Talking About Eating Disorders

Talking About Eating Disorders

What is an Eating Disorder? 

Eating disorders (ED) can be expressed in a myriad of ways including extreme restrictions on one’s food intake, binge eating, purging attempts, mental distortions of body image, and extreme exercise. An excessive obsession with food, weight, and body shape are potentially all alarming signs of an eating disorder. Despite this, not everyone with such thoughts and behaviours may be suffering from such a disorder. A professional diagnosis utilising the criteria from the newly updated 5th edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5), is required to conclusively identify whether an individual may have an eating disorder. 

The DSM-5’s criteria have been deemed highly reputable in its encapsulation of what constitutes a certain mental disorder. For example, in Anorexia Nervosa (AN), the DSM included the following as its criteria: reduction in energy intake, low body weight, intense fear of weight gain, denial of current low body weight, and mental distortions of body image. 

There are various types of ED, as follows: 

  1. Anorexia Nervosa (AN) 
  2. Bulimia Nervosa (BN) 
  3. Binge Eating 
  4. Pica 
  5. Rumination Disorder 
  6. Avoidance/restrictive food intake disorder (ARFID). 
  7. Other Specified Feeding or eating disorders (OSFED). 

Among various types of EDs, AN and BN are the most common ones treated as an outpatient. AN was addressed in abundant research due to its increasing prevalence in adolescents throughout the decade. It has since become the third most common chronic disease in adolescents, next to asthma and obesity. 

Furthermore, in contrast to males, females have higher prevalence rates in most types of eating disorders. For AN, the research concluded that around 0.9~2.0% of females had developed this disorder, a percentage that is approximately sevenfold that of a male. Here we will discuss this mental health condition through research findings regarding ED among female adolescents, and young adults. 

Risk Factors 

There are several etiological and risk factors that contribute to the development of ED: 

  1. Genetic factors 

Among various studies, evidence indicated that females are significantly more likely to develop ED if a biological family member had ED prior. Both the inherited traits of personality and temperament may explain the influence. In addition, the environment in which one grew up is associated with genetic factors that may result in the development of an ED. 

  1. Neurobiological factors 

Neuropsychological functioning plays the role of mediating between underlying neurobiological abnormalities and psychological functioning in eating disorders. Nonetheless, the relationship is bidirectional. While neurobiological abnormalities can contribute to the development of ED, consequences following ED, such as constant low weight and underconsumption of nutrition, also lead to the poor neurobiological wellbeing of the individual. Emphasising the severity of an ED due to such a cycle. 

  1. Psychological factors 

EDs are highly related to underlying psychological distress. Grief, low self-esteem, trauma, or other mental disorders can be associated with its development. Family, especially parents, were often found to be responsible for such conditions. Literature indicated that restrictiveness of the authoritarian parenting style is highly at fault for lower self-esteem and higher levels of depression in their children, two main psychological distresses identified in an early ED pathology. 

According to the research of the risk factors contributing to EDs, mothers who are highly critical and overbearing were found to have caused the development of an eating disorder attitude towards their daughters. The study “Family Interactions and Disordered Eating Attitudes: The Mediating Roles of Social Competence and Psychological Distress” conducted an investigation with a sample group of 286 families in the University of Arizona. Dr. Analisa concluded that young females tend to have poorer social and relationship skills if the individual’s mother frequently communicates with overt criticism, which is a rather unhealthy pattern to be subjected to at such a young age. In these emotional obstacles, the individual experiences are known to cause higher levels of psychological distress and a disordered eating attitude in their daughters. 

The research revealed that the negative form of family communication between mother and daughter impacted the sense of self and social skills of the young female significantly in this developmental stage. This was linked to their struggles over control and self-enhancement. Consequently, disordered eating is developed to deal with negative emotions or compensate for their incompetence in social life. 

These risk factors, along with the developmental changes of young females, are not only associated with the development of an ED but also the maintenance of thoughts and behaviours with such conditions. Clinically, we need a holistic assessment of these aspects of a client’s life to deduce and proceed with the most effective strategy for support. 

Protective factors 

ED can manifest at any age, but the most common age of onset is adolescence. As a result, families are at the front line in preventing, identifying, and supporting their young family members with ED. Adolescents are experiencing tremendous changes in their psychosocial development, including an increased sense of autonomy, a shift in focus from family to peers, and the emergence of abstract thinking. Therefore, self-image awareness and confusion in identity evolving in this stage deeply affects the young adolescent’s social life and overall well-being. 

According to the attachment theory, a secure attachment can create a crucial buffer for young adolescents when facing psychological challenges. In the present, families must have open and transparent communication with the younger generation. By conveying messages clearly and listening carefully, parents can help enforce an environment in which proper guidance is provided in terms of well-respecting the children’s volition. 

