In recognising the need for more comprehensive and intensive support, the Australian Government introduced an Eating Disorders Treatment and Management Plan as a specific Medicare Benefits Schedule (MBS) item in November 2019. This step marked the first time a mental illness had received its own dedicated MBS item numbers.

More commonly, this is referred to as an Eating Disorder Plan (EDP) or Eating Disorders Care Plan (EDCP). The EDCP is designed to provide a structured, evidence-based, best-practice model of treatment for those living with eating disorders with complex treatment needs. It offers a significantly higher level of government-supported care compared to a standard Mental Health Care Plan (MHCP).

Let’s dive into the details, and see how and EDCP impacts the treatment journey for those struggling with eating disorders in Australia.

What Does an Eating Disorders Care Plan Involve?

An EDCP provides multidisciplinary care over a 12-month period. The core components include:

• Expanded Medicare Subsidies: Eligible individuals can access up to 40 Medicare-subsidised psychological therapy sessions, and up to 20 Medicare-subsidised dietetic sessions within the 12-month period. This greatly improves accessibility to intensive treatment by providing regular contact with your treatment team.
• Coordinated Care Team: The plan covers assessment, treatment planning, regular reviews, and ongoing management for both the mental and physical health aspects of care. Care is coordinated by a medical practitioner, typically the General Practitioner (GP), and involves a team of healthcare providers. This team usually includes a GP, a psychologist or other mental health clinician, and a dietitian. In some cases, a psychiatrist or paediatrician may also be involved.
• Evidence-Based Approach: Treatment under an EDCP emphasises evidence-based therapies delivered by appropriately trained professionals. Psychological treatments can be delivered individually or in a group setting. Dietetic services must be provided by an ‘Accredited Practising Dietitian’.

Eligibility For an EDCP

The EDCP is targeted to those with a diagnosable eating disorder. Your eligibility is determined by your doctor based on specific clinical criteria outlined in the MBS Scheduling Book. Broadly speaking, eligible individuals are those with a clinical diagnosis of anorexia nervosa, bulimia nervosa, binge-eating disorder, or other specified feeding or eating disorder (OSFED) who also meet additional complexity criteria. At the time of this writing, those diagnosed with avoidant/restrictive food intake disorder (ARFID) are currently not able to access care an EDCP.

Accessing an EDCP: Step-by-Step

The journey for accessing an EDCP can be tricky to understand. Getting started with an EDCP typically begins with a visit to a medical practitioner. Below is a simple infographic of the process involved, with details listed thereafter:

1. See your GP or Specialist: The first step is to make an appointment with your GP. If you are already under the care of a psychiatrist or paediatrician, they can also initiate the process.
2. Book a Long Appointment: It’s advisable to book a longer or double appointment, and mention that it is for an eating disorder assessment or a mental health assessment. This allows the doctor sufficient time to conduct the necessary thorough assessment. Preparing notes on your symptoms and concerns beforehand can also be helpful.
3. Assessment and Plan Formulation: The GP (or specialist) will assess your eligibility based on the clinical criteria. If you are found eligible, they will create a written Eating Disorder Treatment and Management Plan. This plan will include their opinion on your diagnosis, as well as treatment plan and goals.
4. Referrals to Treatment Providers: Once the plan is developed, the GP will provide you with referrals to the allied health professionals listed in the plan (usually a psychologist and dietitian). If they don’t provide you with such options, you can also seek out your own eating-disorders-informed allied professionals who you feel comfortable engaging with.
5. Ongoing Review and Follow-up: The EDCP includes a structured review process, requiring you to engage with certain team members at certain key session marks. This includes engaging with your GP for a normal review at the 10^th, 20^th, and 30^th psychology session mark, as well as a separate review with your specialist (psychiatrist/ paediatrician) at the 20^th session. This specialist review is necessary to access the full 40 sessions; without it, you are limited to the initial 20 sessions only. The managing GP practitioner should refer you for this specialist review early on in the treatment process to avoid delays in accessing ongoing treatment.
6. Treatment Provider Reports: Treatment providers are required to provide reports to the referring medical practitioner after each course of treatment, typically every 10 psychological sessions. This information will allow your GP to monitor your medical status throughout treatment and make necessary adjustments as needed.

The EDCP is a year-long plan. After the initial 12 months, you require a new EDCP to continue accessing subsidised dietetic and psychological services.

What Specific Services are Covered Under a Medicare Eating Disorder Plan?

An EDCP can include up to 20 Medicare-subsidised sessions with a dietitian and up to 40 sessions with a mental health clinician (such as a clinical psychologist, psychologist, social worker, or occupational therapist) over a 12-month period. The plan is designed to cover both mental health and dietetic treatment for the eating disorder.

Can I Have an EDP and Another Medicare Plan Simultaneously?

Generally, if you have sessions remaining on a Mental Health Care Plan (MHCP) under Medicare, you are required to use those sessions before starting an EDCP. The sessions used under a MHCP will count towards the total of 40 psychological treatment sessions allowed within the 12-month period of the EDCP. Your GP will manage the details of overlapping plans.

What If I Am Not Eligible For an EDP?

If your GP determines you are not eligible for an EDCP based on the criteria, it does not mean your struggles are not serious. It may relate to technical criteria. Your GP can still potentially prescribe you a standard Mental Health Care Plan for psychological therapy, as well as a Chronic Disease Management (CDM) plan for dietitian sessions, allowing you to access some Medicare-supported care. You also have the right to seek a second opinion, particularly from a GP or practitioner with more expertise and experience in eating disorders.

Practical Advice and Support

Navigating the healthcare system and accessing an EDCP can feel complex, especially when dealing with an eating disorder. Here are some practical tips designed to help simplify the proves and support you on your journey:

• Reach out early: If you suspect an eating disorder, contact a GP as soon as possible. Early intervention is crucial, and you don’t need to feel “sick enough” to seek help – any level of concern is valid.
• Prepare for your GP visit: Write down your symptoms, behaviours, concerns, and any physical issues to ensure you cover everything. Be honest; doctors are there to help.
• Plan Financially: While Medicare rebates help, there may still be out-of-pocket costs. Discuss fees with providers upfront. Register for the Medicare Safety Net to potentially receive higher rebates after a certain threshold. Explore other potential financial supports like Centrelink benefits or charity hardship funds if needed.
• Utilise Support Organisations: Organisations like the Butterfly Foundation and the National Eating Disorders Collaboration (NEDC) are invaluable resources. The Butterfly Foundation provides free support, counselling, practical guidance on treatment options, and help finding services. They also have a referral database of screened professionals. NEDC works to support a nationally consistent approach to care. State-based organisations like Eating Disorders Victoria (EDV) and Eating Disorders Families Australia (EDFA), which supports families and carers, also offer crucial support and resources.
• Be Patient: Recovery is a non-linear journey. Utilise the full number of sessions available under your plan, even if you start feeling better. Often, relapses can happen quite suddenly and rapidly. Also, if you’re not seeing sufficient improvement overall, discuss the next steps with your treating team, which might involve another EDCP, or more intensive care. Stay in close contact with your GP as your care coordinator.
• Maintain Hope: Recovery is absolutely possible with the right support. The EDCP is a valuable tool to access this support, as recovery can be a lengthy and slow process for some. Be open and share with your treatment team if your motivation for engaging in treatment is struggling.

Conclusion

Australia’s Eating Disorders Care Plan (EDCP) represents a significant step forward in providing accessible, comprehensive treatment for eating disorders in Australia. Understanding the plan’s structure, how to access it, and the supporting resources available can empower individuals and families to navigate the path towards recovery successfully. It ensures that structured and intensive treatment is available to all who struggle with such conditions, and ensures no one has to face it alone.

If you, or someone you know, is struggling with an eating disorder – consider reaching out to Reverence Recovery. We specialise in supporting individuals facing such complex challenges with dignity and clinical expertise.

The post A Deep Dive Into Australia’s Eating Disorders Care Plan appeared first on Reverence Recovery.

“Stories are wild creatures,” the monster said.
“When you let them loose, who knows what havoc they might wreak?”

— Patrick Ness, A Monster Calls

When it comes to eating disorders, Ness’ statement is very fitting. Eating Disorder memoirs from lived experience – whether written in journals, published in books, or presented in online videos – are powerful. They provide vivid descriptions of how the person lived with their eating disorder, and portray in-depth the mental struggles they experienced.

Yet, ED memoirs also carry risk. The wrong story, told in the wrong way, at the wrong time, can do harm to the personal in a vulnerable mental space. Stories and narratives of others’ eating and body struggles can potentially fuel comparison, perfectionism or shame.

So what does the research say? What should one make of the potential to cause harm? When considering how you should navigate the terrain of eating disorders recovery, these are questions worth considering.

An Experiment: Can an ED Memoir Be Tested Ethically Before Publication?

A new study recently published (August, 2024) in the Journal of Eating Disorders tested this very premise. The researchers asked a bold question: What actually happens when someone with an active eating disorder reads a memoir about recovery? Can such a story help? Or does it risk reinforcing disordered thinking, triggering comparisons, or derailing their recovery progress?

The study asked participants with self-identified eating disorders to read a memoir titled The Hungry Anorexic (HA) before its public release. This was not just a book review exercise—it was a controlled psychological experiment. Sixty-four participants were split into two groups. One read the HA memoir, while the control group read Ten Zen Questions, a non-ED-related book about consciousness and self-inquiry.

