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Anorexia is an illness – not something we can simply blame on the media


Catwalk size doesn’t affect anorexia as much as you think. (Republic of Korea, CC BY-SA)

France has joined Italy and Israel in passing laws banning the promotion of extreme thinness in the fashion industry. The health reforms, which include fining agencies employing models with a BMI under 18 and criminalising pro-anorexia web content, have now passed through the upper house of parliament.

An analysis of the reforms by Sarah Jackson on The Conversation suggested that censoring images of ultra-thin models may ease their adverse effects on young women, such as concerns about body image and behaviours such as unhealthy eating.

But while some have been hailing the legislation as a “crackdown on anorexia”, the laws may be unlikely to have any such effect.

Not a lifestyle choice

In western Europe, around 0.5% of adults are thought to be affected by anorexia nervosa. In around 10% of these cases, the sufferers are men. These figures, however, are likely to be an underestimation. It has the highest mortality rate of any psychiatric illness, mostly due to organ failure and suicide.

Yet, the illness is often mistaken by many as a lifestyle choice with an external cause. Despite accounts of the disorder pre-dating the fashion industry, the view that anorexia is caused by comparing oneself to a catwalk model remains popular. Likewise, while pro-ana websites insist that anorexia is a commitment, not an illness, they are highly exclusive online communities, created by and for those already showing signs of the illness. The merely curious are not welcome.

Instead, the link between media endorsement of extreme thinness and the development of anorexia is neither simple nor clear. Research mentioned by Jackson did find that women evaluated their bodies more negatively after viewing images of thin models. However, this effect was small and mostly determined by women’s pre-existing opinions of their figures – women who were already dissatisfied with their body were most affected.

Pre-existing opinions matter. (Joana Coccarelli, CC BY)

As this effect was only measured at one point in time, the effects of prolonged exposure are not known, but when more images were used there was a tendency for the effect to be smaller. Perhaps, as the authors suggested, these images activated, rather than cultivated, beauty ideals.

Whether the effects of media exposure on body dissatisfaction leads to changes in eating behaviour is also unclear. Another study, also cited by Jackson, looked for a link between a person’s real-life media exposure and eating disorder symptoms. The results were fairly inconsistent, with some factors – such as body dissatisfaction – only corresponding to some types of media, and others – such as self-worth – showing no relationship.

More importantly, the research showed correlation, not causation – it is just as plausible that women already unhappy with their bodies seek out thinness-promoting media more often. After all, if such a simple causal relationship did exist, the pervasiveness of these images in our culture raises the question of why the majority of our population is overweight, rather than underweight.

Model bans but no support

Most researchers currently view the cultural value placed on thinness as a “background risk factor”. Meanwhile, several psychological and biological factors are implicated.

High levels of perfectionism, a need for organisation and a focus on details are often observed in those with anorexia. Recent research suggests there is a lower reward response to food in the brain, even after recovery. Some of these factors seem to be influenced by genetic inheritance. Stressful experiences may then influence whether these existing factors then lead to developing the disorder. More than one risk factor will be necessary.

So the legislation is likely to have little effect on the prevalence of anorexia in the general population, but it also offers no support to the models themselves. The law requires a medical certificate proving that a model has a BMI of at least 18. This is still underweight, according to the World Health Organisation. Regular weigh-ins have been only vaguely suggested and there’s been no mention of an obligation to offer support to a model who fails a weigh-in.

A BMI of at least 18 is still underweight. (Fervent-adepte-de-la-mode, CC BY)

While there is some debate over whether models are at a higher risk of developing eating disorders, this career certainly encourages unhealthy behaviour. Thinness of this degree has hugely damaging effects on the internal organs, bones and brain. It can cause obsessiveness and social withdrawal even in psychologically healthy people. France has already lost a high-profile model to anorexia – yet the new laws almost encourage agencies to wash their hands of models who fall ill.

In the same way, while pro-ana content is undoubtedly harmful, the new laws punish those who are in need of help. This exclusively punitive approach is likely to drive these sites further undergound.

If the measures are enforced – if spot checks continue, weigh-ins aren’t cheated and other countries are supportive – they may be a positive move. They may be a first step towards a culture that prioritises health over aesthetics – whether that means a dangerously small or unhealthily large body. Nonetheless, this will mostly benefit the worried well – those who, regrettably, are unhappy with their bodies, but are otherwise unlikely to develop anorexia nervosa. Claiming that these laws address one of the most treatment-resistant mental illnesses is far too optimistic.

