Eating Disorders Are the Toughest Challenge for Our Counselors

Helping young people battle an eating disorder is one of the toughest challenges ChildLine’s counsellors face, according to a study of calls to the charity about the issue. Now a new report, I’m in Control – Calls to ChildLine about eating disorders, offers fresh insights into these life-threatening problems - revealing that friends are often the first to be told about a young person’s eating disorder, and that family members have a vital part to play if a young sufferer is to recover. The report (based on analysis of calls to ChildLine between April 2001 and March 2002) also found that an eating disorder is almost always part of an ‘intertwined knot of problems’ – including family breakdown, bullying, bereavement, and in some cases abuse - which must be unravelled one by one before the process of recovery can begin.

Each year ChildLine helps around 1,000 children and young people suffering from eating disorders and last year almost 300 additional children spoke to the charity to seek advice about how to help a friend with an eating disorder. The report, sponsored by Next and written by award-winning journalist Brigid McConville, examines the gruelling and compelling testimony of young sufferers and demonstrates that there is rarely a single cause for an eating disorder.

ChildLine’s Chief Executive, Carole Easton, says: ‘This report makes a significant contribution to the debate on this difficult subject because it gives a voice to the young people whose lives are being destroyed by these debilitating conditions. We hope that it will form a springboard to greater understanding and offer fresh hope for young sufferers, as well as their friends and families. The pictures painted by this report are of intelligent, successful, high-achieving and determined young people who may seem unlikely to be vulnerable to destructive behaviours like anorexia and bulimia.

However, a closer look often reveals a "knot of problems" out of which an eating disorder develops. Eating disorders may develop from a need for young people to feel a sense of control, to communicate feelings, and to block out painful emotions. All too often young people get a sense of self-worth from controlling their intake of food and this is what makes it so challenging for others to help break the iron grip of an eating disorder.

‘Children and young people in their thousands turn to ChildLine's experienced counsellors every day of the year to talk about every problem imaginable - including those as harrowing as abuse, and attempted suicide. Yet our counsellors say that, of all the problems they help young people with, eating disorders are among the most challenging. This report shows that ChildLine's counsellors can help to cut through the confusion of denial and distortion facing loved ones when they try to help. When children call ChildLine and talk to a counsellor about an eating disorder they have already taken the first step along the difficult road to recovery – acknowledging that there is a problem. ChildLine is empowering for young people as they are in charge of the process and can call or write when they choose. The relationship can take on a special resonance as their counsellor can’t see them and therefore can't "judge" them on their appearance.'

The report reveals that:

• Friends are enormously influential and have an important part to play in coping with an eating disorder. A significantly higher number of callers said they had told a friend (31%) rather than their mother (16%) or their GP (9%) about their illness. Friends are crucial in supporting each other, and are often extremely distressed by what their friend is going through - many call ChildLine to speak to a counsellor about the effect of an eating disorder on a friend.
• For family and friends, helping a young person with an eating disorder can be incredibly difficult – yet young sufferers tell ChildLine that the support of people around them is indispensable. More than any other issue, family tensions are mentioned in conversations with young people about eating problems. A quarter of those who call ChildLine to talk primarily about an eating disorder also discuss family difficulties, including conflict between parents, resentment about siblings and an atmosphere of unhappiness and tension at home. However, in many cases it is unclear whether these difficulties were a precursor to the eating disorders or had arisen as a result. The report also shows that parents are extremely supportive and a crucial source of help to their children.
• Adolescence and the accompanying emergence of an adult sexual identity is often the time when a young person is most vulnerable to the onset of an eating disorder. Of callers who mentioned their age, three-quarters (74%) in ChildLine’s sample were between the ages of 13 and 16. It is clear from the calls that children as young as 11 have a vocabulary that includes the words anorexia and bulimia. Children in the younger age group frequently talk about the physical symptoms of their eating disorder, while older callers are often the veterans of hospitals and clinics and have a deeper understanding of what they're going through.
• Young people tell ChildLine about a wide range of factors that they believe triggered their problem. These usually include a situation or event that threatens their self-identity or security or lowers their self-esteem. The circumstances most often mentioned by callers include family problems, bullying, school pressures, loss of a friend or family member, illness and abuse.
• Calls to ChildLine demonstrate a range of reasons for the progression of an eating disorder, once it has been triggered off. Among these is an increasingly distorted perception of body image and a sense that they are helpless to stem the progress of the eating disorder as it is ‘out of control’. Pervasive social and media pressures to be thin influence the determination of many to control their body shape, as does the continued sensation that feeling thin equates with feeling good.
• A small minority of calls in the sample were from boys - only 50 of the 1,067 total. The experiences boys have in developing eating disorders appear similar to those of girls but there are significant differences in the way boys and girls talk about their eating problems and some of the triggers setting them off. These appear to be centred on the roles and behaviours considered acceptable to boys in society. The report discloses that boys are twice as likely to say that bullying is part of their problem and are far more likely to confide in their doctor or their mother about an eating problem – perhaps due to fear of being bullied by their peers. Calls to ChildLine also portray boys as feeling an additional sense of shame about having what is seen as a ‘girl’s problem’.
• Boys talk about their eating disorders in a more factual, straightforward way, unlike girls who tend to start by saying they’re worried about their weight, and then to gradually unravel their ‘bundle of problems’. Boys focus on the health or medical reasons for being thin, rather than the aesthetic explanations girls give. Girls often tell ChildLine that they feel judged, and judge themselves, on how they look and they generally express more self-hatred than boys, which is mirrored in the way they speak about their bodies. In contrast to boys, the report’s author found that some girls also appear to be in a kind of ‘anorexic club’ where they all diet and starve themselves to be thin.

