Eating disorders are a complex and insidious mental health illness which has the highest mortality rate compared to any other mental health condition. The condition consists of anorexia nervosa restrictive food intake, bulimia, and binge eating disorder. Approximately 1.25 million people suffer from eating disorder. Many suffer in silence as they’re afraid to seek the help and support that are available based on the label society target them as ‘sneaky, manipulative and evil’. Having no professional help or support in place, service users are at risk of other psychiatric comorbidities, for example, depression, substance abuse, self-harm and, in the worst-case scenario, death. When I worked in an acute eating disorder unit, I noticed that families sometimes have a lack of understanding what eating disorder entails, like one mom who said “Stop being silly and stop using formula, you are not a teenager no more, grow up…”, not realizing that ‘formula’ is a coping mechanism and that her child really needs to gain energy and maintain a healthy weight whilst on her recovery journey.
Although there is a common understanding that eating disorders are a modern mental illness, historical information has highlighted that such diseases of the mind have been around since to 12th and 13th centuries, a phenomenon known at the time as ‘self-starvation’, and often also a religious practice called ‘fasting’. When considering specific historical examples and case studies, it is known that ‘fasting’ practice was carried out by Catherine of Siena as she observed and adopted her behavior from her older sister, Bonaventura, who also used ‘fasting’ as a coping mechanism to help her deal with and attempt to regulate her husband's behavior. As a consequence, Catherine then adopted the same behavior to avoid underlying fears around the pressure to get married at a young age, as discussed in the book ‘Holy Anorexia’.
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Social workers work alongside eating disorder patients by providing direct clinical care in addition to practical and emotional support as well as treatment after care. For the most part, this is achieved through working in multi-agencies and advocating for service users in line with the Mental Health Act, 1983. In an acute eating disorder ward, social workers are tasked with working alongside health care assistants and members of the senior multidisciplinary team (MDT). Gaining direct practical experience of this has enabled me to gain highly relevant, first-hand insight of social work practice in action. Social workers have regular opportunity to liaise with other senior multidisciplinary mental health professionals such as psychiatrists, general practitioners, psychologists, dietitians, and mental health nurses, and are also able to contribute to weekly ward rounds. These tend to involve the entire multidisciplinary team (MDT) to decide on the service user’s care and overall treatment plan. Social workers are also involved in tribunals which are meetings done with professionals to review a treatment order in situations where a patient has been detained under the Mental Health Act 1983, medical and social reports, and to also hear the views of service users regarding their care.
When looking more deeper into the political context, some may argue that eating disorders are based mainly on the food system production. Political researchers have exclaimed that we need to look at eating disorders on a wider scale and to also consider the way that food has changed over a period, according to Science of Eating Disorders. Others have the opposite view to the science of eating disorders research and feel that people are aware that they have an eating disorder but are refused treatment by the NHS system. One such person was a patient with an eating disorder who was told her BMI was not low enough to be referred to a specialist unit, thus denying her the possibility of successful recovery from the disorder. This raised some serious political issues which caused the MP to get physically involved and had to join forces alongside the Woman and Equalities Committee to make a change. They highlighted that the governments obesity strategy can cause some serious health dangers and life-threatening future illnesses as it focuses mainly on calorie labelling but not on the nutritional facts or choice of products that helps to keep a check on the nature of foods we are eating, such as foods that are substantially high in fat, salt and added sugars in relation to the Eatwell Guide. If people’s calorie intake is more than what is burnt, then it enables others to gain more weight. Using this statement as a reference or example when dealing with a patient who has anorexia nervosa that are on a strict treatment regime where there is no form of exercise allowed, not even long-distance walking, may feel guilty and self-conscious that can result in them self-harming, head banging, and restricting their calorie intake further due to increased fears around ‘unhealthy' food items and possible weight gain.
My experience and practical observational insights gained during time spent in inpatient eating disorder units so far have led me to disagree with the political statements stated above based on the evidence because, as with all mental health illnesses, an eating disorder should be highlighted as one of the most serious illnesses as it can often go undiagnosed. If it is recognized early, then those who have the anorexia nervosa condition have a higher success rate of recovery. For one to understand the concept of the eating disorder from a political point of view, we as individuals need to recognize that eating disorders, like any other mental illnesses, need to be addressed, acted upon, and taken seriously. As there are a high number of teenagers awaiting and seeking support, this has also risen during this whole pandemic, which has had a major impact on patients.
