Research Into The Often Hidden Issue Of Eating Disorders
Eating disorders can have a devastating impact. Anorexia nervosa, for example, has been shown to have the highest mortality rate of any mental health condition. Adding to the risk is that eating disorders are often kept hidden because, as with other mental health conditions, there is often a lot of accompanying shame.
The Complexity Of Eating Disorders
According to Your Mental Health, eating disorders form a complex set of mental health conditions that revolve around our relationship with food, eating, weight and body image.
For many, eating disorders are a coping mechanism to deal with difficult emotions and experiences. The person may fear that speaking out about their condition will mean having to give up a habit that they consider helpful or even essential, and to which they feel they have no alternative.
“For me, eating disorders aren’t really about the food or the exercise or my body image. What I’ve learnt is that for me it’s about the fear and not being able to communicate and needing to stifle these feelings. When I’m really stressed or anxious or unhappy I project all of those feelings onto my body and then the eating disorder uses that to pull me back in.” - Hope Virgo is an author, advocate and campaigner for people with eating disorders
Research hopes to address the complexity of eating disorders by identifying the risk factors for developing a condition, and identifying the causes and subsequent treatments for those suffering. Further to this, treatments can be examined for which do and don’t work for different people leading to better treatment outcomes.
One such project is the Eating Disorders Genetics Initiative (EDGI), which aims to better understand the role of our genes and environment in the development of eating disorders (Bulik, 2021).
EDGI in the UK collects psychological, medical and genetic information from 10,000 people with experience of eating disorders; it is part of an international collaboration, with many countries coming together as part of the same initiative. The end goal is that, by understanding these conditions better, healthcare might become better equipped to support and treat those people experiencing them.
"Down the line, we're going to use that biology to inform treatment, to inform prediction and to inform prevention." - Dr Bulik, Clinical Psychologist and lead researcher on the EDGI project.
A Multidisciplinary Approach
Experts in genetics, brain imaging, cognitive science and social psychology are just some of those who could contribute to the research and development of treatments. Most importantly, perhaps, experts with lived experience can provide their vital insight into living with eating disorders. Work also needs to take place in the realm of public health to remove the stigma surrounding eating disorders, raise awareness and address our often unhealthy societal conversations around food. This work could help to unlock the potential for research and enable treatments to have a greater impact.
“I have found the insight of people with lived experience very helpful in our research. This has led to the development of treatments, sharing of skills and materials with patients, and the creation of training and workshops to develop carers’ skills. We’re trying to create a network where we can all support one other as much as possible and where we’re all working on the same page.” - Professor Janet Treasure, Psychiatrist at King’s College London and South London and Maudsley NHS Foundation Trust. Professor Treasure specialises in the research and treatment of eating disorders.
James Downs’ Story In Your Mental Health
James is a writer, yogi, mental health campaigner and expert by experience in eating disorders. He is an associate lecturer for the Open University, a peer researcher, and a patient representative at the Royal College of Psychiatrists.
“It’s hard to pinpoint a time when I became ill. I can’t identify one event or one specific cause among the whole range of factors. Instead there seem to be several strands that came together. I'm 33 now and I was diagnosed with anorexia when I was 15, but I had signs of disordered eating before then. I’m only now making sense of why and how it happened.
I think eating disorders – and all mental health problems – are biological, social and psychological. We think of them as very discrete categories, and I have spent many years being told that everything is ‘all in my head’ when in fact I have had underlying physiological problems.
I think of it like a mosaic: all these pieces that shift and then the environment will change but there might be some underlying constancy in our biology or sensitivities. I think diagnostic categories are quite blinding and eating disorders are narrowly defined, both in terms of the condition and also in terms of treatment and recovery. We need to be more creative – from creating new knowledge about eating disorders to creating new ways of responding to them to help people create the lives they deserve to have.”
Read James’ full story in Your Mental Health
Current Treatments
The current findings on mental health have led to a number of effective therapies for eating disorders, with these key treatments being highlighted in Your Mental Health:
Cognitive Behavioural Therapy – During CBT, a therapist will try to help the patient cope with their feelings, understand the importance of nutrition and the effects of starvation, and make healthy food choices. They will ask that the patient practises these techniques on their own and then measures their progress.
Specialist supportive clinical management – SSCM involves talking to a therapist to help understand the causes of the eating disorder, as well as to discuss nutrition and the causes of symptoms.
Focal Psychodynamic Therapy – This is offered when the patient doesn’t feel that the above therapies are right for them or if they haven’t proved effective. It should include trying to understand how eating habits are related to your thinking, and how the person feels generally about themselves and the people in their life.
MANTRA – This specialist integrative therapy has been developed to address the cognitive, emotional, relational and biological factors related to anorexia. It helps people work out what is keeping them stuck in their anorexia, and then find alternative and more adaptive ways of coping. MANTRA is generally recommended for people who report an extremely rigid thinking style, low motivation for recovery and either no support network or one that they don’t feel is helpful.
