Eating Disorders: A Practitioner’s Guide to Psychological Care

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How can mental health and allied practitioners develop a more nuanced and effective understanding of the complex psychological processes underlying eating disorders?

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Institution: University of Canberra

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How can mental health and allied practitioners develop a more nuanced and effective understanding of the complex psychological processes underlying eating disorders?

Image courtesy of interviewee. March 12, 2025

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This video video discusses various aspects related to eating disorders, including their causes, symptoms, impact on mental and physical health, treatment options, and societal perceptions. It emphasizes the need for understanding and support for individuals suffering from eating disorders, as well as the importance of proper language and awareness to address these issues. Research indicates that eating disorders can affect individuals of all ages and genders, not just females. Efforts to combat stigma, promote self-compassion, and provide appropriate therapy can help in addressing these complex conditions effectively.

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I'm sure it is.

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Hello? Can anyone hear me? Because I can't hear myself.

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Hop it. It's, it's the 30th of September.

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We've just come up to half past five, London.

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We're talking about eating disorders.

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Viv and Lewis, thank you for talking to faculty. Okay.

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What motivated the book and what,

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what would you say is key messages are? So

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I get what motivated the book is

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because I've worked for a very long time with people

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with eating disorders

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and they consistently talk about having a lot

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of difficulties when particularly they're working

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with health professionals.

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And so a lot of the book is

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around helping health professionals,

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whether you're a psychologist or doctor or nurse

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or counselor or school teacher to work with people

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with eating disorders.

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So to understand the issues, understand the myths

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and the stigma around eating disorders

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and help you work effectively with people

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who suffer from those conditions.

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Yeah, really good. Now, there are

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loads of myths, aren't there?

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So we've asked you, I mean you've vote the question with us,

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but what are eating disorders?

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What actually are they and why are they so important?

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Yeah, so eating disorders are quite severe

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mental health conditions.

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So they're essentially around,

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people's perception of their appearance.

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So usually their body shape, weight, weight or size.

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Um, and that affects their feelings of,

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gen general mental health.

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So it affects how they perceive themselves,

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their self-concept, their eating behavior,

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and generally what they're doing day to day.

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So most people with eating disorders will be quite consumed

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by feelings of negativity towards the body

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and take that out in ways

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that might be either restricting their food or overeating

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or getting rid of their food or doing something like that.

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Um, and we know for example, that eating disorders,

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you know, are quite deadly in terms of the physical risk.

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And so it's looking at the mental health

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and the physical side of this particular conditions.

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It really well explained. Now,

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I'm not gonna try and catch you out here.

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I'm gonna ask you a question that doesn't have

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to be in the final interview

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because I'm just wondering, you know, for me,

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we've got young, younger kids, but also I've got nieces.

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What's the kind of percentage

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of people who've got an eating disorder?

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Vivian, do you know? I mean, we don't have to, we just,

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this doesn't have to be an interview.

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Sure, sure. So, so we estimate that people

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who actually fulfill the full criteria

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for eating disorders are only about 1% of the population.

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So that's not, that doesn't sound like a lot of people,

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but disordered eating behaviors, which is

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what you often see in children and adolescents.

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So that sort of early intervention is actually up

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to about 40% of the population.

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So that's quite large.

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And we know, for example, that body image issues, so issues

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around the appearance

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or how you perceive your appearance affect most youth.

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So most youth will actually find that body image.

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So perceptions around the appearance are their

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number one concern.

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Um, and that can lead them

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to engage in dangerous eating behaviors over exercising,

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sometimes, you know, trying to eliminate food

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or worrying a lot about their bodies.

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So it's quite a significant issue in terms

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of body image in general disordered eating.

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Thank you for that brilliant answer.

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Can I just ask you another question to follow up

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before we get back to yours, which is

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because I'm quite old, has it changed over time?

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Because when I think as a child, of course there was bulimia

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and anorexia and that stuff,

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but is more people now Got it. Would you say over time?