This article was written by Rachel Cole-Fletcher, Durham University
This article was co-written by Lexie Thorpe, an MSc in Developmental Cognitive Neuroscience at Durham University

The Conversationconversation-full-logo-1070aea8b0feb9a5f470ed093ecef06e

This article was originally published on The Conversation.
Read the original article.


My Sister and Me: Anorexia Nervosa

Last year, a psychiatrist informed me that when I was twelve years old I should have understood the complexities of my sister’s mental illness, and thus it was my fault I allowed it to affect me the way it did.

I should have known that when she was screaming at me to fuck off and die it was her mental illness.

I should have known that when she refused to be in the same room as me it was her mental illness.

I should have known that when she was throwing a rock at my head it was her mental illness.

You know, when I was twelve.

Even though no-one really explained to me what was happening other than ‘Kathryn was unwell’.

Even though in the early 1990s discussion of mental illness just didn’t happen.

Even though I’d never even heard the term anorexia nervosa let alone know of how it affects someone.

But hey, I should totally have understood what was happening!

You know, when I was twelve.

So, for everyone under the age of twelve years old, here is a brief explainer of anorexia nervosa. Everyone else can just skip ahead, because according to a psychiatrist you should already know all there is to know about anorexia nervosa and how it affects someone.

What is Anorexia Nervosa?

Anorexia nervosa is an eating disorder characterized by severe starvation and dramatic weight loss. People suffering from anorexia nervosa develop an intense fear of gaining weight and often experience high body image distortion, mistakenly believing that they are overweight no matter how underweight they actually are.

Physical warning signs of anorexia include: noticeable thinness and continued loss of weight, obsessive exercise, losing or thinning of hair and cessation of periods. Whilst behavioral and psychological warning signs include: wearing big or baggy clothes, making excuses to avoid meal times, obsessive measuring of body parts and weight checking.

~ For more comprehensive information on anorexia and eating disorders please see The Butterfly Foundation ~

Part 2: Anorexia Nervosa, cause and effect

“There is no magic cure, no making it all go away forever. There are only small steps upward; an easier day, an unexpected laugh, a mirror that doesn’t matter anymore.”
~ Laurie Halse Anderson ~

Kathryn received an official multiple diagnosis of anorexia nervosa and obsessive compulsive disorder at the age of twelve. This diagnosis was made by psychiatrists at Great Ormond Street Hospital after my sister had been admitted to a local psychiatric children’s unit. At the time it was rare for someone so young to be diagnosed with this illness, especially as it had begun to manifest at the age of nine.

At the worst of her illness my sister’s weight was 4 stone. For those not familiar with this measurement, four stone is around 25kg (or 56 pounds). This was also her target weight, with a number of her OCD rituals having to occur in groups of four (twisting the door handle four times, opening and closing the door four times etc.) which she felt would assist in her reaching this goal weight.

My memories of this early period of my sister’s illness are few and far between, and what memories remain are on the negative end of the spectrum. I have often mentioned how I believe this period to have had an impact on the development of my own illnesses (especially the anxiety and self-harm) but like the psychiatrist said, this is impossible.

As my sister’s anorexia developed it became impossible for me to be in the same vicinity as her. If I entered a room that she was in she’d become uncomfortable and resort to screaming at me to leave. Similarly, if she entered a room I was in the reaction was much the same. She wouldn’t talk to me, she couldn’t cope with me talking to her and physical contact was an absolute no-go under any circumstance, including surface contact (e.g. if I had just opened a door she wouldn’t be able to open it until someone else had.)

The reason behind all of this was because I was overweight and she had decided my fat was contagious. Or rather her illness had decided.

When it came to going to Great Ormond Street Hospital I had to spend the night at my Aunt and Uncles who then drove me to London separately from sister as it would have been impossible for us to be in the same car.

On another occasion, when my parents took me to visit my sister at the psychiatric unit, Kathryn threw a stone at me as she was unaware they were bringing me along and wanted me to fuck off.

Whilst the verbal abuse still rings in my ears, especially the occasion she told me she wished I would just fuck off and die.

And writing all this back I find it completely reasonable that a twelve-year-old boy with no knowledge of mental health issues should have understood what was going on. I am of course being sarcastic. For even though specific memories of those years have been blocked, I can still remember the utter isolation, confusion and pain I felt as a result of how my sister was treating me.

She was my sister. I loved her. I was worried about her. I wanted her to be well. I wanted to help her.

I didn’t understand what was happening and why she was treating me like this. How could I have known?

After her diagnosis Kathryn remained at the local children’s unit with the psychiatrists from Great Ormond Street working hand-in-hand with the unit’s team in order to help my sister recover – or so we thought.