Diet Advice – Advice is given on healthy eating and diet, ideally in combination with talking therapy. Doctors normally also advise people to take vitamin and mineral supplements to ensure they’re getting all the nutrients they need to be healthy.
Children and young people will usually be offered family therapy, CBT or adolescent-focused psychotherapy. The CBT will be very similar to that offered to adults.
Family therapy involves the person and their family talking to a therapist, exploring how anorexia has affected them and how their family can support them. The therapist will also help them to find ways to manage difficult feelings and situations, aiming to prevent them from relapsing into unhealthy eating habits once the therapy ends.
Developing Research
Research is constantly expanding our understanding of eating disorders and available treatments.
Psychedelics are one such potential treatment currently being researched. The psychedelic Psilocybin is a controlled drug and a constituent of so-called ‘magic mushrooms’. It is thought that psilocybin enables people to shift from their entrenched thinking patterns, and research is looking to test whether it might be helpful in treating anorexia nervosa.
Participants in this research will be supported by a therapist throughout the experience and it is hoped psilocybin will have the potential to shift thinking patterns and behaviour in those who have had anorexia for a long time.
Also under research is Non-invasive brain stimulation (NIBS), such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), which allows safe, pain-free stimulation of specific brain areas using magnetic fields and electrical currents, respectively. Using brain imaging, researchers found after rTMS a significant decrease in activity in the amygdala, a part of the brain involved in fear and stress (Dalton et al,. 2021).
Genetic factors are also under close examination for eating disorder sufferers. Researchers are now harnessing large datasets to tease apart the complex interactions between our genes and our environment. At a finer level, researchers are discovering more from the field of epigenetics about the mechanisms that govern this interaction, providing a more in-depth picture of mental health that can inform treatments.
By considering the genetic contribution to a mental health condition, a developing ‘genetic counselling’ approach enables individuals to think about how these conditions can result from the combination of experiences and genes and, through this, how best they can manage their mental health for the future.
The wide range of treatment research gives greater perspectives on the variation in symptoms and struggles experienced by those living with eating disorders. The hope is that in the future therapies can be better targeted to each person for better treatment outcomes.
Getting Help
One of the key things to remember about eating disorders is that they can affect anyone of any weight. It is a myth that people with eating disorders are always very thin. In fact, according to Your Mental Health, anyone with an unhealthy relationship to food could be considered to have an eating disorder.
Eating disorders can be very dangerous if left untreated, which is why getting support is so important. It is important to see your GP if you think you need help for an eating disorder.
Further support resources include:
Talk ED is a national, peer-led charity supporting anyone affected by any eating disorder or eating distress. They also have helpful information and guidance if you are thinking about visiting your GP regarding an eating disorder Talking to your GP - TalkED (talk-ed.org.uk)
Beat, the UK’s Eating Disorder charity, provides helplines for people of all ages, offering support and information about eating disorders no matter where you are in your journey.
Beat’s helplines are open 365 days a year from 1pm – 9pm during the week, and 5pm–9pm on weekends and bank holidays.
Help for England
Helpline: 0808 801 0677
Email: help@beateatingdisorders.org.uk
Help for Scotland
Helpline: 0808 801 0432
Email: Scotlandhelp@beateatingdisorders.org.uk
Help for Wales
Helpline: 0808 801 0433
Email: Waleshelp@beateatingdisorders.org.uk
Help for Northern Ireland
Helpline: 0808 801 0434
Email: NIhelp@beateatingdisorders.org.uk
For Online Chat Support Visit: Online support - Beat (beateatingdisorders.org.uk)
Discover Beat Ambassador Kel O'Neill’s online service, Recovery Champion:
The Eating Disorder Recovery Companion was created as a way of providing resources for people with a suspected or diagnosed eating disorder, who are stuck on a waiting list for specialist help and/or therapy. However, you might also find the resources helpful if you have an eating disorder but are struggling to get a referral, for example, if you do not meet referral criteria, or if you are currently accessing treatment or therapy but feel some additional resources would be useful for you.
Mind provides advice and support to empower anyone experiencing a mental health problem. If you need non-urgent information about mental health support and services, call Mind’s Infoline on 0300 123 3393 or email: info@mind.org.uk
References
Bulik, C.M., Thornton, L.M., Parker, R. et al. The Eating Disorders Genetics Initiative (EDGI): study protocol. BMC Psychiatry 21, 234 (2021). https://doi.org/10.1186/s12888-021-03212-3
Dalton, B., Maloney, E., Rennalls, S.J. et al. A pilot study exploring the effect of repetitive transcranial magnetic stimulation (rTMS) treatment on cerebral blood flow and its relation to clinical outcomes in severe enduring anorexia nervosa. J Eat Disord 9, 84 (2021). https://doi.org/10.1186/s40337-021-00420-w
Davenport, F., edited by Brady C., and Westbrook, T., (2023) Your Mental Health. London, Penguin Random House UK.