The researchers then measured psychological changes using two gold-standard tools in eating disorder research:

• EDE-Q (Eating Disorder Examination Questionnaire): A comprehensive measure of ED symptoms and distress.
• ANSOCQ (Anorexia Nervosa Stages of Change Questionnaire): A tool assessing readiness to change and motivation for recovery.

Participants completed these measures before and after reading their assigned books, over a two-week period. They also responded to reflective prompts during the reading process. The aim was to establish whether the memoir had any observable impact, positive or negative, on their psychological state.

The Results: Encouraging and Cautiously Optimistic

Contrary to the fear that memoirs might trigger relapse or worsen ED symptoms, the HA memoir did not lead to any increased harm, when compared to the control group. In fact, both groups improved significantly on ED symptom severity and motivation for change, suggesting potential clinical relevance.

Equally intriguing was the qualitative analysis. The ED memoir group showed a more vivid, sensory-engaged language in their responses. They talked more about bodily sensations, emotions, and actions. In contrast, the control group engaged more abstractly. This suggests the ED memoir may have prompted more embodied reflection—a potentially valuable outcome when considering ED recovery.

Why This Matters: Memoirs as Tools for Eating Disorders Recovery

The idea of incorporating books as a therapeutic tool in ED recovery is not new. Although the findings in the study were based on a very small, self-selecting sample, the study provides some weight to what therapists and clients have sensed intuitively: the right book, offered at the right moment, can potentially open important doors to someone in their ED recovery journey. There are a few reasons why this may be the case:

1. Memoirs model self-compassion and insight. They show that recovery is not linear, nor perfect. They allow readers to witness real cases of relapse, resistance, and recovery – and shift their expectations to a more balanced perspective.
2. They provide identification and hope. Clients often feel alone in their experience within their eating disorders. Reading about someone else’s battle can reduce shame and foster connection with the author’s struggles.
3. They encourage reflection. When clients read thoughtfully, especially alongside reflective prompts, it helps them notice their own thoughts and reactions with greater clarity. This is a cornerstone of good and effective recovery.
4. They address elements of perfectionism. When written honestly, memoirs expose the illusions of the “ideal recovery”. They show that messiness, fear, and confusion are part of healing—not proof that their own failing.

Still, the risks cannot be ignored. A poorly written ED memoir, or even a well-written one read at the wrong time, can backfire. It might idealise thinness, romanticise suffering, or present a narrow version of recovery that doesn’t reflect the diversity of client experiences. This is especially true when clients only read the earlier parts of the ED memoir that tend to focus on the severity of the author’s eating disorder, and do not finish the book where it emphasises the recovery process.

What This Means for Clinical Practice and Eating Disorders Recovery

Within therapy, we often work with individuals who feel burnt out by advice, pressure, and prescriptive approaches. The findings of this study affirm an important point of eating disorders recovery: Recovery is not just about nutrition and symptom reduction, but also about meaning-making.

That’s why we encourage clients, when ready, to read reflectively. Whether it’s an ED memoir, an ED poem, or even a novel that touches on themes of identity, control, and embodiment—stories can be impactful on their thoughts, feelings and recovery.  The therapy space should consider using the power of ED memoirs and stories as powerful tools for the following reasons:

• Therapist-Client Dialogue: When clients engage with ED memoirs or media, we can explore their reactions together. What parts they relate to? What parts angered or unsettled them? This becomes fertile ground for potential insights to be gained.
• Reflecting on their own thinking: It invites deep reflection. What stories resonate with you? What have you read (or seen) before that shaped your current beliefs about food, control, or the body? These are important aspects within therapy, and can be aimed at challenging negative beliefs.
• Creative Counter-Narratives: Some clients choose to write their own “anti-memoirs”—accounts of their own recovery that challenge cultural- or internalised myths. This reframing can be deeply empowering.

No one-size-fits-all recovery journey: It reminds clients that memoirs are not fixed blueprints. They are mere snapshots of someone else’ journey. No single story of recovery will mirror their own. And that’s okay. In fact, it’s normal.

A Word of Caution: Not All Stories Are Safe

It’s good to know we can use ED memoirs to the benefit of recovery. However, a word of caution is needed. Not every story about eating disorders helps recovery. For people who are still in the grip of an eating disorder, these kinds of stories can be risky. Some ED memoirs dwell so heavily on the details of the illness that they risk pulling the reader deeper into it. They might stir up comparison, shame, or even admiration for the author’s eating disorder. Instead of offering hope, the story ends up feeling like a manual for staying ill.

Additionally, the researchers highlighted key methodological caveats, such as a lack of long-term follow up, no measurement of actual behaviour changes (only self-reports), and that the specific ED memoir was safely constructed with clinical oversight—unlike many public ED memoirs.

Just as a scalpel can heal or harm depending on how it’s used, so too can a story. So timing matters. Supervision matters. Context matters.

Final Reflections: How Should We Think About Eating Disorder Memoirs?

In a world saturated with content—TikTok confessions, Instagram recovery reels, anonymous blogs—it’s really important that we think critically about the stories we tell about eating disorders.

This study reminds us that:

• Stories have power, but power is not inherently dangerous. It depends on how it’s used in the ED recovery context.
• Clients deserve access to diverse, honest narratives, that focus on ED recovery. Such stories don’t gloss over relapse, and they don’t romanticise emaciation. And they certainly don’t claim to have all the answers.
• Memoirs can spark change, but only if integrated thoughtfully into the broader recovery journey. When discussed in a supportive setting (like therapy or a guided group), they can help individuals reflect on their own patterns, challenge entrenched beliefs, and imagine new possibilities for recovery.

Maybe that last point is the most important takeaway of all: Recovery is not found in someone else’s ED memoir, but rather in the quiet, courageous act of narrating your own.

If you’re navigating recovery and want to explore how story, meaning, and narrative can support your healing, Reverence Recovery can help. Blending evidence-based care with deep respect for your own eating disorders experience, we’ll focus on helping you develop the courage to write your own recovery story.

Because you are more than your symptoms. You are the author of a life still unfolding.

Contact us today for an appointment, and take the first step of writing your own recovery journey.

The post Eating Disorder Memoirs – Do They Help or Hurt Recovery? appeared first on Reverence Recovery.

Many of us strive to be slimmer – ask any person whether they would like to lose some weight, and the answer would almost inevitably be yes. But why this obsession? Why is this thin ideal so important to us? And how can the pursuit of being slender contribute to the development of eating disorders? We can’t deny that western culture applies pressure for us to achieve this thin ideal, influencing our thoughts, feelings and choices – sometimes in very unhealthy ways.

Let’s delve into the complex web of factors that contribute to this powerful and often damaging cultural phenomenon.

Defining beauty

Beauty is often defined by the collective ideas of our society— what is positive and desirable. Whether through spoken work, visual media, online content, or influencers, our culture creates numerous definitions of what is beautiful and worthy. Is beauty in the eye of the beholder? Or is it defined by the culture and context of the day? The latter influences beauty significantly more than we often care to acknowledge. The world around us plays a major role in shaping our thinking and behaviour about beauty.

Being influenced by those around us falls to the basic principles of social learning. Even as young children we are influenced in our definition of beauty by family members (our micro-society) as we develop. Later, in teenage years, we’re also significantly influenced by our social peers and what others think of us. Being viewed as beautiful provides us a path to be accepted, and this becomes a focal point in our thinking by wanting to adhere to what those around us define as good enough and worthy. This need for acceptance is not easy to resist, or rebel against. The pressure we can feel in our search of acceptance (to be beautiful enough) can weight heavy on those with vulnerable self-esteems, or those searching for connection with others.

How the “ideal” body evolves with time

The definition of beauty is not fixed – it constantly evolves with new influences at play. And so, the quest to be beautiful shifts with it, chasing the next thing we believe will make us more appealing in the eyes of society. Throughout history, different body types have been celebrated, influenced by cultural and social trends.

The 20th century, in particular, saw a significant shift in Western society’s perception of the ideal body. The different events, icons and attitudes of the changing times exerted considerable influence over perceptions of different body types. These changes are easily noted when studying the changes in mannequins through the decades.

Since their introduction, shop mannequins have reflected fashion trends, and they provide a history of how body trends have changed. Emerging in shop windows in the 1920s, they served as a marketing tool intended to encourage the passer-by to imagine themselves in the clothes on display. As department stores began to feature increasingly large window displays, the mannequin quickly became synonymous with the ideal body type, defining what most aspired to look like.

In the earlier part of the 20^th century, a fuller figure was once associated with wealth and status (particularly in times of food scarcity), with woman strongly aspiring to achieve this ideal body shape. However, as food become more readily available and sedentary lifestyles increased, the ability to be thin became associated with the body ideal. The post-war 1950s period saw the introduction of more curvaceous figures, championed by celebrities such as Marilyn Monroe. Mannequins soon mirrored this new ideal – male figures became larger and bulkier, and female figures became fuller-bodied and hourglass in shape.

Moving in through the 60s and 70s, mannequins resembled more toned and athletic bodies to the likes of Jane Fonda and Olivia Newton-John. By the 1990s, styles began to imitate the slim frames of Kate Moss and other supermodels, which saw mannequin’s hips narrowing significantly. This influence continues until today, with social media and icons like Taylor Swift and Beyonce’ influencing their followers by defining fashion and beauty trends.

