We snuck into the annual Australia and New Zealand Academy for Eating Disorders (ANZAED) conference to illuminate the future of eating disorder diagnosis and care. We recorded on-site at the conference, where we asked various speakers to give us a taste of their research for the sake of all those who’d be interested but couldn’t be there.

Segment 1: Reviewing current treatment approaches
Dr. Anthea Fursland, a distinguished clinical psychologist for the past 40 years, shares a candid perspective on the strides made in treatment, especially for Anorexia Nervosa, but offers insights about the gap between new understandings and legacy approaches to care.

Segment 2: NDIS engagement for people with eating disorders
Hilary Smith, a National Manager at the National Eating Disorder Collaboration (NEDC), talks about what may be required and what we still need to know for people with eating disorders to access support from the National Disability Insurance Scheme (NDIS).

Segment 3: Body dysmorphic disorder and cosmetic surgery
The point where body dysmorphic disorder and cosmetic surgery intersect is where researcher Dr Toni Pikoos does much of her work. She’s been deeply involved in crafting new, enforceable guidelines to protect the psychological safety of patients. 

Segment 4: The possibility of laws to protect body image
Marilyn Bromberg is an Associate Professor of Law at UWA and an expert on laws that discourage content researchers understand to negatively impact body image. While there is some precedent in other parts of the world, we can do more in Australia. 

Segment 5: Dealing with an eating disorders crisis and emergency care
Mental health occupational therapist Genevieve Pepin presented on “Eating disorders, carers, and the emergency department: A recipe for disaster.” It’s a carer’s worst nightmare, and Genevieve tells us just how bad it can get and how we can make the experience less traumatic for families.

This is the first of two episodes covering the conference. Look out for Part 2 in October 23. 

FIND OUT MORE ABOUT THE ANNUAL ANZAED CONFERENCE [https://conference.2023.anzaed.org.au/]

FIND OUT MORE ABOUT ANTHEA FURSLAND [https://swancentre.com.au/our-team/#1613036744491-54172908-1c32]

FIND OUT MORE ABOUT NEDC’S WORK AROUND THE NDIS [https://nedc.com.au/eating-disorder-resources/find-resources/show/ndis-for-people-with-eds/]

FIND OUT MORE ABOUT TONI PIKOOS [https://www.readymind.com.au/about/dr-toni-pikoos/]

FIND OUT MORE ABOUT MARILYN BROMBERG [https://www.uwa.edu.au/Profile/Marilyn-Bromberg]

The latest in diagnosis and care from the annual ANZAED conference

According to the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V–also known as the psychiatrist’s bible–there are only four official diagnoses for eating disorders. Though experts expect that number to double in the next edition, the reasons someone might develop or maintain an eating disorder are as variable as the number of people affected.   

This is because eating disorders are not just a set of behaviours. They are a way of coping with difficult things.  

Psychologist and former Butterfly Helpline Manager, Juliette Thomson, specialises in a person-centred, holistic approach to recovery. “An eating disorder is often the tip of an iceberg,” she says, “Underneath, there is likely a lot more going on for a person about themselves in their lives.”  

To help someone struggling with an eating disorder, a therapist will seek to understand their psychological and social reality. That’s why there shouldn’t be a one-size-fits-all approach; people need treatment plans tailored to their own situation. In addition, insists Juliette, you don’t need to be certain that you even want to recover, as a good therapist should support you wherever you’re at.  

Listen to Juliette explain why she tells clients that recovery may be the hardest thing they’ll ever do in their life, and why it will also be the most rewarding.

See omnystudio.com/listener [https://omnystudio.com/listener] for privacy information.

In depth with former helpline manager Juliette Thomson on person-centred recovery

There’s a medication for almost every illness, and that’s true for mental illnesses,
including eating disorders. But how do they work, and how do they help? We’re
launching our fourth season of Butterfly: Let’s Talk with an investigation into
medications used to treat people with eating disorders, including some brand-new
developments that could offer hope.

“Many people with an eating disorder will be prescribed some kind of psychiatric
medication,” says psychiatrist Professor Richard Newton, who has been working in
the sector since the 1980s. “But most of those treatments will be for associated
concerns such as anxiety, depression, poor sleep, hearing voices, obsessive-
compulsive disorder, etc. They’re more adjunct interventions and are not for the
eating disorder itself.”

Having suffered from an eating disorder since age 11, Emma has tried
several different prescriptions. “I was first given a psychiatric medication when I
was 14,” she tells us. “It was an antidepressant, and it helped. It showed me that
there was something chemically not quite right.” Later, she was prescribed
antipsychotics, that she says also helped.