In essence, parents are role models to children, emphasising the importance of demonstrating how grown-ups maintain a healthy relationship with food, appearance, identity, and social interactions. In addition to the family, the community, like schools and peers are also vital in the prevention and recovery of young people with ED. 

Early treatment is the key 

ED, especially AN is highly related to risks of potential morbidity and mortality. Despite such statistics, nearly 45% of people with ED do not receive professional treatment for their eating disorders. It is beyond crucial to seek help earlier before it further affects the health of both the client and the family. 

Eating disorders can indeed be treated, but preparations for adverse situations like negative reactions and relapses, are quintessential. It is an emotional and delicate journey for not only the individual who succumbed to it but the family who also walks alongside the young adolescent through such disorder. If you are aware of someone undergoing these conditions, please reach out to your GP or qualified healthcare provider for a professional assessment and support as soon as possible.

Megan Chang

Find out more about Megan: HERE

If you would like to speak with a counsellor about how Megan or AMindset can support you, please contact us.

References:

1. Common Types of Eating Disorders (and Their Symptoms)

https://www.healthline.com/nutrition/common-eating-disorders

2. Over-bearing mothers can produce daughters with poor social skills and disordered eating attitudes

https://www.sciencedaily.com/releases/2013/09/130918090208.htm

3. Bryant-Waugh R. and Lask, B. (2013) Overview of eating disorders in childhood and adolescence.

In: Bryant-Waugh, R. and Lask, B. (eds) Eating Disorders in Childhood and Adolescence, 4th edn. Hove: Routledge, pp. 33-49.

4. Teens Visiting ER for Eating Disorders Doubled During Pandemic

https://www.google.com.hk/url?sa=t&rct=j&q=&esrc=s&source=newssearch&cd=&ved=2ahUKEwjgkPfx-oL6AhWMp1YBHWy-Ar0QxfQBKAB6BAgSEAE&url=https%3A%2F%2Fwww.healthline.com%2Fhealth-news%2Fnumber-teen-girls-in-the-er-for-eating-disorders-doubled-in-pandemic&usg=AOvVaw2eUiRaYrDLJHweAGt31jvV

5. Stice E & Bohon C. (2012). Eating Disorders. In Child and Adolescent Psychopathology, 2nd Edition, Theodore Beauchaine & Stephen Linshaw, eds. New York: Wiley.

6. Analisa Arroyo, Chris Segrin. Family Interactions and Disordered Eating Attitudes: The Mediating Roles of Social Competence and Psychological Distress. Communication Monographs, 2013; 1 DOI: 10.1080/03637751.2013.828158

7. Bohrer BK, Carroll IA, Forbush KT, Chen PY. Treatment seeking for eating disorders:

Results from a nationally representative study. Int J Eat Disord. 2017 Dec;50(12):1341-1349. doi: 10.1002/eat.22785. Epub 2017 Sep 30. PMID: 28963793.

8. Nicholls, D. (2013). Aetiology. In B. Lask & R. Bryant-Waugh (Eds.), Eating disorders in childhood and adolescence (p. 50–76). Routledge/Taylor & Francis Group.

9. Fonagy, P., Gergely, G., Jurist, E.L. and Target, M. (2004) Affect Regulation, Mentalization, and the Development of the Self. London: Karnac Books.

10. Enten R.S., Golan, M. (2009) Parenting styles and eating disorder pathology, Appetite,Volume 52, Issue 3, Pages 784-787, ISSN 0195-6663,

https://doi.org/10.1016/j.appet.2009.02.013.

“Doing” Leadership

“Doing” Leadership

“DOING” LEADERSHIP by KELLY HUTCHISON

As a long-time leader of teams, I often get asked for my thoughts on how to “do” leadership.  Just recently, I was talking with a bright, early-career entrepreneur who said, “My business is growing like crazy and I’m starting to hire people.  I don’t know how to manage and lead others.  What training course would you recommend? Or are there some books I can read?”

These questions are more common than I’d like them to be.  While they are well-intended, and it’s great that people who seek leadership responsibility actually want to do it well, the assumption (or perhaps hope) beneath the question is that if you read the right books, and/or take the right training course, you will be able to lead.

The question I asked this poor soul in return was, “regardless of the training course or the books – how will you know when you can manage and lead other people?  Does reading the books and attending the training mean you’re done?  Tick, you’re a good leader? Cross it off the list of things to do?”