Weight stigma and Fat phobia

Western culture often exhibits a strong fat phobia – a fear of gaining weight. This fear is perpetuated by negative stereotypes associating fatness with laziness, ugliness, and failure. This societal weight stigma can lead individuals to internalize negative attitudes towards larger bodies, including their own, driving a desire to be thin to avoid this stigma. The phenomenon of “fat talk”, where individuals frequently criticize their own weight and body shape can be seen as a manifestation of this fat phobia and a focus on negative comparisons with the thin ideal.

In recent years, alongside the thin ideal, a healthy ideal has emerged, often promoted through wellness culture. While seemingly positive, this can sometimes inadvertently reinforce anti-fat attitudes by strongly emphasizing the need to control one’s weight through diet and exercise to achieve a healthy body, which is often still equated with thinness.

The role of media and social platforms

Perhaps the most visible architect of the thin ideal is the mass media. From glossy magazine covers showcasing impossibly slender models to television shows and films featuring predominantly thin actors, we are constantly bombarded with images that equate thinness with beauty, success, happiness, and desirability.

Research has shown that the average weight of fashion models has decreased significantly since the 1950s, while the average Australian woman’s weight has increased. This growing disparity between reality and the promoted ideal has created a perfect storm for body image concerns and eating disorders.

In Perth and across Western Australia, the rise of social media has intensified exposure to unrealistic body standards. A 2023 study by the Telethon Kids Institute found that young Western Australians spend an average of 6.7 hours daily on social media, where they encounter countless filtered and edited images promoting the thin ideal.

In the digital age, social media acts as a powerful amplifier of the thin ideal. Platforms like Instagram and TikTok are awash with carefully curated images of seemingly flawless, often very thin, individuals. This fosters negative social comparison, where individuals constantly measure themselves against these unrealistic online personas, leading to feelings of inadequacy and a stronger desire to be thin. The algorithms controlling our online experiences tend to amplify content promoting wellness and fitness lifestyles, which often mask disordered eating behaviours behind a veneer of health consciousness.

The global influence of western beauty standards

The idealization of thinness, once largely confined to Western cultures, is increasingly spreading through globalisation and the reach of Western media. With social media being accessible to the rest of the world, numerous cultures are exposed to the western ideal beauty standards.

Different cultures and ethnicities have their own values regarding standards of beauty. However, with the media increasingly promoting the western ideal, other races and cultures around the world face more dissatisfaction with their bodies as they perceive these westernised standards to be ideal. This shows how the western beauty standards are portrayed to other cultures, it is showcased to be unattainable and unrealistic, but still deemed the ideal by our society. This ultimately leads to more cases of eating disorders and mental health issues around the world as people want and attempt to obtain the ideal body.

The thin ideal and eating disorders

The desire to be thin is not solely driven by external pressures. Psychological factors also play a significant role. One of my recent clients described the impact of weight loss on her psyche:

“I feel like weight loss is the only mechanism to become happy in life. Achieving a thin body gives me self-acceptance and happiness. It’s the shape and weight that society expects of a woman. The more I lose weight, I feel more in control, and I feel so much better about myself. I know I can become obsessed about it, but I can’t help it. As I lose more weight, it’s like I start feeling like a new person, a better person…”

In a world where individuals may feel a lack of control in other aspects of their lives, regulating food intake and pursuing thinness can provide a sense of agency and control. This can be particularly relevant for individuals who struggle with perfectionistic tendencies, have vulnerable self-esteems, and struggle with insecurities. For some, their self-worth can become overly tied to body image, believing that being thin is a sign of self-control and discipline, or my self-worth is measured by how thin I am. Such belief can fuel a relentless pursuit of thinness.

The economic profitability of the thin ideal

Another underpinning to the thin ideal is its economic profitability. The diet industry thrives on our insecurities about our bodies, offering a constant stream of new diets, weight loss products, and exercise regimes. This perpetuates the message that our natural bodies are somehow flawed and in need of fixing, further reinforcing the desirability of thinness.

The diet industry is worth billions of dollars annually, relying on their ability to make being thin fashionable and aspirational, creating demand in young and old alike to pursue unattainable standards, while selling solutions to fix perceived flaws or provide quick results. This industry constantly promotes dieting as a means to achieve happiness, health and attractiveness.

Diet culture often promote the idea that weight is entirely within our control, neglecting the complex interplay of genetics, metabolism, and other factors that determine our body size and shape. When diets inevitably fail for many, it can lead to feelings of personal failure and further fuel the cycle of body dissatisfaction and restrictive eating.

Breaking free from the thin ideal

Society is starting to recognise the negative, and potential destructive impact the pressures of being thin can place on vulnerable people, which may contribute to them developing eating disorders. As awareness grows about the impact of the thin ideal, we have seen a rise in body-inclusive movements, promoting body positivity.

These approaches encourage individuals to value their bodies for their functionality and uniqueness, to resist internalizing unrealistic media ideals, and to focus on health and well-being regardless of size. By fostering critical thinking about societal appearance standards, embracing size diversity, and reducing weight bias, we can begin to dismantle the harmful obsession with thinness and create a more inclusive and accepting culture.

The journey to recovery often involves understanding and challenging these cultural narratives. Within treatment, we incorporate discussions surrounding this topic to educate, and hopefully challenge the thin ideal. In this way, recovery is not only focussed on changing certain behaviours, but recognising and resisting harmful societal and cultural messages.

Conclusion

The relentless obsession with the thin ideal in Western culture has significant negative consequences for individuals’ mental and physical health. It contributes to widespread body dissatisfaction, low self-esteem, anxiety, depression, and significantly increases the risk of developing eating disorders. It also fosters a culture of self-criticism and judgment, hindering individuals from embracing their bodies and living fulfilling lives.

The idealisation of the thin body in Western culture is not just another trend, but a deeply fixed cultural norm influenced by historical, societal, and economic factors. The pervasive nature of media, deeply ingrained societal values, early family messages, underlying psychological factors, and the relentless promotion of diet culture all contribute to this enduring obsession.

Understanding these multifaceted influences is the first step towards challenging this unattainable ideal and fostering a culture that celebrates body diversity and promotes positive body image for all.

It’s time to shift our focus from the narrow pursuit of thinness to a broader appreciation of health, well-being, and the inherent worth of every body. The journey to self-acceptance starts with realising and rejecting the unrealistic beauty standards enforced by society. It is important that we create a culture where health is viewed all-inclusive, emphasising the importance of mental health, self-worth, and physical health. By embracing a more inclusive and realistic definition of beauty, we can create a society and culture that values every body, regardless of size or shape, where people look beyond these unrealistic expectations regarding the pressures of the “thin ideal.”

If you’re struggling with body image concerns or an eating disorder, remember that help is available. Reverence Recovery offers specialised treatment for those struggling with an eating disorder. Our Telehealth treatment option allows us to treat those afflicted anywhere in Australia, whether metro or regional. You don’t have to walk the recovery journey alone.

Ready to take the first step towards recovery? Visit Reverence Recovery to book a consultation. We’re here to help you navigate your path to healing.

The post Why does Western Culture Idealise the Thin Ideal Body? appeared first on Reverence Recovery.

The presence of multiple diagnoses or conditions can complicate accurate diagnosis, treatment efforts, and the path to recovery. In today’s blog post we’ll consider the most commonly observed co-occurring conditions with eating disorders, and hopefully understand better how they influence each other.

Eating Disorders and Mood Disorders

Approximately 50% of individuals with eating disorders also qualify for a diagnosis of major depressive disorders. Depression can be experienced before the onset (primary depression), together with, or after the onset (secondary depression) of an eating disorder. Many of the criteria used to diagnose clinical depression are also the consequences of restriction, binge-eating, and/or engaging in compensatory behaviours like purging or excessive exercising.

In most cases, as treatment unfolds, depressive symptoms will improve with the normalization of eating patterns and the elimination of compensatory behaviours. However, if the person experiences primary clinical depression, the use of psychotropic medications can often be very useful in relieving depressive symptoms, helping them participate better in their psychotherapy treatment for their eating disorder.

Eating Disorders and Suicide

There is a complex and interconnected relationship between eating disorders and suicide, although it’s important to note that not everyone with an eating disorder will experience suicidal thoughts or behaviours.

Many factors can contribute to an increased risk of suicide or attempted suicide among people with eating disorders. Some of these factors may include:

• A history of multiple mental health comorbidities (i.e. anxiety- and  mood disorders).
• A history of previous suicide attempts.
• Social isolation.
• Family issues and conflicts.
• Family history of suicide.
• Substance misuse.
• Adverse or traumatic childhood experiences (e.g. abuse, bullying etc.).
• A sense of being a burden on others. Feelings of excessive guilt and shame.
• Self-harm behaviours.
• Hospitalization and treatment history.
• Tolerance for high risk and impulsive behaviours.
• Difficulty regulating emotions.

Statistics highlight suicide to be one of the top causes of death for young people aged 10 to 24 years old. Suicide is also the second leading cause of death among individuals with anorexia nervosa, and suicidal behaviour is elevated in those struggling with bulimia nervosa and binge eating disorder.

Approximately one-quarter to one-third of people with anorexia nervosa, bulimia nervosa, or binge eating disorder admit to having thoughts about suicide; with one-quarter to one-third of people with anorexia and bulimia having previously attempted suicide. Those with anorexia are 18 times more likely to die by suicide and those struggling with bulimia are 7 more times likely to die by suicide.