Even though my family and I didn’t know it at the time, the psychiatrists at the unit (you won’t have heard of it) had refused to work with Great Ormond Street (an internationally renowned children’s hospital) as they thought they knew the best way to treat her – even though they’d never treated someone with anorexia as young as my sister. They also refused to allow family therapy meetings as they thought this would bring no benefit whatsoever. What they did do to help my sister, I don’t know, all I can remember is that a few years after being admitted she was discharged and went to live with my Aunt and Uncle as she couldn’t cope being in the family home.

By this point in time I hadn’t seen my sister for nearly three years. I was coming on sixteen, struggling with being bullied at school, whether or not I should disclose I was self-harming, endlessly worrying about my sister, confused over what was happening to her and trying to study for my GCSEs whilst being so anxious I couldn’t talk to anyone or think straight. I had no friends to speak of and certainly no-one who knew of my sister’s condition – for want of a more original stereotype, releasing this information would have been like throwing kerosene on a bonfire!

One Sunday (I believe it was a Sunday) whilst I was studying for exams my parents received a phone call; my sister had taken an overdose of tablets and been rushed to hospital. For weeks I could think of nothing but this. School work was out. Studying was out.

My sister had tried to kill herself…but according to the psychiatrist I should have understood why she’d done this, and again, it was my fault at the tender age of fifteen that I’d allowed it to effect my thinking as much as I did.

It baffles me that, nearly twenty years later, I still cannot remember this period other than the pain and confusion I was feeling for my sister, yet according to a trained mental health professional, I had no reason to feel such pain and confusion in the first place so it has no consequence on anything that happened to me.

I remember my sister’s screaming sessions, sometimes going for hours. I remember her banging her head against the door at such force it shook the house. I remember her getting thinner and thinner until it looked like she would just disappear in front of me. I remember her turning on the charm and perfection whenever doctors or psychiatrists questioned her to make them think nothing was wrong, before flicking the switch back to chaos the moment they left. I don’t want to remember my sister’s pain, nor the pain it caused me, as it physically hurts to do so. In all honesty I’ve never really processed this period, and now I know it’s my fault, I don’t think I ever will.

Four years after I’d last seen her, my sister returned to live in the family home. She was a lot more stable than she’d been the last time she was living with us but it was obvious things would never be the same again. Although she could be in the same vicinity as me, even hold down conversations with me, it was difficult for me to get past all that had happened, although as always, I tried.

By now I was more aware of what was happening. I had read up on mental illness (focusing on anorexia, OCD, self-harm and depression) courtesy of the local library and my parents had established a charity called ‘MH Carers’ with assistance from National Lottery grants. Although I didn’t completely understand mental health, I was far more knowledgeable of it than I had been in my pre-pubescent youth; not only in terms of what was happening to me, but also in what was happening to Kathryn, and more importantly, how I could help.

For a year or so my sister and I would spend a lot of time with my brother and his girlfriend. The four of us would go on weekend breaks to visit relatives, take day-trips to Chessington World of Adventures (where my sister and I would reminisce over the robin incident) and just talk about things.

It was around this time that I began reading my sister’s writing, and vice-versa, reminding me of those long-ago homework sessions of our childhood. She would correct my grammar; I would give her plot advice. We’d talk novels, television shows and for a little while we almost became proper siblings again.

At the age of sixteen Kathryn moved out of the family home and took a flat in a nearby town. After work, I would often visit her, discussing everything from how my day had been to the latest Shakespeare play she’d been enjoying. I particularly remember a fiery debate about Hamlet; which we would go on to watch at the cinema together when Branagh’s version was released.

Following my decision to go backpacking Kathryn and I kept in regular contact; emails, letters and postcards were exchanged whilst lengthy phone calls were made from such random locations as the top of the Wallace monument, an isolated phone box on Mull and an even more isolated phone box in Glenfinnan.

By the time I traveled to Canada our phone calls would last upwards of two hours covering everything and anything we could think of; Eddie Izzard, the philosophy of Buffy the Vampire Slayer, how cute Oz was, what to do in the event of a bear attack and my questionable sanity were all fair game.

She seemed to have stabilised herself and was working toward a better future – educating herself with multiple courses from the Open University, having stories and articles published in various publications – whilst I was making headway in rectifying my own issues. In fact, for a while there, I thought the worst was behind us.

Then, in 2001, contact stopped; no phone calls, no emails, no letters, no nothing.

For six years I heard nothing from her other than snippets from my parents.

Then, in 2007, she attempted suicide…again.

Other entries in this series…
Part 1:
Childhood, the most beautiful of all life’s seasons