In this podcast, we talk about psilocybin, the psychedelic chemical associated with
magic mushrooms. "Psychedelic drugs offer an incredible way to access an altered state of consciousness that can change how people think about their behaviour,” says neurologist and researcher Dr Claire Foldi. While psilocybin is still
undergoing clinical trials, she's upbeat about its potential for eating disorders.

We also go into depth with Dr Kristi Griffiths, who has studied Vyvanse, a stimulant
traditionally prescribed for ADHD, now being used to treat people with Bulimia
Nervosa and Binge Eating Disorder. “In one randomized study," she says, "People
who took Vyvance over a set period had around a 4% relapse rate. That's a
pretty low rate.”

Listen to our experts and Emma, who believes that she is well into recovery thanks in part to her medications. Perhaps this episode will offer insights for you, your client’s or your loved one’s treatment plan.

See omnystudio.com/listener [https://omnystudio.com/listener] for privacy information.

What medications can help you recover from an eating disorder?

The results from the new Butterfly Body Kind Youth Survey are in, and they’re concerning. More than 1600 young people aged 12-18 took part in the survey, with at least half saying they were dissatisfied with their bodies. About one in three kids say they’re completely dissatisfied with the way that they look.

"The problem is there’s a real cost to young people's body dissatisfaction," says Helen Bird, Butterfly's Education Manager. "A significant number limit their involvement in everyday activities like sports, going to the beach, hanging out with their friends, or going clothes shopping. It’s also impacting their learning. Something like 50% of young people say that their body image has stopped them from putting their hands up in class, focusing on their schoolwork and, for some, even going to school."

In the latest episode of Let’s Talk, our host Sam Ikin talks to Helen, mental health counsellor Stella Ladikos and social worker AJ Williams-Tchen who all work closely with young people and listen to their concerns. He also chats with two high school students who aren’t surprised by the survey results but who make it quite clear that adults and institutions need to be doing a lot more to support them.

See omnystudio.com/listener [https://omnystudio.com/listener] for privacy information.

What 1600 young people told us about their body image

In February this year, ABC dedicated their flagship investigative report, Four Corners, to eating disorders. This was, in part, because of a few Members of Parliament.

The MPs are Teal Independent Zoe Daniel, Liberal Andrew Wallace and Labor’s Susan Templeman. Based on continuous calls for help from their constituents, the three resolved to act for change. To start, they’re co-chairing a new Parliamentary Friends Group for Eating Disorder Awareness to highlight the critical need for more care and support.

“We've been absolutely avalanched in my office by families and people from across the country, saying that it really needs action,” says Zoe Daniel. “And it’s been interesting to have conversations with other MPs. Eating disorders aren't confined to the stereotypical groups.”

Susan Templeman agrees. “I don't think there's an elected office in the country where someone hasn't phoned in at the end of their tether, saying, I don't know what to do. My son or my daughter or my partner is suffering from an eating disorder, and I can't get the help that I need.”

Andrew Wallace was once in a Cabinet meeting where a senior health official assured the Prime Minister that Australia was getting on top of the issue. “I said, sorry, Prime Minister, but I totally disagree with what you've just been told,” he recalls. “We have absolutely no idea how you first suffer from it, why you suffer from it and, importantly, how you best treat it.”

As a carer, Wallace speaks from his own experience, as does Susan Templeman. Eating disorders are mental health issues that do not discriminate. And as more policymakers lean in to educate their political peers, the more hope there will be for real investment in care.  

 

See omnystudio.com/listener [https://omnystudio.com/listener] for privacy information.

Meet the three MPs committed to better care for eating disorders

Many of us remember being teased about our appearance in primary school because it happens - a lot. Perhaps we don’t think about it much now, but chances are the experience has left a mark on who we’ve become. The research is clear: Appearance-based teasing is a key risk factor for a child to develop body dissatisfaction which, in turn, can negatively impact their life outcomes, including their mental health, career, and relationships. Body dissatisfaction is also one of the highest risk factors for eating disorders.   

"There's research showing children as young as eight describing their weight and size as a problem because they've experienced appearance-based teasing," says expert researcher Dr Steph Damiano. Appearance-based teasing, which is rife, is also related to more intense disordered attitudes and behaviours around food." To a large degree, this problem is related to cultural stigmas around size and weight, which can be internalised by children as young as three.  

"I was always naturally a very low weight and also very tall for my age," says mental health worker Jenna Abbasi, who has lived this firsthand. "I was teased about my size and height, my colour, my teeth, my hair, my nose...I was labelled as the skinniest person in school and a rabbit. It's still very difficult for me not to be self-conscious about my body because the social anxiety from that time has never left."  