Eating Disorders and Anxiety Disorders

Overall, research findings highlight anxiety disorders to be highly comorbid with eating disorders. Approximately 48% of adults with anorexia nervosa, 81% of adults with bulimia nervosa, and 65% of adults with binge-eating disorder have at least one co-occurring anxiety disorder. These include anxiety disorders like generalized anxiety disorder, social anxiety, and panic disorder. Anxiety disorders most frequently precede the onset of an eating disorder and often persist after recovery.

Eating Disorders and Obsessive-Compulsive Disorders

Approximately 15-18% of individuals with eating disorders also qualify for a diagnosis of Obsessive-Compulsive Disorder (OCD). The prevalence OCD in the general population is about 2%. Roughly 1 in 6 people with an eating disorder also have OCD, nearly 8 times more than the general population. In general, OCD is more common in individuals with anorexia nervosa than in people with bulimia nervosa or binge eating disorder.

There are a number of similarities between OCD and eating disorders that could account for this high rate of co-occurrence. For example, both conditions involve intrusive thoughts, image or impulses, which are unwanted and distressing. These phenomena can focus on food, weight, body image, contamination, self-harm, or perceived mistakes. People with OCD and those with eating disorders also engage in repetitive compulsive behaviours as a response to these thoughts. These behaviours aim to reduce the anxiety experienced.

Fear of losing control is another likeness. Individuals with eating disorders fear gaining weight and losing control around food, similarly to those with OCD who may fear losing control of their thoughts, actions, or emotions. These issues are compounded by their strong need for perfection, causing them to engage in rigid and inflexible thinking and behaviours. Another similarity is that OCD and eating disorders can be triggered by stress or anxiety. Once again, ritualistic and compulsive behaviours may be used as their main coping strategies. However, these behaviours only bring temporary relief, and may actually increases overall anxiety in the long run.

Finally, people with OCD and those with eating disorders often have prevailing and enduring low self-esteem. Although there could be multiple reasons for the low self-esteem, it’s perpetuated by negative thoughts about themselves, their weight, or their body image.

Eating Disorders and Trauma

Posttraumatic Stress Disorder (PTSD) is a serious mental health condition that develops when someone is exposed to one or more, or enduring traumatic events. According to the Diagnostic and statistical manual of mental disorders (DSM-5 TR), traumatic events include situations where there is a real or perceived threat of death, serious injury, and/or sexual violence. These events can include those that are directly experienced by someone, witnessing someone else being exposed to the trauma, and/or repeatedly listening to details of other people’s traumatic experiences (e.g., first responders).

Despite research showing a strong correlation between PTSD and eating disorders, it remains unclear exactly how these two conditions are related and why there is such a high co-occurrence between them. One possibility is that eating disorders and their associated symptoms may predispose someone to develop PTSD after experiencing trauma. Several studies have indicated that people with eating disorders are more likely to have:

• A pre-existing anxiety disorder.
• More easily perceive threat or hostile intent from others.
• Are preoccupied with negative consequences.
• Are sensitive to punishment.
• Have difficulty adapting to change.
• Have a heightened reaction to stress and trauma.

All the afore-mentioned components may increase the individual’s risk of developing PTSD after experiencing trauma.

Some researchers have also proposed that eating disorders may develop as a way to self-medicate and cope with the unmanageable feelings associated with their PTSD. It’s been shown that binge eating and/or purging behaviours can help individuals manage their PTSD symptoms by decreasing feelings of anxiety, hyperarousal (extreme anger, paranoia and irritability), and by allowing them to numb or avoid intrusive thoughts about the traumatic event(s).

Others have argued that PTSD related negative thinking may cause or exacerbate symptoms of low self-esteem, perfectionism, and poor body image which then lead to engaging in disordered eating behaviours. Studies have also shown that the traumatic events and subsequent PTSD symptoms often occur before someone shows signs of an eating disorder, which supports evidence that trauma and PTSD may have a causal relationship to the development of eating disorders.

Conversely, other researchers have suggested that rather than one disorder causing the other, the symptoms of both PTSD and eating disorders maintain or exacerbate each other. For example, avoidance of PTSD symptoms such as hyperarousal by binging, purging, and/or restriction may serve to maintain both eating disorders and co-occurring PTSD. Since these behaviours can reinforce each other, it can be difficult to break this cycle of disordered eating and avoidance of PTSD related symptoms. As a result, traumatic experiences and their harmful consequences are not effectively processed and can continue to cause harm. In this way, trauma, PTSD, and eating disorders can be very much intertwined.

Substance Abuse

Substance misuse and eating disorders frequently co-occur, with up to half of individuals with eating disorders also using alcohol or illicit drugs – a rate 5 times more than the general population. Each of these illnesses alone significantly increases mortality rates and when they occur together can lead to serious physical and mental health consequences.

Below is a short video focussing on the dual diagnosis of eating disorders and substance abuse, and what treatment should look like to address these as effectively as possible.

Conclusion

As discussed, eating disorders have close and significant comorbidities with a range of psychiatric conditions. This is partly why eating disorders treatment can be complicated and difficult, because you’re attending to multiple problems of thought, emotions and behaviours at the same time.

For these reasons you should access treatment that addresses all your issues, by someone who has the capacity to assist with most, if not all, of your diagnoses present. This is one of the founding principle behind Reverence Recovery, and a central principle to everyone treated there. We don’t shy from difficult and complex cases, and comorbidities are not barriers to treatment.

If you struggle with any of these conditions described, share these with your treatment team and family. Struggling with an eating disorder is already difficult, but keeping silent on any other issues your experiencing does not help. Treatment needs to be tailored specifically to help, focussing not only on some of your issues, but all of them.

In the next few blog posts we’ll consider some of the comorbid diagnoses in detail, and try to uncover the links with eating disorders better.

The post Eating Disorders and Co-occurring Psychiatric Diagnoses appeared first on Reverence Recovery.

These settings provide for intensive and comprehensive treatment, addressing both the physical symptoms and psychological underpinnings of an eating disorder. The aim is to be in an intensive supportive space where you, and a treatment team of specialists, can focus entirely on your wellbeing and safety.

But if you’ve never been admitted for inpatient treatment, this process can provoke a lot of anxiety and stress for some. Handing over control to others feels daunting, especially if you don’t know exactly what to expect.

So in today’s blog, we’ll look at some of the practical and emotional aspects that come with being admitted to an inpatient unit for eating disorders treatment. If you’re considering inpatient treatment, hopefully the info provided can help demystify the process and reduce the anxiety you may be experiencing.

Addressing Concerns and Fears Before Starting Treatment

Most people have concerns and fears before beginning eating disorders inpatient treatment. These feelings are a normal part of the process. It’s not every day you take a life changing step that will affect many, if not most areas of your life going forward. If you have specific worries, such as fear of weight gain, unfamiliar surroundings, or the intensity of therapy program, discuss these openly with the treatment team and your family. Writing down your questions before you speak to them can help you gather your thoughts and concerns in a way to help them understand your concerns.

Readiness to change is a crucial predictor of treatment outcome. Resisting treatment, when your health and medical status clearly indicates you need it, is unconstructive and does not serve you, or your family, in any way. Openness to consider others’ genuine concerns for your health may be necessary. Try to be open to the process, and trust that your family, and treatment team, are helping you in your best interest.

Preparing Your Emotional Readiness

Preparing emotionally for eating disorders inpatient treatment is a vital step towards your recovery. It’s perfectly normal to experience anxiety or fear about entering an unfamiliar setting and confronting deep-seated issues. Recognising these feelings and allowing yourself to feel them without judgement is an important part of the process. These feelings are valid and signify that you are taking a courageous step toward healing.

One way to manage such emotions is by practising some mindfulness. Mindfulness can help you stay present and focused, reducing feelings of being overwhelmed by what lies ahead. Simple practices, such as deep breathing exercises or short meditation sessions, can make a significant difference in your emotional state in the moment.

Self-compassion is equally important. Treat yourself with the same kindness and understanding that you would offer a loved one in a similar situation. Accept that it’s okay to feel vulnerable and that recovery is a journey with its ups and downs. Self-compassion can help you maintain a positive attitude, even during challenging times.

Building emotional resilience is another key aspect of preparing for inpatient treatment. Resilience involves developing the ability to bounce back from setbacks and to approach obstacles with a problem-solving mindset. You can cultivate resilience by setting small, achievable goals and celebrating your progress, no matter how minor it may seem. Every step forward is a step toward recovery.

Lastly, prepare for the emotional ups and downs that will inevitably come with treatment. There will be good days and challenging days, and both are part of the recovery journey. Remind yourself that healing is not a linear process, and it’s okay to have setbacks. With emotional readiness, you are equipping yourself with the tools to navigate this journey with courage and determination.

Medical Monitoring and Daily Structure

In the initial stages, medical monitoring becomes an integral part of inpatient care. This ensures that any physical complications arising from your eating disorder are addressed. There is a myriad of physical complications that are associated with inpatient eating disorders recovery, and having a full compliment of medical staff addressing those difficulties does not just make the road easier, but it can also be life-saving in extreme cases. This is a key benefit of inpatient treatment – i.e. the constant availability of professional support. The 24/7 access to care provides a safety net, ensuring that you always have resources available to manage difficulties as they arise. This can be particularly reassuring during moments of vulnerability or crisis, offering immediate assistance and guidance.