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Yeah. Yeah. So, so the most common eating disorders

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that people think about are anorexia

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and most people think about anorexia being an

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emaciated teenage girl.

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That's the sort of stereotype of eating disorders.

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But we know actually the most common eating disorder is

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actually binge eating disorder.

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And that tends to actually affect more adults,

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particularly middle aged adults.

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And so we see eating disorders

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affecting people across the spectrum.

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So this idea that eating disorders only happen

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to youth is a quite a big myth.

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So we know that eating disorders can occur in,

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in children in primary school, all the way up

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to people in older age who might have had an eating disorder

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for many, many.

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So it's becoming more common and more well known.

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Um, and and often the reason why we perhaps don't hear about

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it is because people don't go around talking about it.

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It's like a lot of mental health issues.

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People keep it to themselves and there's a lot of shame

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and guilt in particular around having an eating disorder

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and that prevents a lot

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of people coming forward and asking for help.

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Brilliant, brilliant so far.

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Okay, so let's get back to your questions then.

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What causes a eating disorder?

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So the cause of an eating disorder is quite complex,

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but generally the research in particular looks at, at the,

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the culture and the society that we live in.

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So we are bombarded by images around

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what we should look like,

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and what success looks like,

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what attractive people look like, and that's a big myth.

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So for females in particular,

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it's looking at a slender image.

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And for males it tends to be lean and more muscular and,

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and people aspire to look that way,

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and they also think

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that looking those particular ways

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is going to make them feel good.

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Um, and there's a lot of stigma as well around obesity

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and being overweight and eating certain foods.

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So that sort of perpetuating whether you should feel good

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or bad about yourself, depending on what you look like or,

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or what you're eating is a big part of it.

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But we also know there's a lot of things which are around

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perfectionism or need to feel in control.

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People who've experienced trauma growing up,

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or poor parenting or teasing for their body size

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or shape, as well as, early dieting, those are factors

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that influence people's development

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of eating disorders as well.

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And earlier on you were talking about some

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of these things, Mobil, the,

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the mortality issues with them.

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What are the dangers then of these e eating disorders?

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Yeah, so for, for a lot

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of people eating disorders cause them physical damage.

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So particularly in the case of

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where people might be either undereating

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so they're malnourished

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or overeating where they're actually causing a lot

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of stress on the heart or the guts.

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So we often see people being hospitalized

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for physical health injuries, particularly the heart.

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So the heart's a big factor as well

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as just the gastrointestinal tract,

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skin can be affected, your ability to feel hot

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and cold, you know, as well as the brain being starved

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of nutrients as well.

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So the the effect

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that it has on things like concentration, attention, sleep,

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memory, those sorts of things can be affected as well.

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So can I add just a quick follow up?

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So that's obviously the, the, the physical stuff.

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What about the mental, sort

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of danger mental health dangers of them?

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Is that, is that sort of getting stuck in that rut?

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Yes, so, so with the mental health dangers, a lot

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of it is it's, comorbid with depression and anxiety.

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So where, how a person sort of feels about themselves

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or their day-to-day life,

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that's usually significantly affected.

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As well as people with eating disorders tend to spend a lot

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of time engaged in either eating type behaviors

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or exercise behaviors.

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And that often comes at the expense of doing other things.

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So it might come at the expense of work or study

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or relationships with friends

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or sexual relationships as well.

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So it quite significantly interferes

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with people's day-to-day life.

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Brilliant. Vivian been brilliant. Okay.

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So what therapy helps these people,

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helps people who are suffering?

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Can you help us, with how certain groups

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and professions can deal with

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With? Sure. So for,

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for a lot

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of people it depends on the age of a person.

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So typically for children

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and adolescents, usually family based therapy is used, so

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where essentially parents

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or carers take over the feeding of the child.

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So that real nurturing side of things.

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For older adolescents

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and adults, it's us usually

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what we call cognitive behavioral therapy

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for eating disorders.

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So it's a specific type of therapy

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and that therapy is quite long, so it's usually 20

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to 40 sessions, so which might take someone a year

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or two to go through.

