It is often suggested that exposure to overly thin models leads to eating disorders in adolescent girls. However, such a belief not only fundamentally misunderstands the nature of an eating disorder but minimises the seriousness of this often life threatening mental health problem.

A desire to be thin and the resulting steps that an individual with an eating disorder undertakes to achieve this (including restricting calorie intake, self induced vomiting, misuse of laxative, excessive exercising) are a symptoms of an eating disorder, not the eating disorder itself.

An eating disorder (inc. anorexia nervosa, bulimia nervosa, binge eating disorder and other eating disorders not otherwise specified {EDNOS}) is a manifestation of low self esteem; the beliefs that the sufferer holds about their current eating, shape and weight and the behaviours that they engage in to achieve a different version of these are all a way of dealing with an entrenched and often overwhelming belief that they are not good enough.

Focusing on their weight not only diverts the sufferer away from the intolerable feelings that accompany a sense of low personal worth, but it offers them a potential solution i.e.

“I might not be the prettiest/smartest/most popular/best at sport, but I can be the thinnest”.

This potential solution is not what it initially seems and overtime the advantages of trying to manipulate one’s weight as a way of feeling better about one’s self starts to be outweighed by the disadvantages of an eating disorder.

These include:

· Attitudes and behaviour related to eating (increased preoccupation with food, always planning meals, tendency to hoard, change in speed of eating, increased hunger)

· Emotional changes (depression, anxiety, irritability, apathy, neglected personal hygiene)

· Social and sexual changes (withdrawal, reduced sense of humour, feelings of social inadequacy, isolation, strained relationships, reduced sexual interest)

· Cognitive changes (impaired concentration, alertness, comprehension, judgement)

· Physical changes (gastrointestinal discomfort, reduced need for sleep, dizziness, headaches, hypersensitivity to noise and light, reduced strength, edema, hair loss, reduced tolerance for cold temperatures, abnormal tingling sensations in hands and feet)

· Physical activity (tiredness, weakness, listlessness)

Understanding an eating disorder in this way explains why just trying to get a sufferer to eat in a ‘normal’ way does not ‘cure’ an eating disorder. Although it is necessary to work with the presenting symptoms of an eating disorder and help an individual to replace their beliefs about eating shape and weight with more accurate, helpful and self enhancing alternatives in parallel with helping them to develop a balanced and regular pattern of eating, this is not sufficient.

For long lasting results the sufferer’s underlying low self esteem must be addressed, if it is not, symptoms will return or be replaced by others (e.g. substance misuse, obsessive compulsive disorder {OCD}, self harm).
Currently the most effective type of therapy for an eating disorder is Cognitive Behavioural Therapy (CBT). However, as an eating disorder is a bi-dimensional problem (i.e. involving both physical and psychological aspects) it is important that the therapist delivering this therapy has breadth and depth of training and experience, ideally this would be either a Doctor of Clinical Psychology or Counselling Psychology.

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