Although each inpatient unit will be unique, the daily schedule in an inpatient programme is designed to ensure a balanced approach to treatment. Generally, the treatment will follow fixed treatment protocols and structures that plan out the day’s activities. Daily activities often include, but aren’t limited to, attending individual- and/or group therapy sessions, receiving nutritional counselling, as well as personal time where you can reflect on your feelings and thoughts. All these elements are aimed at helping you rebuild a healthier relationship with food through education and guided practice. The structure may seem rigid at times, but it helps to create a rhythm on the ward where everyone knows what is happening and expected for the day ahead.

Structured Eating and Nutritional Counselling

The structured environment also means that meals and snacks are planned and supervised, reducing anxiety around eating and providing a routine that supports nutritional rehabilitation. Depending on your specific diagnosis and treatment, your meals and snacks will usually be tailored to meet your body and medical needs for rehabilitation. In cases where weight regain is necessary, the prescribed meal plan will ideally be tailored to your needs. Some individuals find this extremely anxiety provoking, as they must surrender control over their food choices. But others find this part of treatment very relieving, as they do not have to obsess over food choices anymore, or try to plan when and what they will eat next to the finest degree.

In comprehensive treatment, nutritional counselling will be provided to help you learn about balanced and nutritional eating that feeds your body and provides all the sustenance needed. Having an open mindset that is geared towards treatment and recovery will help you best here. If you consider that treatment is trying to help rid you of an eating disorder, then changing some of your core dietary beliefs and habits is probably part of the journey ahead. Recovery progress will be limited if you approach this with a closed mindset. As best possible, you should be willing to consider food from a different perspective, which allows for a healthier relationship to develop. This is what nutritional counselling will focus on primarily.

Psychological Therapy

Various therapies, such as cognitive behavioural therapy (CBT) or dialectical behaviour therapy (DBT), may be utilised to help reframe negative thought patterns and develop healthier coping mechanisms. These therapies can be applied during individual- or group therapy.

Individual therapy allows for intense focus and discussions on your thoughts and your beliefs about you and your life. Whether focussing on your eating disorder, or other primary issues that need addressing, therapy allows you the space to start engaging with a qualified person who is trained to listen, provide feedback, and apply psychological interventions to assist you with your most difficult struggles. Once again, an open mindset and a willingness to engage with serve you well. Therapy is like most endeavours in life – what you invest is related to the rewards you will reap.

Connecting with others during group therapy who understand what you are going through can be immensely helpful. Knowing that you are not alone can lessen the burden of your worries. Sharing with others your thoughts and feelings who are going thought a similar experience, can help provide relief and a sense of camaraderie.

Different treatment programs will differ in their application of individual- and group therapy during treatment. Some will focus exclusive on one modality, whilst other programs will utilise some combination of the two. Both have been shown to be effective and helpful in eating disorders recovery.

The Importance of Self-Kindness and Patience

When entering eating disorders inpatient treatment, nurturing self-kindness and patience will become important. The journey to recovery is a gradual process, often filled with ups and downs. It’s a long and arduous journey, and you’re going to need to learn to be there for yourself – whether it be encouraging yourself, coaching yourself, or supporting yourself.

Maintaining a positive outlook, even when faced with setbacks, can help a lot. Although easier said than done, be gentle with yourself in times when you’re struggling. Inpatient recovery is certainly not easy, and being gracious towards yourself in these periods can really be key in helping you embrace your difficulties and struggles.

Again, cultivating self-kindness is key here. Replacing self-critical thoughts with affirming and positive self-talk will be important. Focusing on your strengths and successes, instead of focussing on your weaknesses or mistakes, will form a foundation whereby you can start building a better relationship with yourself. It can be helpful to keep a journal where you note down daily achievements and positive experiences, reinforcing your progress and boosting your self-esteem. Take note how you “talk” to yourself, and try to start correcting these statements as best you can.

How Friends and Family Can Support Your Journey

Friends and family can be pivotal in aiding your recovery journey by being informed, patient, and compassionate. One of the first steps they can take when you are admitted to inpatient treatment is to educate themselves about eating disorders. Understanding the complexities involved in your specific diagnosis, and the treatment you’ll receive, helps them provide more informed support.

Offering emotional support is vital. This can be as simple as being present, actively listening, or offering words of encouragement. In general, family and friends should avoid giving unsolicited advice or making judgemental comments, as these can be counterproductive. Instead, taking the lead from the treatment and the team will help them validate your feelings and experience of inpatient treatment. This, in itself helps, build trust and open communication going forward.

Eating disorders do not only impact the individual, but family systems too. Some inpatient units offer family therapy sessions as part of their inpatient treatment provided. This is usually the case in units where younger individuals are treated. Family therapy can be very beneficial, offering a structured environment to discuss dynamics and challenges, guided by a professional who offers strategies for better interaction and support. During these sessions, take the lead from the facilitator whilst you try to share your concerns and feelings about what you are going through, and what you need from your family. Your family will also engage in this process, and listening to their feedback and replies may be challenging at times, but is certainly necessary to help in healing any negative impacts you, and the family have experienced.

Other Tips

Here are some other tips that can help you during your inpatient journey:

• Connecting with others who have been through inpatient treatment can be beneficial. Speaking to former patients, or perusing their stories online through videos or blogs,  or even reading a complete autobiography of a recovered person who underwent inpatient treatment can all provide valuable info on what to expect. These insights can help ease your mind and provide a sense of calm over what’s to come.
• It’s also important to communicate with your friends and family you trust about your upcoming treatment. Their understanding and support can be invaluable. Let them know about your specific needs and how they can best assist you during this time. Perhaps you need them to contact you multiple times per day, or perhaps you need more space? Whether it’s emotional support, practical help, or simply being available to listen, having a robust support network that knows what you need from them during your admission can really make a significant positive difference.
• Preparing a list of personal items to bring with you can offer a sense of comfort. Familiar objects, such as photographs, a favourite blanket, or books, can make your space in the unit feel more like home and provide emotional solace during your stay.
• Don’t compare yourself to others in the unit. Recovery is a highly individualised process, and comparing your progress to others can be discouraging. Try to stay focused on where you’re at in your own recovery journey. Also, don’t let others in the unit sway you from the goal of recovery (yes, sometimes others can actually encourage you to NOT recover). Write down your recovery goals and what you want for your future, and remain 100% focused on these.
• Lastly, remember to focus on the reasons you are seeking treatment. Reminding yourself of your goals and the long-term recovered life you want to achieve can help to keep you motivated, even when facing fears and uncertainties.

The Journey After Inpatient Treatment

Although inpatient treatment can be very daunting, it’s important to understand that this is merely one step in a long road of recovery. As your health improves in inpatient treatment, discharge from the unit will become more of a reality.

When returning home, practical support from others can be incredibly beneficial. This may include receiving help with daily tasks or chores that may seem overwhelming, or even keeping an eye over you when you’re struggling with urges like restriction or exercising. Don’t feel intimidated to ask for help from those you trust, as those who love you will certainly want to see you succeed in your recovery. They won’t see these requests as impositions, but rather providing help to someone they care for.

Conclusion

Being aware of the various elements that comprise inpatient care can make the experience less daunting and more manageable. Understanding the structure and support available can enable you to embrace the process more fully, providing a solid foundation for your recovery journey.

Remember, seeking help and committing to inpatient treatment is a brave and commendable step. It’s a testament to your strength and determination. By being kind to yourself and exercising patience, you can create a supportive inner environment that enhances your healing journey. Treat yourself with the same care and compassion that you would offer to a dear friend in a similar situation.

During your inpatient treatment, stay focused on your own unique path and pace. Change doesn’t happen overnight, and it’s normal to encounter challenges. Be patient, and allow yourself the time needed to work through your difficulties without feeling pressured to meet unrealistic expectations. Be open and honest with your treatment team and your support network, as you take the first step of this long, yet completely valuable journey that will benefit your long-term health and happiness.

If you’re considering inpatient treatment for eating disorders, remember that it’s a courageous step toward recovery. You don’t have to navigate this journey alone. Please contact us to schedule a FREE consultation and learn how we can support you during this transformative process. Take the first step towards healing today—your recovery is worth the effort.

The post Preparing Yourself for Eating Disorders Inpatient Care appeared first on Reverence Recovery.

In a previous blogpost we highlighted the specific medical and psychological risks associated with eating disorders. Today, however, we’ll zoom in on the biggest risk of all: premature end-of-life. As we delve into this important topic, it’s crucial to understand that behind every statistic is a real person, a family, and a story that deserves attention and understanding.

Mortality in Eating Disorders

The most serious risk for all eating disorders is the link with elevated mortality rates. Whether the person struggles with anorexia nervosa, bulimia nervosa, or binge eating disorder – each present unique challenges and risks associated with serious impairment and tragic conclusions.

Research indicates that mortality rates can vary significantly among the different types of eating disorders. Understanding the differing mortality rates is important for awareness and education. Although anorexia nervosa is recognised as one of the deadliest psychiatric conditions, it’s important not to discount the risk associated with other eating disorder diagnoses.

Mortality Risk for Anorexia Nervosa

Anorexia nervosa is commonly seen as the most profound serious eating disorder, characterised by a fear of gaining weight and a relentless pursuit of thinness, often leading to extreme food restriction and significant weight loss. People struggling with anorexia nervosa may exhibit behaviours such as severe calorie restriction, excessive exercise, and the use of laxatives or diuretics to lose weight.

