1 00:00:02,080 --> 00:00:05,560 Great. Good morning, everyone, and thanks ever so much for joining us. 2 00:00:05,560 --> 00:00:12,650 For the latest in our mental wellness sessions, which are hosted by the Department of Experimental Psychology here in Oxford. 3 00:00:12,650 --> 00:00:21,730 So my name, Kathy Creswell, and I'm really delighted to be chairing this session today on understanding and managing eating disorders. 4 00:00:21,730 --> 00:00:27,700 We just wanted to remind you before we get started that this series, as I said, is hosted by the Department of Experimental Psychology. 5 00:00:27,700 --> 00:00:34,210 So you can find all our previous talks on the experimental psychology YouTube channel and on our Web page. 6 00:00:34,210 --> 00:00:40,930 So so far, we've had talks on managing stress and anxiety, on depression and low mood and on sleep problems. 7 00:00:40,930 --> 00:00:48,890 And we've got some other exciting events coming up shortly on coping with trauma and also overcoming mistrust and paranoia. 8 00:00:48,890 --> 00:00:55,600 So please do keep an eye out for those. As you know, this session is going to be running for 45 minutes. 9 00:00:55,600 --> 00:01:01,840 We deliberately do 45 minutes in the hope that you'll have 15 minutes break before whatever you're doing next kicks in. 10 00:01:01,840 --> 00:01:08,830 So because some of these sessions can raise difficult issues for people, we'd really encourage you to use that time to step away. 11 00:01:08,830 --> 00:01:10,510 Give yourself a bit of a break. 12 00:01:10,510 --> 00:01:18,220 And also, we also want to highlight that if there are any issues raised for you, then please do reach out to others, to friends, 13 00:01:18,220 --> 00:01:27,010 to your GP, for example, to charities, and we'll be signposting some useful resources as we go on through the talk. 14 00:01:27,010 --> 00:01:33,510 But without further ado, let's move on to the talk itself. And I'm delighted to introduce you to Dr Rebecca Murphy, 15 00:01:33,510 --> 00:01:38,980 who is a senior research clinician here in the university in the Department of Psychiatry 16 00:01:38,980 --> 00:01:44,350 and also an honorary clinical psychologist in Oxford Health NHS Foundation Trust. 17 00:01:44,350 --> 00:01:48,860 So over to you, Rebecca, and thanks so much for joining us. 18 00:01:48,860 --> 00:01:55,190 Thank you very much, Kathy. I'm just going to share my screen with you. 19 00:01:55,190 --> 00:02:00,560 So I'm delighted to be here today to talk to you about eating disorders. 20 00:02:00,560 --> 00:02:06,110 And I'd like to thank the organisers of the talk from experimental psychology 21 00:02:06,110 --> 00:02:12,230 for inviting me here to present as part of their series of mental health talks. 22 00:02:12,230 --> 00:02:21,140 I'm based at the Centre for Research on Eating Disorders at the University of Oxford and. 23 00:02:21,140 --> 00:02:28,270 Let's begin by thinking about what eating disorders are. 24 00:02:28,270 --> 00:02:38,540 So eating disorders have been defined as medical illnesses marked by severe disturbances in eating. 25 00:02:38,540 --> 00:02:48,590 Or disturbances of behaviour intended to control white and these disturbances calls somebody considerable distress, 26 00:02:48,590 --> 00:02:58,530 and I have a clear and negative effect on someone's health and other areas of one's life, such as relationships and work. 27 00:02:58,530 --> 00:03:05,400 And conventionally, eating disorders have been divided into different diagnostic types, 28 00:03:05,400 --> 00:03:14,610 and these include anorexia nervosa, where somebody is a severely low weight and is restricting their food intake. 29 00:03:14,610 --> 00:03:23,910 Believe me, if I saw where somebody has episodes of losing control of their eating and eating an unusually large amount of food and then 30 00:03:23,910 --> 00:03:32,100 tries to compensate for these episodes or counteract the effects of binge eating by strict dieting or self-induced vomiting, 31 00:03:32,100 --> 00:03:42,240 laxative, misuse, there's binge eating disorder where people also have the frequent and highly distressing episodes of losing control of one's eating. 32 00:03:42,240 --> 00:03:47,370 But without the compensatory behaviours such as strict dieting or vomiting. 33 00:03:47,370 --> 00:03:55,980 And then importantly, there are also other types of eating disorders where people still have a significant and impairing eating disorder. 34 00:03:55,980 --> 00:04:02,900 But the features just don't map exactly on to the other categories. 35 00:04:02,900 --> 00:04:08,450 However, for people familiar with a range of people with eating disorders. 36 00:04:08,450 --> 00:04:16,700 Well, it's actually quite striking is how much different eating disorders have in common rather than their differences. 37 00:04:16,700 --> 00:04:27,710 And this, in fact, is what has led researchers to develop a TRONS diagnostic theory of understanding eating disorders. 38 00:04:27,710 --> 00:04:34,040 So what are the common features of eating disorders? 39 00:04:34,040 --> 00:04:41,210 Well, I'd like to start with what's arguably a central feature for many eating disorders, 40 00:04:41,210 --> 00:04:48,690 and it's something we might not have thought a lot about, but it's to do with how we judge ourselves as a person. 