Psychologist Louise Adams, who counselled clients on body acceptance long before she had her own children, has worked hard to protect them. However, she admits her larger-bodied daughter experienced the full brunt of fat-phobic comments in primary school and still suffers from it.

To address all of this, Butterfly Body Bright was developed in association with experts from La Trobe University to promote body-positive peer environments for younger kids. "The program shifts all of our mindsets," says teacher and pastoral care worker Sarah Price. "We’re not only teaching kids about the impact of what they say to other people but also what they can say to themselves."  

"The full program is evidence-based, easy to execute, and comprehensive about developing a positive body image,” says Dr Damiano. Regarding appearance-based teasing, the teachings are all about encouraging children to treat each others' bodies with respect and to stand up for themselves and others in the face of hurtful comments.

See omnystudio.com/listener [https://omnystudio.com/listener] for privacy information.

It still hurts: Appearance-based teasing when you're a kid

Dr Beth Shelton is a psychologist and long-time director of the National Eating Disorder Collaboration (NEDC), leading a team that develops national standards for preventing and treating eating disorders and works actively to build the system of care.

As a highly respected professional in the field, we asked Beth to explain the different diagnoses for eating disorders, the possible causes, and what she believes constitutes “normal” eating.

First, Beth makes one thing clear:  An eating disorder is a mental illness with serious physical and mental health consequences for the person affected. It causes a lot of dysfunction and suffering.

Though there are several separate diagnoses for eating disorders, they are more similar than they are different. Absent recovery, many people move from one form to another. Different eating disorders often manifest from similar risk factors, for example, genetics or psychological profiles.

She also confirms that these conditions do not discriminate. We too often default to thinking about an overly thin teenage girl, but an eating disorder can affect anyone; we don’t see it. An eating disorder is also not a choice – perhaps beginning a diet to lose weight initially may be a conscious decision, but once the eating disorder takes hold, the person affected has lost control of their health and needs support.

Beth puts it best: “No one I've ever worked with or spoken to about an eating disorder would ever choose one or choose one for anyone else.”

Fortunately, she and numerous others in the sector are working tirelessly to help, not only for those with lived experience but for their loved ones and carers too.

Find out more about NEDC [https://nedc.com.au/]

Eating disorders explained [https://butterfly.org.au/eating-disorders/eating-disorders-explained/]

Find out more about Parliamentary Friends Group for Eating Disorder Awareness [https://butterfly.org.au/news/federal-mps-unite-to-establish-parliamentary-friends-group-for-eating-disorder-awareness/]

Find a Professional [https://butterfly.org.au/get-support/butterflys-referral-database/]

 

See omnystudio.com/listener [https://omnystudio.com/listener] for privacy information.

In Depth with NEDC director Beth Shelton

We’re all subject to continuous appearance-based pressures which impact our self-worth. The LGBTQIA+ community is no different. In fact, it’s a community that faces unique challenges regarding pressures that affect body image. And, for some people, it can escalate during Mardi Gras season.  

“People will go on a big shred or a big diet for the month,” says one of Australia’s most popular LGBTQIA+ content creators, Matt, also known as Alright Hey. “As soon as Christmas is over, it starts. Mardi Gras lands around the start of March and people think they have two months to totally transform their body.” 

Author, podcaster, and creator Allira Potter says much of the pressure often comes from others in each community. “I feel it 100%. Being a lesbian, I have this pressure to dress and act a certain way.” 

Non-binary and queer creator, Jonti Ridley says appearance-based pressure is unhelpful to everyone. “A large facet of the queer community is enforcing these standards that we didn’t even come up with. We don’t even like them. They’re not for us.” 

Actor and creator Jeff van de Zandt has this to say: “Mardi Gras prep diets come from a place of hate,” he says. “They come from hating oneself. But Mardi Gras is a celebration of love, a celebration of pride, of all these positive things. It’s just backward to me.” 

Mardi Gras is a seminal time for 78er Peter Murphy who was at the very first Mardi Gras, when he was seriously injured by police as they attempted to shut it down. He says it’s not compulsory to do anything special around your appearance at all. “I’m going in comfortable clothes and comfortable shoes and I still expect to have a great time.” 

Listen to these fascinating and enlightening guests as they explore body and beauty ideals within the LGBTQIA+ community, how pressures to conform can manifest, and why they’re choosing to participate in WorldPride with BodyPride, starring their unique, kind, and most authentic selves. 