The physical manifestations of this disorder are severe, with malnutrition leading to a cascade of medical complications, including cardiac arrhythmias, bone density loss, and organ failure. Those affected frequently struggle with co-occurring conditions such as depression, anxiety, and obsessive-compulsive disorder, which not only exacerbate the severity of the eating disorder but also contribute to the elevated risk of suicide. The interplay between physical deterioration and psychological struggles experienced creates a dangerous situation for individuals with anorexia nervosa. Compounding this risk, those struggling with anorexia nervosa are often resistant to receiving treatment, with many individuals experiencing chronic symptoms and multiple relapses.

Anorexia nervosa is considered one of the deadliest mental disorders, and significantly higher than other eating disorders. Overall, the mortality rates for anorexia nervosa has been estimated to be 5.9 – 15.9 cases per 100 000, per year. It has the second highest mortality rate among psychiatric disorders, second only to opioid use disorder.

Mortality Risk for Bulimia Nervosa

Bulimia nervosa is characterized by episodes of binge eating followed by efforts to regulate the negative emotions and aversive internal experiences (such as physically feeling full) that emerge after a binge. Binges are typically followed by compensatory behaviours such as voluntary purging, excessive exercise, or the misuse of laxatives and diuretics. The physical toll of these behaviours can be profound, significantly elevating the risk of premature end-of-life.

Bulimia Nervosa and Binge Eating Disorders share one key similarity – those who struggle with these disorders are not in the underweight range where body-mass index (BMI) is concerned. It’s important to note that only 6% of those diagnosed with eating disorders are medically underweight. This challenges the common stigma that most eating disorders present with a thin body or low weight. Thus, never assume that a person cannot have an eating disorder simply because of the weight of their body.

Similarly to anorexia nervosa, bulimia nervosa is frequently accompanied by co-occurring mental health conditions such as depression, anxiety, and substance abuse. The emotional distress associated with this disorder can lead to a higher risk of self-harm and suicide. Overall, the mortality rates for bulimia nervosa has been estimated to be 1.7 – 2.2 cases per 100 000, per year.

Mortality Risk for Binge Eating Disorders (BED)

Binge-eating disorder is one of the most common eating disorders, characterized by recurrent episodes of binge eating, accompanied by a strong subjective feeling of losing control, without the use of any inappropriate compensatory behaviours afterwards. Many individuals with binge eating disorder report longstanding symptoms, being highly comorbid with obesity and is usually associated with several health risks, including Type 2 diabetes and hypertension. The disorder is also associated with marked distress and impairment in functioning.

In a nationally representative US-based study, virtually all (94%) reported lifetime mental health symptoms: 70% mood disorders, 68% substance use disorders, 59% anxiety disorders, 49% borderline personality disorder, and 32% posttraumatic stress disorder. Data on mortality within binge eating disorder are scarce, with the mortality rate is estimated to be 1.5 – 1.8 cases per 100 000, per year.

Mortality Risks for Eating Disorders in Australia

A report by the Butterfly foundation, Paying the Price: The Economic and Social impact of Eating Disorders in Australia, 2024, 2nd ed, highlights the mortality risks associated for eating disorders in Australia. The research estimated that the average premature all-cause mortality rate for those with an eating disorder is 0.12%, which equates to a total of 1,273 deaths in Australia in 2023 (for those aged 5 and above). Out of all the eating disorder types, anorexia nervosa presented the highest premature mortality rate at 0.14%. However, the number for premature mortality is greater for binge eating disorder and other eating disorders, as they are statistically more prevalent.

Conclusion

Every 62 minutes at least one person dies as a direct result from an eating disorder. Understanding mortality rates in eating disorders is crucial for recognizing the severity of these conditions and the importance of early intervention.

While the statistics can be alarming, they also emphasize why immediate action and support are so vital. Remember, behind every number is a person who deserves help, hope, and healing. Recovery is not just possible – it’s worth fighting for.

If you or someone you know is struggling with an eating disorder, don’t wait until it’s too late. Contact Reverence Recovery for a confidential consultation. For more information about eating disorders, visit our other informative articles on our Blog page.

The post Mortality Risks for The Most Common Eating Disorders appeared first on Reverence Recovery.

Eating disorders are not a new phenomenon, but our understanding of these conditions has certainly changed over the centuries. In today’s blog we’ll look at the history of eating disorders by tracing their historical roots, up until current perspectives.

Middle Ages: Self-Starvation As a Religious Act

During the 12th and 13th centuries, the dominant interpretations of self-starvation were founded within religion, especially in Western Christianity. Refusing to ingest food in the Middle Ages was seen by many as a method to become closer to a god, viewed as acts of piety, great faith and holiness. Suffering was considered a way to imitate Jesus in remembrance of Christ’s torments to save humanity. Holy men preferred experienced suffering through physical punishment, whereas women preferred voluntary pain by fasting. They practiced anorexia mirabilis, or holy anorexia, as part of their religious practices.

Food abstinence became a religious ascetic ideal, exemplified by miraculous maidens (i.e. women who starved themselves) and fasting saints. One of the most famous examples was Saint Catherine of Sienna who lived in the 14th century. Saint Catherine died at age 33 of starvation after having survived on eating only bread, raw herbs and water for many years. However, as time passed, these views on holy anorexia changed, and by the late Middle Ages women who fasted excessively were thought to be possessed by evil spirits, rather than viewed as fasting saints.

The First Medical Description of Anorexia Symptoms

There exists some uncertainty over the exact origins of when and how anorexia nervosa as a diagnosis was realised. Recognising that certain types of food abstinence were representative of a medical problem became evident somewhere in the late 17th century.

Many believe that anorexia nervosa was first identified as a medical syndrome in Europe in 1689 by English physician Richard Morton. The medicalisation and understanding of anorexia nervosa culminated in Morton’s textbook Phthisiologia, or, A Treatise of Consumptions. In it, he described two cases of a ‘wasting’ disease of ‘nervous origins’ (‘nervous consumption’) that could be considered the first clear medical description of anorexia nervosa. One such case described an adolescent girl with ‘nervous consumption’ caused by ‘sadness and anxious cares’. Morton managed to rule out any physical cause for the disturbance and underscored ‘nervous causes’ for the observed weight loss.

At around the same time, the French psychiatrist Charles Lasegue reported the loss of appetite as a form of ‘hysteria linked to hypochondriasis’ and emphasised an array of encompassing emotional problems. His theory emphasised the role of the family, as he believed that anorexia nervosa was a disease that could only develop in comfortable homes with an abundance of food. He believed women who interpreted their lives as ‘suffocating’, and could not display emotional distress, would protest by not eating.

Modern History

In the 1920’s and 1930’s, the focus on anorexia nervosa nearly disappeared from psychiatric discussions. Eating disorders were thought to be predominantly physical diseases due to medical conditions. Researchers attributed these disorders to hormone imbalances and endocrine deficiencies. Simmond’s disease, named after its discoverer Morris Simmonds in 1914, which identified a lack of pituitary gland functioning, dominated popular conceptualisations of eating disorders and its development.

Not until the 1930s did psychiatrists’ and physicians’ focus became re-engaged, as they began to understand that the causes of eating disorders were part psychiatric and part emotional – rather than wholly physical. The land-mark case study of Ellen West from 1930 to 1933 provided further support for this shift in thinking. This paper provided West’s subjective perspective, describing her own desperate obsession with food and thinness, which tragically led to end her life by suicide.

In the 1970’s, The Golden Cage was one of the first books to suggest that eating disorders were becoming a serious problem. A broader interpretive framework for eating disorders would come in this era with the publication Eating Disorders by Hilde Bruch (1973). In Bruch’s work, she concluded that patients had delusional proportions of body image and body concepts, a disturbance in their ability to recognise nutritional needs, and a paralysing sense of ineffectiveness which pervades all thinking and activities. These were key contributions in starting to identify and understand specific symptomatic aspects of eating disorders.

The occurrences of anorexia nervosa continued to increase rapidly into the next decade, with some identifying it as the disorder of the 80’s. This notion contributed to suggestions that diseases, particularly psychiatric disorders, could possibly be directly linked to specific cultural contexts. By the mid-1980’s, college campuses in the United States of America were instituting counselling or support systems for those suffering from the disorder. The release of a feature film named The Best Little Girl in the World in 1985 offered the public a glimpse into the life of someone living with an eating disorder. During that same year, public awareness for eating disorders reached a peak when the high-profile pop singer and composer Karen Carpenter died from heart failure, as a direct consequence of her anorexia nervosa.

The 1990’s saw an increase in the momentum of research and development into eating disorders. In 1992, binge eating disorder (BED) was first recognised as a formal diagnosis. Prior to that, when BED was officially introduced at the International Eating Disorders Conference, individuals with these types of behavioural problems were merely labelled as emotional overeaters, compulsive overeaters, or food addicts. In that same year, the National Collegiate Athletic Association in the USA also revealed that eating disorders had taken significant precedence in most men’s and women’s college sports. Also in 1992, Andrew Morton published his biography on the Princess of Wales, titled Diana: Her True Story. It contained intimate details about Princess Diana’s struggle with bulimia nervosa, bringing more public attention to eating disorders and its growing prevalence in society.

The 1990’s was also the era in which researchers’ thinking shifted to a consensus that genetics and brain chemistry could play a significantly larger role than societal pressures in determining whether someone develops an eating disorder.