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There's also schema based therapies

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and attachment therapies that are used as well,

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which help people deal with.

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It might be childhood trauma issues

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or attachment with parent issues that have occurred,

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which might be related to their eating disorder as well.

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But a big part, and this is one of the things I've tried

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to talk about in the book, is around self-compassion.

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So working on being able to be your best friend, look, look

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after yourself and do, really be in tune with your body

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and in tune with what you need.

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Throughout this interview, I've been cautious about

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how I speak about, certain conditions.

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What language should we be using to talk

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and to talk to people who we may feel concerned about

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with people with bodies and eating?

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Yeah, so it's, I mean, generally trying to,

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when we talk about someone trying to stay away from

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what they look like, so making less appearance based

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comments, but in terms

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of if we are actually worried about someone is just being

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able to stay, say, you know, I'm worried, you know,

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you don't seem yourself or you seem unhappy

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or you seem really anxious lately, do you want me

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to help you try and find some help?

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So making it more about

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that you've noticed different emotional things

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or the way a person's coping rather than

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specifically commenting on their eating or their exercising

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or what they look like to make it more about their

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mental health in general.

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Fantastic. Okay.

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What do health professionals need to be mindful

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of when working with people with eating disorders?

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Yeah, certainly health professionals need to be mindful

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that, about stereotypes around eating disorders.

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So a lot of people

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who have eating disorders are not underweight

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and they're not young people as well.

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So when someone might present to an emergency department or,

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or a hospital with an eating disorder,

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they might have something like a binge eating condition

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or what we call atypical anorexia, which is

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where someone is restricting their intake,

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but they, they're not underweight.

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So not basing, a an assumption

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that someone has an eating disorder based

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on what they look like.

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And it's also around that there can be dangers at any weight

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and with any eating disorder.

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So not thinking that it's only people

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who are very underweight

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or people who have anorexia that are in that dangerous area.

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Certainly people with bulimia

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or binge eating disorder, may not present

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as looking unwell,

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but can actually be very medically unstable

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and that needs to be considered.

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So, you know, doing things like blood tests

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or checking people's heart rates

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and actually asking people around how they're feeling,

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what they're doing with their day to day

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and really taking a holistic approach.

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So 40% you said at the beginning have

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got some sort of disordered eating.

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So what do we need to do as a society to help this

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and where should future research be?

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Yeah, so a lot of it is just as a society trying

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to get away from stigma around what people look like

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and what that might mean, as well

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as commenting on people's food

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and labeling certain foods as good foods

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or certain foods as bad foods, really sets people up

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to worry about what they're eating, being ashamed

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of their bodies or ashamed of what they're eating

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or feeling like they're going to be judged.

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So just really focusing on you know, who people are as,

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as people rather than what they look like.

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And, and that's really hard

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and that's hard, particularly in the school system.

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Um, you know, when we are working on sort of teasing

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and bullying, you know, really helping children to

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understand, their own bodies, understand about

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where people as a whole

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and looking at people for all the wonderful things

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that we are and what we do,

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and really cranking down on these stereotypes around

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a appearance being the be all and end all,

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because it's really not for a lot of people.

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That's all the time we have. Vivian,

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thank you for talking to us.

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Before you go, let me just take about

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your next step for the editors.

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Okay. So, Vivian's just gonna do about the myths,

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which I think is just after question

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two, but they'll work it out. The editors,

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Yeah. Yeah. So,

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so one of the big myths around eating disorders is

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that they're a female issue

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and we know, for example, for ev there's about one in 10,

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people presenting with an eating disorder are male,

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and that it affects people across the age span.

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So it's very important that we are looking

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after our, our, our boys and our men as well

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because they're just as susceptible as females are, to

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pressures around body image.

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And we're certainly seeing more

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and more males presenting with disordered eating

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and body image issues

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and that's really important to recognize.

311
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Yeah, good point. That's very concerning, isn't it?

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