Welcome to all my visitors

Thank you for visiting my thoughts and ideas site. If you want to speak directly or have my thoughts on something that is important to you email me at admin@ncfed.com

Wednesday, 20 October 2010

Anorexia, Orthorexia And Autism

I was marking an essay today with a man who feels very proud of himself because he tries to stick to a very rigid diet with very little wheat and no fat and a whole range of forbidden foods. He periodically binges when his willpower fails and feels it is a sign of what a weak person he must be.  He isnt underweight and now realises that he has a serious problem in his relationship with food.

That got me thinking about orthorexia and anorexia its cousin. The latest thinking is that anorexia is a form of autistic spectrum disorder. That kind of figures to me, since everyone I see with the illness is driven, perfectionist, pays intense attention to detail and likes things to be predictable and ordered. We don't tolerate mess and uncertainty very well and go round with a high baseline level of anxiety.

Like people with autism, the anorexic can be easily disgusted by the idea of certain things like food contaminated with fat or by certain textures and smells.

Orthorexia is thought to be a  variant or escape from anorexia. The choice of a limited range of foods appears to be motivated by concepts such as "love of animals" or the desire to eat a healthy natural diet. All of these are understandable motives, but personality studies consistently show common features between the anorexic personality and the person who feels compelled to eat a very healthy diet and who feels bad if they cannot follow their strict food rules.

The other clue about this kind of eating is that it is often a proxy for weight loss.

So does a focus on food really handle these problems properly? Experts now think that the core problem is some kind of executive failure in the brain which causes a failure to handle all the information flows correctly. In other words there is some kind of disconnect between the information coming in and the ability to manage and respond to it flexibly.

So what we see in the room with anorexics and orthorexics is poor thinking flexilbility, poor problem solving skills, too much attention to detail, high anxiety, a compulsion to get it right which is paralysing (because you can never get it right) and great rigidity. If it ain't working, just do it more but never change.

 "Cognitive Remediation" is supposed to help with this and one good benefit is that it doesn't focus on eating habits- which in any case are heavily defended in anorexics and orthorexics alike.

This kind of treatment involves exercises like finger tapping and rhythmically clenching and unclenching hands. The client may think you are silly but at least he or she will not make you their enemy.

CR is supposed to be helpful, but we do not have any up to date research about it. The autism connection is interesting however and I think we may need to go further with it. Perhaps more of us are "autistic" than we think.....or perhaps we need to give "autism" a different name.

Sunday, 17 October 2010

Food For Thought

Wanna starve?
The brain needs 500 calories per day but it also needs nutrients to make the right connections. if we dont get the calories and the nutrients, our capacity for learning diminishes and our capacity to make the right responses deflates. We become rigid and inflexible. We can't make good decisions.

So what does the brain need? Sugar first of all, we get that from carbohydrates like bread, rice and fruit.
It also needs water, and amino acids from proteins like meat, chicken and fish. These amino acids help the brain to make the transmitter chemicals that help us to be human, experiencing love, fear, excitement, motivation and connection. The brain also needs antioxidants like Vitamin C to protect the brain from the damage caused by all the work it does.

But the brain also needs fats in the form of essential omega fats, in particular omega 3s found in oily fish and seeds and some nuts. The only way of getting these fats is from our diet. Without these fats, the transmitter chemicals cannot "dock" into the receptors that are designed to  take them and so the brain cannot feel them and do its proper work.

Some of these transmitter chemicals control our appetite, so if the brain cannot feel these stop-eating messages you will continue to feel hungry even if you think you have eaten enough for now.

So, don't count calories, feed your brain and it will thank you in spades.

Have you seen our other eating disorder related articles?  Log onto our information page at  http://www.eating-disorders.org.uk/

Wednesday, 13 October 2010

Figures Of Lightness

Today it is announced that children account for 1 in 3 admissions to hospital for anorexia, bulimia and other eating disorders. That is not quite correct.

NHS statistics show that girls and young women remain the worst affected. Of 2,579 admissions to English hospitals in the year to June, 882 (32%) were patients under 18 and of those 31 (1%) were under 10 years of age including 11 boys (33% of this group);  367 (14% of all admissions ) were aged 10-14. In the group 15-19 years,  698 (93%) admissions are girls and 49 are boys

Does this point to any remarkable trends? I think the answer is "no".

Working with the figures, less than 1 in 6 hospital admissions are under 14 and it is only these I could stretch to call "children". Children tend to be admitted to hospital because they are new cases, have less body fat which puts them in more danger, and are under the control of carers.