Conclusion

Eating disorders, particularly anorexia nervosa, are not modern-day phenomenon. The history clearly shows that its origins can be traced to distant times. With the development of the internet and the information age, it’s clear to understand that eating disorders are significant problems that affect many people in our society. In psychological terms, eating disorders may signal deep emotional difficulties for the sufferer, and research has highlighted that underlying factors are multifaceted, ranging from genetics to wider cultural- and media influences.

The post A Short History on Eating Disorders appeared first on Reverence Recovery.

Whatever the specific eating disorder diagnosis, its consequences are profound and highly destructive: The physical-, cognitive-, emotional-, and familial impacts of these disorders may result in being excluded from many areas of life. When the disorder has taken significant precedence, there may come a time when you plunge into severe social isolation. The disorder can halt your personal development and fill you with feelings of emptiness.

With this in mind, it’s necessary to have a proper reference of the most common impacts an eating disorder can have on your life. The following lists illustrate the numerous negative impacts eating disorders may have, but are not exhaustive. It does, however, comprehensively illustrate the potential destructive consequences of these illnesses.

The lists may help you identify symptoms that have become significant part of your life, but haven’t yet recognised as a probably a consequence of your eating disorder.

The Impact of Eating Disorders on the Brain

Destructive eating disorders behaviours like self-induced starvation, binge eating, or purging of food can cause alterations in brain functioning, causing impairment in emotional functioning, as well as cognitive functioning:

Emotional Functioning

• Diminished self-concept.
• Low self-esteem and poor self-image.
• Changes of personality.
• Depressive characteristics:
  • Negative overall view of the self and the world around them.
  • Depressed mood.
  • General irritation and quick to anger.
  • Emotional instability (e.g. crying, quick-to-anger).
  • High emotions, tearful, uptight, overly sensitive.
  • Suicidal thoughts.
• Anxiety:
  • Rarely relaxed or comfortable.
  • Generalized phobia or social phobia may appear.

Cognitive Functioning

• Overall decreased work productivity (capacity and speed).
• Decreased concentration and attention.
• Difficulty concentrating and lapses of memory.
• Obsessive thought patterns (e.g. excessive concern over the possibility of becoming fat).
• Impoverishment of imagination and creativity.
• Cognitive errors in thinking:
  • Constant mistaken thoughts/beliefs about food, weight and figure.
  • Over-estimation of weight and size.
  • Confusion of feelings of satiety/fullness.
  • Errors of thought regarding generalizations, dichotomies, etc.
  • Most frequent errors of thinking:

• Mistaken thoughts and beliefs about several areas:

The Impact of Eating Disorders on the Body

Eating disorders are known to have the highest mortality rates of any psychiatric condition. This is due to the overlap between the psychiatric condition and how these issues interact with the person’s physical body. Struggling with an eating disorder affects your thoughts and feelings, which in turn affect your choices and habits, which ultimately impact upon your physical health and body.

The most significant physical long-term complication for those struggling with anorexia nervosa is the increased risk of osteoporosis, often associated with amenorrhea (i.e. loss of menstruation). Although these complications are often reversible when normal eating patterns and body weight return, if not addressed soon enough, the prolonged combined effects may lead to even more severe complications, sometimes with fatal consequences.

Below is a list of the major bodily systems usually impacted by prolonged eating disorder behaviours:

Physiological Functioning

• Cardiovascular complications:
  • Hypotension.
  • Bradycardia (low pulse rate).
  • Heart muscle atrophy.
  • Heart arrhythmia (irregular heartbeat), and/or Congestive heart failure.
  • Reduction in heart size.
  • Altered cardiovascular response to exercise.
  • Pericardial effusion.
  • Superior mesenteric artery syndrome.
  • Mitral valve prolapse.
  • Hypotension (low blood pressure).
  • Loss of subcutaneous cellular tissue, sometimes accompanied by increased pigmentation, carotenaemia, acrocyanosis with cold hands and feet.
  • Cold intolerance.
• Neurological complications:
  • Cerebral atrophy (CAT, RNN).
  • Abnormal Electroencephalogram (EEG).
  • Peripheral neuritis.
  • Convulsions.
  • Altered ANS function.
  • Loss of brain volume.
  • Slowed reflexes, paraesthesia.
• Neurological complications:
  • Anaemia: normochromic anaemia, normocytic anaemia, or iron deficiency anaemia.
  • Leukopenia, relative lymphocytosis, thrombocytopenia.
  • Hypocellular bone marrow.
  • Reduction in plasma proteins.
  • Reduction in ESR.
• Renal complications:
  • Pre-renal azotaemia.
  • Chronic or acute kidney stones and kidney failure.
  • Electrolyte- and mineral imbalances/alterations (hypokalaemia, hypomagnesemia, hypocalcaemia and hypophosphatemia), as well as Oedema (tissue swelling from water retention due to electrolyte imbalances).
  • Hypothermia, dehydration.
• Endocrinological complications:
  • Delayed growth and puberty (adolescents).
  • Reduction in gonadotropins, oestrogens and testosterone.
  • Euthyroid syndrome.
  • Increased cortisol.
  • Increased growth hormone.
  • Disturbed liver (and liver failure) and thyroid functioning.
• Muscular/Skeletal complications:
  • Cramps, tetanus, muscular weakness, myopathy.
  • Osteopenia, stress fractures.
• Gastroenterological complications:
  • Inflammation of the salivary glands, dental cavities and tooth enamel erosion (with vomiting), lesions to palate.
  • Irritation and ulcerative lesions in the throat, oesophagus and stomach.
  • Delayed gastric emptying, bowel irritation, acute constipation and intestinal obstruction.
  • Long-term disruptions of normal bowel functioning due to laxative abuse, Cathartic (non-functioning) colon, intestinal rupture from excessive use of laxatives, as well as laxative dependence.
  • Oesophagitis, gastroesophageal reflux.
  • Hypoglycaemia and raised hepatic enzyme levels.
• Immunological complications:
  • Bacterial infection (staphylococcus, with lung infections and tuberculosis).
• Dermatological complications:
  • Acrocyanosis.
  • Dry, rough and fragile hair (as well as extensive hair loss), and dry cracked skin.
  • Lanugo (development of excessively fine hair on the face, arms and legs).
  • Russell’s sign (calluses on the knuckles of the hands).
  • Oedemas.
• Gynaecological complications:
  • Amenorrhea (cessation of regular menstruation cycles).
  • Mammary atrophy, atrophic vaginitis because of decreased oestrogens.
• Metabolic complications:
  • Osteoporosis (i.e. inadequate bone calcium).
  • Hypercholesterolemia and hypercarotenaemia.

To wrap up…

The above lists illustrate the serious impact an eating disorder can have on your health. Many of these symptoms would develop over considerable time when living with an eating disorder. Symptoms development is often slow and subtle, and you could be struggling with any combination of them without recognising that they are a consequence of your disorder.

Hence, it’s really important to acknowledge when you have an issue, and undergo proper medical assessment by your healthcare provider to see whether any of these conditions might need attention. Don’t delay – the longer you avoid, the higher the chance that these will result in irreversible physical consequences.

If you need support navigating these challenges, contact us to schedule a consultation and take the first step toward recovery through our online eating disorder treatment program.

The post How do Eating Disorders Affect the Body and Brain? appeared first on Reverence Recovery.

It’s like we have a personal mandate that we must create an online presence (and community following) by distinguishing ourselves from others. In this way the self becomes a created product, and success a matter of perception from others. If you want others to see you in a certain way (and thus feel self-worthy), you need to portray a person that meets certain societal- and cultural standards. The impact of this technological and cultural shift has vast implications for identify formation, especially with up-and-coming generations. It’s clear to see how identity and forming a self-esteem is far more complex than in past generations.

This is especially true for adolescents and younger adults who are currently in the phase of life where identity formation is one of the most consuming tasks. This major shift to an always-connected-world, can, unfortunately, also have negative consequences for those who are vulnerable to developing eating disorders.

The Connection With Social Media and Eating Disorders

The development of eating disorders has been linked with a wide range of contributing factors, including family dysfunction, trauma exposure, genetics, cultural factors, and personality traits. However, in many of my clients it’s noticeable how technology and social media affects their thoughts, feelings, and perceptions of themselves and the world around them that encourage their eating disorders.

The association between exposure to beauty and fashion media and eating disorder symptoms has been well established. In childhood, even just having a social media account is associated with a greater likelihood of eating disorder thoughts and behaviours developing. Other research also highlights how particular potent photo-based media is in influencing body image and eating concerns.

During treatment and recovery, it’s quite necessary to discuss social media use because it invariably becomes part of the picture of the eating disorder pathology. Although there are no simple answers of how to do this, I’d encourage anyone to analyse their thoughts about social media, their relationship to it, how they feel it strengthens their own biases, or even how it changes their way of thinking.

The Deficit of Identity

During adolescence and early adulthood there are many variables that may contribute to developing an eating disorder. A key aspect that can contribute significantly, is the deficit of identity. Having a diminished sense of self, or a vulnerable self-esteem, significantly increases the likelihood of developing an eating disorder when coupled with body dissatisfaction and eating disordered behaviours.

We can all relate to the developmental and social pressures beginning in adolescence and progressing into early adulthood. This is a period when the push for our independence accelerates. During this period the question of “Who am I?” becomes a significant focus. Our efforts to seek answers to this question is intensified by rapid brain changes, as well as social influences that encourage us to be constantly connected, yet distinct and individual.