CHECK OUT BUTTERFLY’S BODY PRIDE CAMPAIGN [https://butterfly.org.au/get-involved/campaigns/bodypride/]

CHECK OUT OUR LGBTQIA+ RESOURCE HUB [https://butterfly.org.au/get-involved/campaigns/bodypride/bodypride-resources/]

FOLLOW ALRIGHT HEY [https://www.instagram.com/alrighthey/?hl=en]

FOLLOW ALLIRA POTTER [https://www.instagram.com/allira.potter/?hl=en]

FOLLOW JONTI RIDLEY [https://www.instagram.com/_toughboy/?hl=en]

FOLLOW JEFF VAN DE ZANDT [https://www.instagram.com/jjzandt/?hl=en]

QUICK GUIDE TO TERMS – LGBTQIA+ [https://aifs.gov.au/sites/default/files/publication-documents/22-02_rs_lgbtiqa_glossary_of_common_terms_0.pdf]

See omnystudio.com/listener [https://omnystudio.com/listener] for privacy information.

All about #BodyPride as an LGBTIQ+ human

It goes without saying that we want to give our young children the best start. We also know from years of research that negative body image can impact almost all life outcomes – including relationships, education, and careers. 

So how do we protect our children from developing a negative body image? And when should we start? The answer could shock you. 

Dr Stephanie Damiano is a psychology researcher and an expert in this space. 

“We see quite consistently that around the age of three, children start to develop pretty strong weight attitudes and weight stereotypes around bodies,” she says. "They tend to attribute positive characteristics to thin bodies and negative characteristics to large bodies. Their body image starts to develop a little bit later, around the age of four.” 

Biological, psychological, and socio-cultural factors contribute to the development of positive or negative body image. In the socio-cultural space, our kids’ attitudes are shaped by family, the media, and their peers – and this is where adults can influence them.  

Dr Damiano also leads Butterfly’s pioneering Body Bright program that is available free to primary schools. Listen to her chat with Sam about helping young kids establish a positive relationship with their bodies for their future well-being and success.

find out more about Butterfly body bright [https://butterfly.org.au/school-youth-professionals/about-our-programs/bodybright/]

butterfly body bright - information for families [https://www.butterflybodybright.org.au/about-the-program-families]

butterfly body bright - information for schools [https://www.butterflybodybright.org.au/about-the-program-schools]

for educators - register your school [https://events.butterfly.org.au/portal/Resource/resourceregister?Name=eb1a353c-a4df-eb11-bacb-002248159bde&id=Body_Bright4181810325]

See omnystudio.com/listener [https://omnystudio.com/listener] for privacy information.

In depth with early childhood body image expert Dr Stephanie Damiano

The summer holidays usually come with some expectations. We meet the extended family for a holiday meal. We wear fewer clothes in the summer heat. We make new year’s resolutions pushed by the diet industry. We smile and nod at the inevitable comments about our appearance from well-meaning family members. And we’re expected to find all of this a joyous time of year. But it’s events like these that make the summer holiday period difficult for some people, particularly anyone experiencing negative body image or eating disorders. 

“How do people look compared to how they looked last year,” says Tania Nichols from Butterfly’s National HelpLine. “Are they bigger or smaller? There’s a lot of anxiety around potential judgement from others and the inevitable comments that go with them.”

“Most of us, in general, start to feel the stress around getting together with people we haven't seen for ages,” Tania tells us. “And of course, that's magnified for people who are experiencing disordered eating and eating disorders because all of these festivities, of course, happen around food.”

Jennifer White suffered from an eating disorder for years and says it was the holiday get-together over food that would always stress her out. “In the Australian culture, people feel comfortable, rightly or wrongly, commenting on how people look, what people wear, and what people eat,” she says. “At functions that I have gone to in the past, whether it be family, friends, work, whatever, it's just something that people say without really having a second thought.”

Clinical psychologist Chris Cheers tells us negative body image can have a huge impact on how people cope with difficult situations. “People connect the way their body looks with their ability to be liked,” he says, “Or to form relationships with people or to get that boyfriend or girlfriend or get that partner, especially if you're single. There seems to be this pressure of you needing to look a particular way to make friends.”

But he says by being aware of a few things, we can make a world of difference for our family and guests. “I think a really helpful question to ask someone is what would support look like for you right now. And we sometimes feel pressure to know how to support people too. And sometimes that can stop us from reaching out or saying anything.”

He says, on a personal level, you can “give yourself permission to notice those expectations,” he says, “But choose instead to go inward, and be guided by what's important to you, be guided by your body and what you need.”

For more tips and advice, go to Butterfly’s Summer of Kindness page. [https://butterfly.org.au/get-involved/campaigns/summerofkindness/] https://butterfly.org.au/get-involved/campaigns/summerofkindness/

 

See omnystudio.com/listener [https://omnystudio.com/listener] for privacy information.

How can we be kind to our bodies this summer?

This is the Butterfly Podcast from the Butterfly Foundation, your national voice
for people living with body image issues and eating disorders.

Sam Ikin

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