Social media can be extremely detrimental and it can have a high influence on individuals who look up to others to seek justification based on the stigma society can have on a person with eating disorders, especially apps such as Tik-Tok alongside Instagram and Facebook. Social media influencers image can often cause body objectification and body dysmorphia for service users using these apps and can be seen as a trigger. These social media apps are correlated with the norms of what is the perfect weight and figure. I had a conversation with my service user, and she expressed that when she was at school she was often bullied and was called a twig and told to eat more by her peers. This is to highlight that what is seen as acceptable is sometimes facades, people with an eating disorder are complex human beings like us with unique struggles that just wants to be recognized and help in society, and not turned away because of the misconception that they’re too ‘healthy’ to qualify for service, as highlighted above in the discussion surrounding the use of BMI criteria for determining access to treatment and follow-up care.
To give you a broader, community-based view, here I include an anecdote based on the experience of a service user I have previously worked with during my time spent in an acute eating disorder inpatient unit. I went out with my patient, and whilst walking she was being stared at because she had a nasogastric tube (NG), a tube that brings food to the stomach through the nose attached to her, people were just openly staring. I asked how she felt about it and she told me that she sometimes feels ashamed, and like ‘she wants to hide away’ as many people do not seem to understand why she uses it, and when they stare makes it very uncomfortable as she feels that they might just be judging her without knowing her circumstance, personal history, or underlying emotional experiences trauma.
In an inpatient eating disorder unit, the multidisciplinary team (MDT) is set up in such a way that the framework aims to implement and uphold a standard concerning the care of the patient based on their individual needs, mental capacity, and emotional and psychological state. This way, professionals can carry out the appropriate care for the induvial to meet their needs. A framework such as the Mental Health and Wellbeing (2018) is used in my social care setting to reflect on the service user's values using the ‘You in Mind’ strategy. This helps health care professionals to care plan individual treatments and give individuals a better chance at a successful, long-term recovery and a greater degree of overall emotional and physical well-being.
As such, the importance of listening to the views of service users and their families is vital. Everyone has a voice that deserves to be heard, and in this respect, listening to a service user can impact positively as they sometimes need that word of encouragement to get them through the day. When you listen, you can learn more about them and how you can meet their needs, something that is also shown to have a positive impact on their own sense of self and self-esteem; both of which are vital for anyone embarking on recovery from an eating disorder.
In both community and inpatient eating disorder treatment settings, it is important to use inclusive practice to encourage service users to join in with groups and activities, even though they might initially be reluctant, as research shows that eating disorders can be incredibly lonely, isolating illnesses. Giving service users the opportunity to share their thoughts, feelings and experiences in a supportive environment can also help them to develop a better understanding of why their eating disorder developed, what keeps it going, and ultimately, what could be useful in supporting them to step away from it in favor of more helpful, less destructive, or maladaptive coping mechanisms.
From my experience to date, I have seen first-hand how service users can sometimes find it difficult to build a relationship with professionals, as they often find this process intimidating and overwhelming, particularly if they have never been in treatment before or have had negative experiences in the past. As such, it is vital that professionals find a way to, express empathy, get down to the service user level and give them good eye contact to show that they are actively engaging in their well-being. In addition to this, when professionals listen to the views of others in their care and take their opinions on board, this ultimately makes the organization more diverse and inclusive. The over-arching benefit of this is that every individual feels empowered and valued as their views are not only heard, but taken seriously and acted upon, and the system as a whole functions better because the patients they treat are given a fairer, and more individualized, chance at full recovery. Overall, working with service users and hearing their views in my setting has become an enlightening and enriching experience as it enables service users to express themselves freely.
Throughout this essay, I have demonstrated the devastating and often life-threatening impact that eating disorders can have upon the individual, as well as those in their support network. Eating disorder steals childhood, devastates relationships, and pulls the family apart, but with the right treatment and support from mental health professionals, clinicians and social workers, full recovery is entirely possible, if all those involved are committed to moving away from a flawed internalized history. A better future for eating disorders depends on understanding the stigma that exists around the illness. Having any form of eating disorder, whether anorexia nervosa, bulimia, binge eating disorder or other specified feeding or eating disorder (OSFED), can hinder a service user's holistic well-being. It can be treated if the signs are highlighted at an early stage, and the service user will then be able to make a full recovery.
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