However, the world has been extended from our physical realities to the addition of cyberspace. The internet and social media have expanded the contexts in which we live in and develop our identities. With all the wonderful opportunities the internet provides us (information, connection, sharing), we also influence each other in potentially negative ways. Those that are vulnerable, or easily swayed in their views of self and the world, may become affected by what they see and hear – especially if these messages come from someone they perceive as important to their own identity (i.e. same culture, same age group, etc.). Two particular toxic aspects in social media that influence the deficit of identity formation within eating disorders are the Thin Ideal-Internalisation, as well as Social Comparison. Both are usually aimed at social acceptance.

Thus, for those in an age and developmental period of identity formation, where they are trying to develop their own distinct individuality, it’s particularly important to refrain from internalising the thin ideal, or to use social comparison too much to build self-esteem – otherwise an eating disorder may surface. Relying on these too much will negatively affect your ability to work on building a relationship with yourself, getting to know yourself in the physical form, or come to understand your psychological uniqueness.

Your identity is like you – unique and special. We are not supposed to be like anyone else, even if social acceptance is something we all value and strive for. We should try to remember these things are we strive to develop our identity, building a relationship with ourselves that recognises our uniqueness, as we build connections with others.

Identifying How Social Media Affects You

Social media can be a constant factor in the lives of many people struggling with eating disorders. Looking at your social media habits can provide good insight as to the impact it has on you. Consider excessive use, damaging images that foster certain beliefs, and specific messages you’re exposing yourself to, as well as how these may be feeding into your low sense of self-worth or your eating disordered beliefs. Some indicators of problematic social media use include:

• Comparing yourself too much to others in an unhealthy manner.
• Behaviours that encourage disordered behaviours (e.g., extreme dieting).
• Idealising other people and viewing them above yourself (or more valuable than yourself).
• Excessive technology use that interferes with other important areas of your life (especially relationships).
• As well as prioritising others and their content, and neglecting or minimising your own thoughts and feelings.

In trying to analyse the impact of social media on you, you need to invest time and effort into tracking your time spent, the types of videos and images you focus on, as well as consider how these impact upon you. Your smartphone can help you with this. Most phones can provide some metrics on how many hours you spend on specific apps, which can highlight where you are investing your time. Then, try to view your media history to see what content is grabbing your attention. You can even categorise these if you wanted to see which were related to eating disorders thought and behaviours, and which were neutral or unrelated. Then you’d need to see how these affect your biases and beliefs, which will be the most difficult.

For the best perspective, it may be worth spending time away from those apps, sites, or content. This can help you notice how your thinking changes when you’re not exposed to them continually. This takes some time, and I realise this might cut into something that perhaps brings you enjoyment. But it’s one of the better ways to find perspective on your own social media use, and how your thinking and beliefs are being affected by continued exposure to it.

What If I (or My Child) Already Have Body Image Concerns Relating to My/Their Social Media Use?

A great resource for younger people to consider is the Media Smart Online program. As of the writing of this blog post, the “I am Media Smart” research trial is running, and anyone qualifying can participate in their research program. This program focusses on body image concerns, with a specific focus on becoming media smart. The program has been shown to help people with body image concerns, as well as those already showing signs of an eating disorder. The trial is open to 13-25 year-olds, of any gender, from Australia or New Zealand.

The world of social media will remain a part of our lives from here on. We can’t resist it, or deny this fact. Despite the negative impact it can have on people’s lives, it’s important to reflect that it has positives too. It has enriched our lives, and contributes to a more connected society. However, there is a call on us to know how to use social media responsibly, and be aware of its impact on our thoughts and beliefs. This truism could not be more applicable when considering eating disorders.

If you need support navigating these challenges, contact us to schedule a consultation and take the first step toward recovery through our online eating disorder treatment program.

The post Eating Disorders and Identity in the Social Media Age appeared first on Reverence Recovery.

It’s one thing to talk about recovery, but meeting recovery’s many calls-to-actions will certainly challenge you. It’s best you prepare yourself so that you can meet these responsibilities head on and with the healthiest mindset you can muster. Let’s understand what this intentional mindset entails.

The Misconception of Passive Recovery

Many people struggling with eating disorders fall into the trap of viewing recovery as a passive process. Passive process refers to those believing that merely attending therapy sessions, talking about their feelings, or following a meal plan will erase years of disordered eating patterns. Even though such steps are good in themselves, it’s important to understand that you need to bring your own will and intention to the table. True recovery demands active participation, and your own pursuit of changing your life.

In this sense, recovery is not something that happens to you – it’s something you consciously pursue. The emphasis being that eating disorder recovery infers change. Change in how you think about yourself, change in how you deal with emotions, change in what you focus on, change in how you come to make decisions, and so on. It requires daily commitment and conscious choices to challenge ingrained behaviours and thought patterns. And such changes aren’t something that I, or anybody else can do on your behalf. Even though I, or anybody in your life, could provide advice and support – the changes need to come from you actively choosing to do these things, not just passively waiting for such changes to come about.

This highlights a simple, yet difficult prospect: Change will be something I need to choose.

The Road Less Travelled: Embracing Discomfort in Recovery

Intentional recovery often means choosing discomfort. In that sense, recovery isn’t about feeling good all the time. It’s about being willing to feel everything—the good, the bad, and the uncomfortable—because that’s what it means to be fully human. The road to recovery is never a straight trajectory of improvement, but rather ups-and-downs that can be uncomfortable, even sometimes terrifying.

So why must I choose the uncomfortable?

Because the uncomfortable space is where growth and development takes happens. This is a fact of life that you’ve been part of since you were born. Any real personal growth, whether physical or mental has come about from you engaging with something that challenged you and challenged you to grow stronger in skills, mindset, knowledge, or strength. During your recovery this fact remains true as well.

Think about the person you’d like to become. Hopefully you describe something like: “Someone who is content with who I am, and copes well enough with what happens in life”. Essentially, this describes someone who embraces all feelings, thoughts, and events – whether they are good or bad, simple or complex, easy of difficult. To become this type of person implies that you don’t avoid difficulties or discomfort, but rather willingly choose to face them. You stop using ways to avoid these, or using maladaptive ways of approaching life’s tougher realities (including your own insecurities).

By no means do I infer you’ll always be happy with what happens in life. However, by truly accepting (and thus, embracing) life in its totality, you’ll accept that life does what it does. This already makes things easier in itself, because we accept we are mere ships on the ocean of life. The ocean and currents will do what they wish, and all you can control is your reaction to it, even if it makes you uncomfortable. Thus, discomfort and pain will not be something to avoid, as you accept that they are part of life.

By extension, even your own discomfort towards yourself will be easier to embrace, because you willingly choose to face uncomfortable feelings and thoughts (whether they come from food, body, or self).

The Psychological Landscape: Cultivating Self-Compassion

Living with an eating disorder often means navigating a minefield of negative self-talk, including thoughts on you own distorted body image. Intentional recovery requires consciously challenging these thought patterns and cultivating self-compassion. Sounds simple? Unfortunately, this is very complex, takes time, and once again, calls on you to engage with the one person you’ve probably been trying to avoid for a very long time – YOU.

I encourage clients to start this journey by noticing and attending to how they talk to themselves. We all talk to ourselves, but some of us are more aware and more intentional in the way we talk to ourselves than others. Usually within eating disorders, the self-talk is extremely negative, condescending, and focussed on critique. If you’re going to change this, you will have to be the one that addresses and challenges your own statements. But if you aren’t even aware of how, and when, you have these thoughts towards your own person, then changing them is quite impossible. So, try to keep track of your thoughts and your self-talk. You can write these down if that makes it easier (in a journal), or stay focussed on your inner voice as you go about your day. But when you notice yourself being very critical, try to step back and align yourself with the idea that you’d like to change such statements, and grow a healthier relationship with yourself.

Another way of thinking about this is to imagine how you would change the words and actions towards your partner if both were working on mending your fractured relationship. Let’s imagine both parties recognise they’ve grown apart, haven’t been treating each other well, and need to work on connecting more with the other. In such a situation, both of you would be very attentive and acutely aware of how you act and talk to the other, because there is a focus on healing the relationship. In the same way, try to focus on prioritising the relationship with yourself. Meaning, stop focussing on your apparent faults, and engage with yourself in a kinder and gentle way that encourages appreciation for you as a person.  Even if you don’t feel this way yet towards yourself, you can still choose to treat yourself in a more respectful way, which paves the way that appreciation for the self can develop over time.

The above suggestion is just one step of a journey that encourages a real change in the relationship you foster with yourself. In my opinion, cultivating genuine self-compassion is one of the hardest things to do in recovery, but it’s also one of the most important. Healing the relationship you have with yourself (physically and psychologically) is a wonderful growth process that sets you up for a rewarding and happier life. It can be very freeing to people when they stop this internal war they’ve been having with themselves (and their bodies) for the last few years, and sometimes even decades.

Recovery’s Intentional Effort

It’s clear to see that recovery calls for your intentional effort. You need to actively pursue and engage a process of growth and self-discovery that, perhaps, hasn’t occurred for a very long time in your life. It’s a very personal journey, but one of the most rewarding you could take.

If you need support, don’t hesitate to reach out to loved ones or professionals who could be of assistance. But in doing so, try to understand how you will be called upon to be the primary driver of your own recovery and healing.

The post Eating Disorder Recovery: An Intentional Journey appeared first on Reverence Recovery.