Carole Easton says: ‘Eating disorders are a minefield for everyone affected by them. One of the saddest revelations in ChildLine's report is the sense among some sufferers that their eating disorder is a coping mechanism that stops them from “doing something worse” – and “as an alternative to suicide, is a familiar friend that keeps them alive”. The cycle of denial and deceit, and frequently withdrawn and angry behaviour of a young person with an eating disorder, can almost seem designed to drive away those who care about them, leaving parents and friends utterly bewildered and at a loss as to how to move forward.

'But our report also brings home the fact that friends and family must not give up – their love and support is essential in building up a young person’s self esteem and bringing them back to health. Although there is no single solution to the tortuous situation an eating disorder can provoke, families and friends are the best allies a young person has, and the most effective remedy is when everyone – friends, family, school, professionals, and ChildLine counsellors – works together to ensure there is always someone to turn to.’

Case Studies:

All identifying details have been changed

Becky, 14, called ChildLine because she wanted to know more about the symptoms of anorexia and bulimia. 'I've lost a lot of weight recently', she said. 'I only eat one meal a day and often I throw it up.' Becky told her counsellor that she enjoyed swimming at school but often felt faint when she did it. 'I've no energy so I've stopped doing exercise', she said. 'I haven't told my mum - we argue a lot.' Becky said she often felt fat - even though really she knew she wasn't.

Rhiannon, 13, was very upset when she called ChildLine. 'I got a swimsuit for my birthday but when I tried it on I realised I'm too fat to wear it', she said. 'I know I'm fat because my friends at school tease me about it.' Rhiannon paused and then she said, 'I've started making myself sick. It's been a few months now.' She said she had done this in the past and had lost weight - but she had ended up in hospital. 'I liked being thin - but I didn't have any energy so I couldn't play out with my friends.' Rhiannon said that her mum always tried to make sure she ate regularly.

When Ian, 13, called ChildLine he said he had recently started a special diet to help him lose weight. Ian told ChildLine that he had been 'really overweight' so his GP had given him a course of medicine to suppress his appetite. 'They worked and I lost weight which made me happy', he said. Now that he had finished the course Ian told the counsellor that he felt 'very alone' without the back-up of the drugs. 'Now I'm scared that if I start eating again I'll put the weight back on.' Since stopping taking the tablets he had only been 'snacking now and then'.

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'My boyfriend is really annoying me', said 16-year-old Emma when she called ChildLine. 'He keeps asking me what I've had to eat - I always read the information on food to check I am eating well'. Emma told ChildLine that she was feeling pressured about her eating habits by several people in her life. 'My friends at school like pointing out who in the group has put weight on and where on their body. And sometimes my dad says to me watch what you eat or you'll end up as big as your auntie.'

When Natalie, 15, called ChildLine she said, 'I want to talk about food. I can't stand the thought of it inside me - so I throw it up.' Natalie said she was very unhappy about her weight but couldn't talk to her family. 'I'm being picked on at school 'cause I'm fat. If my folks find out I may as well just run away - I think they're embarrassed to know me anyhow'. She said that she had always had a problem with her weight. 'I'm so big it's unreal', Natalie said. 'I feel like food is destroying me - making me feel bigger - but then I feel so hungry'.

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