptoms. This is occasionally referred to as ‘pregorexia’. It is very important to remember that extreme dieting and exercise is risky when not pregnant but can be risky both for the mum and the growing baby when it occurs during pregnancy. Professional help can be very important when pregnancy triggers the onset or relapse of an eating disorder
3. Body Dysmorphic Disorder: BDD is a psychological condition where an individuals perception of themselves becomes distorted. Perceived flaws become completely preoccupying and extremely distressing. BDD both occur during pregnancy and can also make the body changes that occur during pregnancy harder to cope with.
4. Losing control: When you’re pregnant, you’re no longer living for yourself — you’re responsible for a growing baby. Pregnancy results in all kinds of physical, emotional and lifestyle changes, many of which are far beyond your control. The fear of losing control can be especially troubling for women with eating disorders because they typically focus on perfection and maintaining control. Getting pregnant may be the ultimate way of losing control.
5. Losing weight due to morning sickness: For some women, gaining pregnancy weight is not a difficult issue, rather the fear of losing weight usually due to morning sickness may result in high levels of anxiety. It is always recommended that medical attention be sought when morning sickness is severe and / or weight is not going up as recommended, but it is also important to talk about and find support to manage the anxiety that this may be causing.
6. Losing your style: Pregnancy will inevitably influence and change your fashion choices. Especially towards the end of pregnancy, a growing bump can be very hard to dress, leaving many women feeling distressed and dissatisfied. For some women, their changing fashion style can trigger anxiety that they will be seen differently, treated differently, or that they will no longer fit in to friendship groups. For a lot of women appearance, weight, shape and fashion sense is heavily tied into their sense of identity and their view of themselves. When this changes due to pregnancy women can be left struggling with their identity and with fears about how they are perceived by others.
Pregnancy is a challenging time for many women, and body image issues can add to this challenge. Added to this is the impact of comments about your growing body, a sense of your body no longer being your own, and an unspoken pressure to ‘love your bump’. The blog this week will continue to think about the issue of body image issues in pregnancy. Look out for tips on how to stay happy and healthy in your pregnant body later in the week.
The Sunday times this week released an article detailing concerns of occurrences of anorexia increasing in school age boys. These concerns came from a head teacher at a private school in the North of England who believed pressure to achieve academically and anxiety over school performance was at the root of this increase. The Royal Grammar School (RGS) in Newcastle is pioneering in its efforts to reduce school related stress and address mental health issues by hiring dedicated counsellors and holding a conference for teachers on helping pupils to cope with stress.
A recent report from NHS England suggests that rates of anorexia in school age children are indeed increasing. It is now estimated that 1 in 10 children will experience a mental health condition at some point during their school career.
The London Centre for Eating Disorders and Body Image has also seen an increase in schools sharing concerns over male pupils and is increasingly being asked to run their education and awareness sessions to boy only groups. Dr. Bryony Bamford of The London Centre says “We are pleased that schools are picking up that anorexia is not a female only illness, but equally concerned at the increasing rates of emotional stress and distress that we are seeing in very young children. Both parents and teachers need to be fully aware of how to support children to cope with pressure and anxiety in as well as outside of school”.
Recent data published from 35 NHS hospitals in England over the past 3 years showed that more than 2,100 children were treated for eating disorders before they reached their sixteenth birthday. Of these, 197 children were under the age of nine and almost 400 were between the ages of 10 and 12. A further 1,500 children were aged between 13 and 15 years old. Given that this data is taken from only 35 hospitals within England, and that anorexia in young children is not always detected, these figures are likely to be well below the actual number of young children suffering from anorexia within the UK.
There are a range of eating disorders that can be diagnosed in childhood, anorexia nervosa being the most serious of these disorders. Anorexia is a psychological diagnosis where the sufferer will restrict their food intake and fluids. They may also exercise in response to consuming food. Anorexia almost always results in a weight loss, although in young children whose weight should be increasing, it may result in lack of weight gain rather than noticeable weight loss.
Here is what to look out for if you are worried that your child is restricting his/her diet and could be displaying early signs of an eating disorder.
My child hasn’t lost any weight so I don’t need to worry
If your child is displaying the warning signs, but seems not to have lost any weight, there could still be cause for concern. It’s important to remember that children are growing and should be putting on weight. A child’s weight shouldn’t be stagnant. On average children gain about 2-3 kg (5-7 pounds) per year between the ages of 6- 10 years old.
My GP says not to worry…
If you take your child to your GP, and they consistently dismiss problems with your child’s eating behaviour, it is worth seeking the advice of an eating disorder expert. Childhood anorexia is still relatively rare and it may not be spotted by your GP. If you know there is something wrong with your child’s eating behaviour, it is always worth seeking the advice of an eating disorder expert.
Remember, the earlier the diagnosis, the better the chances of a full recovery. Anorexia is a particularly difficult illness to overcome when it has become entrenched in a young person’s mind over a number of years. The sooner your child can receive help, the sooner your child will overcome their disorder and go on to live a happy, healthy life.