We already know that among the very young a greater proportion of sufferers are boys and their problems are associated with anxiety disorders and obsessive compulsive disorder. But the admission figures show that boy cases are very rare.

With 2 in 3 patients being adult, I expect that these are chronic cases with long standing problems and possible recurrent crises. The adult body can withstand and adapt to low weight better than the body of a young person and an adult can refuse to go into hospital despite the concerns of others.

I would be interested to know more about this adult group. What proportion are new cases and what proportion are chronic for example?

Only this week the Guardian ran a piece headlined "The new anorexics: big increase in eating disorders in women after the age of 30". Experts link these adult onset eating disoders in women in their 30s, 40s and even up to their 60s to feeling under pressure to look young because of exposure to the age defying older females in the media like Madonna and Sharon Stone.

(If I had Sharon's money I would look pretty young as well!)

I think that we are all guessing about the numbers and the reasons. Personally, I think that eating disorders are more likely to arise in someone who already had problems when she was young. But I would like to know more.

If you have had a NEW eating disorder in your adult life please get in touch with me. Email admin@ncfed.com and tell me your story.

Tuesday, 5 October 2010

Do People Really Think That Eating Disorders Are Silly, Continued?

I have to change my opinion following my last blog about how people feel about eating disorders.

Reading some research yesterday it would appear that people do view eating disorders more negatively than other mental health conditions including schizophrenia, at least in some aspects. People with eating disorders are viewed with significantly more negative stereotypes overall, and in particular they are viewed as more unhealthy, more disgusting, more vain and more isolated that are people with depression, OCD and schizophrenia. And yes, there was a high level of agreement that the eating disorders are self inflicted conditions.

But there are also positive stereotypes associated with eating disorders, such as being focussed, and  having high standards  - suggesting that positive and negative stereotypes can exist together and do not cancel each other out.

We have a job to raise awareness of these conditions. Why? So people can get the treatment they need and can come forward rather than suffer in silence. This can be done by having awareness days, memorials, fund raising actitivities and so on. The result of all this is that far more people know about eating disorders than they did when I started my eating disorder career.

But publicity brings our attention toward the worst of eating disorder symptoms. You cannot really talk about anorexia without showing the lengths some people go to as a result of the illness. We cannot talk about bulimia without pulling attention to its symptoms, which are highly unpleasant. A teenage girl at one of my PHSE sessions in school fainted when looking at a short film clip of someone binge eating from a pan full of spaghetti, and I never dared show the film again.

We have had many years of exposure to the reality of eating disorders with public awareness campaigns, reality TV shows and even sensitive portrayal of the disorders in TV and radio "soaps."  The cost of such portrayals is to unwittingly reinforce the negative stereotypes of these problems.

So how do we get the balance right?  Will more media exposure help people to get help sooner or prevent them from getting help by raising the stigma associated with their problem?

Sunday, 3 October 2010

Do People Really Think That Eating Disorders Are Silly?

B-EAT suggest that many young people with eating disorders are failing to come for help because young people believe that eating disorders are silly. They also feel that there is a lot of stigma attached to having an eating disorder. Meanwhile Nigella Lawson has expressed horror about the number of young people going on diets. I have been asked by the British Psycholgical Society to comment.

Things have changed a lot since I started working with eating disorders in the late 1980s. Now many people know what eating disorders are because of publicity in the media, with both male and female celebrities coming clean about their difficulties with food. There is now a great deal of PSHE in schools about these subjects. Indeed, some people wear their mental health and eating issues as a badge of pride.

At the coal face however, we still have problems. There are problems with GP sensitivity, if not awareness and difficulties getting the right treatment fast. Nigella Lawson is right, almost 9 out of 10 young people diet at some point to lose weight but there is a thin dividing line between dieting and a chronic problem with food.

So it is really no wonder that some people who are very thin believe that they are really no different from all the other dieters around them. And my experience is that a lot of people do not regard eating disorders as silly; even people who know that they have anorexia do not always understand their illness so how, they suppose, can anyone else? It is thus human nature that what we cannot make sense of, we fear, scorn or dismiss as unimportant.

As far as denial is concerned, bulimia and binge eating are by far the majority of eating disorder cases and sufferers are well aware that they have problems which they long to overcome. The terms “bulimia" and "compulsive eating” are useful in legitimising their symptoms and offering hope for change. And in anorexia, fear and mistrust motivate the difficulty accepting that you may be in need of help.

All mental health problems carry stigma, and yes, especially eating disorders, which are still regarded as self- inflicted by the public at large. We can correct these misperceptions one person at a time with the right messages and education. I think we are doing a good job.