Walking a thin line

Mental health professionals all agree that eating disorders are on the rise but could it be that what we define as an eating disorder has become broader?, asks Sylvia Thompson.

The number of people with eating disorders is much greater than the estimated 200,000 individuals, participants at a conference on young people at risk heard last week.

And, could it also be that as our culture becomes more fast-paced and more obsessed with food and nutrition that we are, in some ways, creating new categories of illness such as those defined as night-eating syndrome and orthorexia nervosa (an obsession with eating healthily which leads to very restricted diets).

Prof Susie Orbach, London-based psychotherapist, author, activist and leading expert on eating disorders, says that "an epidemic of eating and body image problems plagues us".

Orbach is a strong believer that the cultural backdrop is in itself part of the problem. "We've bought into a scare and an aesthetic that fat starts the minute you can pinch a bit of flesh. Every study shows that women and girls of perfectly average weight and low weights consistently judge themselves to be too large."

According to Orbach, those who go on to suffer from eating disorders are then on the clinical end of a continuum of a disturbed approach to food which crosses all ages of women and increasingly is affecting men also.

Orbach first came to prominence with her groundbreaking book, Fat is a Feminist Issue (1978). More recently, she wrote a book, entitled On Eating - change your eating, change your life (Penguin, 2002), in which she recommends that "people free themselves from dieting and denial by turning eating into something that nourishes and calms you".

Simple as it may sound, appreciating food for its taste and texture is not easy for those individuals who start to use food to block out painful emotions and then find themselves in a cycle of over-eating and vomiting (bulimia) or restrictive under-eating, over-exercising and/or the use of laxatives (anorexia).

For these individuals, an obsessive pre-occupation with food and weight camouflages other vulnerabilities such as low self-esteem in adolescence, problematic family dynamics or traumatic early-life experiences.

That psychological causes lie at the heart of every eating disorder is rarely disputed nowadays, yet in Ireland, it is still difficult for people with eating disorders to see a psychologist within the public mental health services.

Dr Eoin Galavan, clinical psychologist and member of the newly formed Association of Psychologists in Mental Health Services, says there might also be over-diagnosis of eating disorders, due to the lack of multidisciplinary teams - and in particular psychologists - working in the mental health services.

"The emphasis on diagnosis comes from the psychiatric tradition and when there is a lack of psychological input in mental health services, this will be met with an over-medicalised response," he says.

According to Galavan, people who present with eating disorders may have other problems such as depression, personality or family problems which are best dealt with by therapy and counselling.

"In Ireland currently, there is still an over-reliance on medical interventions because the multidisciplinary teams set out in last year's Government mental health policy, Vision for Change, have not been put in place," he says.

When those with eating disorders do see a psychologist, a cognitive-behavioural approach is usually used. This approach aims to change the thought and behaviour patterns of the individual with an eating disorder.

However, according to Trinity College Dublin researcher Michael Daly, cognitive-behaviour therapy works for only about 50 per cent of people with eating disorders. Daly is currently carrying out a PhD study on a newer approach to eating disorders which is based on mindfulness-meditation training.

"Jean Kristeller, a researcher in the Department of Psychology at the Indiana State University, has already found that by using six weeks of mindfulness meditation training, individuals reduced their binge-eating episodes from four to one and a half a week," explains Daly.

He says that through mindfulness meditation training, people learn to accept their negative emotions and forgive themselves rather than continue in a cycle of forbidding themselves certain foods and then giving in to eating these foods and punishing themselves for doing so.

"The advantage of mindfulness-based eating training is that it is more cost-effective because it can be done in groups. There are also elements of home-training and integrating it into your everyday life," he explains.

And, on a societal level, can we do more to reduce the cultural values that propel vulnerable individuals towards eating disorders?

Yes, we can, according to Orbach. "We can help mothers not pass on their difficulties around food to their children. We can train health visitors to help new mothers deal with the pressures that they have to get their bodies back too quickly after giving birth.

"We can teach children about the emotional meaning of food.

"We can broaden the visual culture so that we see more images of girls and women of different sizes," she says.

Orbach believes that the recent shocking advertisement of anorexic French model Isabella Caro is useful as are the advertisements for Dove soap products which show women of different ages and shapes.

Orbach is also a founder member of the website www.any-body.org. which challenges the limited physical representation of females in contemporary society. For instance, one of its main aims is to encourage a change in cultural attitudes towards bodies, food and eating so that women of the next generation can learn to be happy in and look after their bodies.

And is she hopeful? "Yes and no. On the one hand, I feel there is still a high level of body fear and body terror but, on the other hand, there are a lot more people who are angry about this and want to change things."

SUPPORT DETAILS

www.bodywhys.ie is the comprehensive website of Bodywhys, the Eating Disorder Association of Ireland which offers support to people with eating disorders, their families and friends. Its helpline is 1890 200444.

The National Organisation for Women in the United States annually celebrates a Love Your Body Day and encourages women of all ages and sizes to celebrate their bodies. Tomorrow is Love Your Body Day for 2007. See http://loveyourbody.nowfoundation.orgfor more details.

See also www.any-body.orgfor ways to challenge the female body image standards set by advertisers. The website allows browsers to nominate advertisements that are offensive to women and those that offer positive images of women.

It also includes a very valuable section for mothers on how to influence their daughters positively in terms of body image and self-esteem.