The truth (like it or not) is that managing and leading others is not a destination.  It’s a practice.  Kind of like yoga.  In fact, yoga can teach us a lot about leadership.  No matter how good you get at yoga, there’s always something more to learn.  There’s more to practice.  You never FINISH working at yoga.  And if you’ve practiced yoga, you’ll know that some days are great – you nail the pose, you go deeper, you balance longer.  Some days are terrible.  You fall over, or you can’t hold even the most basic version of the pose you held for 10 minutes yesterday.  It requires focus, getting back into the pose even when you’ve fallen out of it six times already, and tuning in to your thoughts and feelings. Perhaps most importantly, it requires a willingness to push beyond your comfort zone – taking your pose just a bit further, without a guarantee that you’ll nail it the first time (knowing, in fact, that you’ll probably fall over).

The same is true for leadership.  This is because leadership exists within a human system.  One set of leadership behaviours which works perfectly well with one group of people may completely backfire with another.  Or a style of leadership that works when times are good, fails when times are difficult.  Some days are great – the team is humming, people are happy.  Others stink – business is underperforming, there’s tension between people, tough decisions to be made, and politics to manage.  Pesky human beings – they are so unpredictable.  

So what is this achievement-oriented entrepreneur to do, as the company grows and leadership becomes a necessity and requirement?  While I do not endorse the concept of a “checklist for good leadership”, in the spirit of helping these shooting stars along the journey, I offer the below as a non-linear process.

First: understand the baseline.  Look for clues.  Do you lose people from recruitment processes after they interview with you?  What’s your voluntary employee turnover rate?  If you use an employee engagement survey, what does the data tell you about how people feel about their manager and/or senior leaders?  You should also look inward.  Who’s been your favorite or most respected leader over the course of your career and why?  Who do you emulate as a leader?  

Second: ask your people what they need from you  – what motivates them to perform at their best.  Again, these pesky human beings are all slightly different.  But one thing remains consistent – people join great companies and leave bad managers..  The trick is to find out what “bad manager” means to your people – and practice behaving differently.

On the note of PRACTICE…this is a critical third (and ongoing) step. Just as you don’t become a star tennis player on day 1, and you can’t learn to play the piano with one lesson, leadership is a practice.  Remember that feeling of trying something new when you were a kid?  It’s frustrating and uncomfortable.  Get used to this feeling – in fact, seek it out in your workplace.  It means you’re learning – and learning is supposed to feel uncomfortable.  Try new behaviours.  Refine.  Try again.  Try again.  

Fourth – ask your people how you’re doing.  And “your people” should include those below you, above you, and beside you.  If you’re heading a start-up, maybe there’s no one technically above you.  Whose opinion do you respect and admire?  Do you have a board of directors? An investor or business partner?  Importantly, consider this guide for soliciting feedback (and ignore it at your peril).

Fifth (and arguably the most important element to include in your practice): Reflect on the feedback and use it as a source of data to improve your practice.  Extending the “learning to play the piano” analogy, consider how listening to a recording of your practice can shine a light on areas where you need more practice.  You listen, you think about what you want to work on, and then you work on it.  The same is true in leadership.  What can you learn from the feedback you received?  What should you try differently?

What can you learn?  What can you try?  

Sixth (or maybe first!) – ask for help. What professional athlete does not have a coach? What opera singer doesn’t study under another professional?  It can be very lonely at the top.  Cultivate your network, join leadership forums or communities, and consider a psychotherapist, counsellor or performance coach to help you reflect, learn, and grow.  As someone who has been practicing leadership for decades and advising others who are doing the same, I firmly subscribe to the view that every leader needs a therapist and coach.  

Finally – Repeat steps 1-6.  Often, and for as long as you hold a leadership role.  In doing so, you will exceed your own expectations and you will make a difference to your team, your company and potentially by extension, the world around you.  

After all – isn’t this why you became an entrepreneur in the first place?

Kelly Hutchison

Kelly Hutchison is a psychotherapist, counsellor and executive coach with aMindset, based in Hong Kong. 

To book an individual consultation or discuss mental health & wellness initiatives for your organization, contact Kelly on +852 9179 4454 or kellyamindset@gmail.com 

Other Articles by Kelly:

Find out more about Kelly here

Qualifications:

  • Master of Counselling, Monash University, Australia
  • Master of Applied Science (Innovation & Organisation Dynamics), RMIT University, Australia
  • Bachelor of Arts (Liberal Arts/Music), Florida State University, USA
  • Executive Coaching – Level Two Coach, Institute of Executive Coaching & Leadership, Australia
  • Member, Hong Kong Society of Counselling & Psychology
  • Member, Australian Counselling Association
  • Member, Hong Kong Professional Counselling Association

If you would like to speak with a counsellor about how Kelly or AMindset can support you, please contact us.