41 00:04:48,690 --> 00:04:57,370 And if we're meeting our personal standards in the areas of life we value, we tend to feel reasonably good about ourselves. 42 00:04:57,370 --> 00:05:07,660 If not, we feel bad. And what's notable in people with eating disorders is that often they judge themselves largely 43 00:05:07,660 --> 00:05:17,440 or even exclusively in terms of eating shape and weight and their ability to control them. 44 00:05:17,440 --> 00:05:25,600 And this is not the same as what might be described as more sort of normative body dissatisfaction, 45 00:05:25,600 --> 00:05:31,030 which can affect many people in societies with particular body ideals. 46 00:05:31,030 --> 00:05:42,640 This is really quite different. And this is exemplified in this quote here where somebody says, I feel so disgusted with myself as a person. 47 00:05:42,640 --> 00:05:50,790 When I fail to stick to my diet or my weight goes up, I lose all hope for the future. 48 00:05:50,790 --> 00:06:00,840 So in terms of other common features of eating disorders, in addition to this sort of self-worth, being dependent on eating weight and shape. 49 00:06:00,840 --> 00:06:08,760 People often have the associated extreme concern about their eating and their weight and their body, 50 00:06:08,760 --> 00:06:17,850 accompanied by a kind of intense scrutiny and checking of one's body and weight or possibly avoidance. 51 00:06:17,850 --> 00:06:23,310 Somebody may lose weight or gain weight as a result of the eating disorder. 52 00:06:23,310 --> 00:06:32,100 But often people's weight is in the sort of normal range. There's often strict dieting and preoccupation with food. 53 00:06:32,100 --> 00:06:36,600 There may be vomiting, which is self-induced, or laxative misuse. 54 00:06:36,600 --> 00:06:43,650 And under exercising and people might have occasions where they lose control of their eating. 55 00:06:43,650 --> 00:06:54,200 I need to an unusually large amount of food and each individual with an eating disorder may not have all of these features. 56 00:06:54,200 --> 00:07:01,070 So we just want to launch a poll now. And this is entirely anonymous. 57 00:07:01,070 --> 00:07:07,670 Would you be able to indicate if you or someone you know has experienced an eating disorder? 58 00:07:07,670 --> 00:07:14,700 I'm just going to. That was quite interesting. 59 00:07:14,700 --> 00:07:24,840 So clearly, the very large majority of you are very familiar either yourselves or because of knowing someone else, 60 00:07:24,840 --> 00:07:36,540 and this really isn't surprising because eating disorders are relatively common with estimates of around sort of one point two to five million people. 61 00:07:36,540 --> 00:07:48,510 But also studies have found that actually one in five women and one in eight men scream positively for a possible eating disorder as well. 62 00:07:48,510 --> 00:07:55,290 So that doesn't surprise me. That overwhelmingly sort of high response. 63 00:07:55,290 --> 00:07:59,380 So. Just moving on. 64 00:07:59,380 --> 00:08:15,130 I want to have a little bit of a think about common eating disorder myths. 65 00:08:15,130 --> 00:08:28,180 So one myth that is very common is that eating disorders only happen to kind of young, white, thin, heterosexual, affluent women. 66 00:08:28,180 --> 00:08:33,910 And whilst it is true that many young women do experience eating disorders, 67 00:08:33,910 --> 00:08:46,690 eating disorders can affect anyone of any gender weight sized age, race, ethnicity, sexual orientation, socioeconomic status or culture. 68 00:08:46,690 --> 00:08:53,170 Another unhelpful myth is that people choose to have an eating disorder. 69 00:08:53,170 --> 00:08:58,900 In reality, many factors contribute to somebody having an eating disorder. 70 00:08:58,900 --> 00:09:03,730 Nobody chooses to have one. They're not a phase or a means of getting attention. 71 00:09:03,730 --> 00:09:09,660 And in fact, people often hide the fact that they have an eating disorder. 72 00:09:09,660 --> 00:09:19,900 A third myth is that families cause eating disorders, whereas actually people with eating disorders come from all kinds of families. 73 00:09:19,900 --> 00:09:23,350 And families are not to blame. 74 00:09:23,350 --> 00:09:32,920 It is the case that sometimes families do develop problems as a result of the difficulties of having a family member with an eating disorder. 75 00:09:32,920 --> 00:09:41,110 But in most cases, family families are a really helpful resource in terms of helping people get better. 76 00:09:41,110 --> 00:09:46,090 Another myth is that you can't recover from an eating disorder, 77 00:09:46,090 --> 00:09:54,970 whereas actually most people who receive one of the recommended evidence based treatments for eating disorders do get better. 78 00:09:54,970 --> 00:10:02,590 And there is always hope, no matter how long the eating problem has been going on. 79 00:10:02,590 --> 00:10:05,860 So we're going to launch another poll now. 80 00:10:05,860 --> 00:10:17,410 I'd like to know if you have ever felt uncertain of what to do to help yourself or someone else with an eating disorder. 81 00:10:17,410 --> 00:10:22,440 So I think that's well, that come up now. Great. 82 00:10:22,440 --> 00:10:29,370 So, yeah, so I can just see. We've got about 90 percent view. 83 00:10:29,370 --> 00:10:34,080 It's varying a little bit saying that you have been. 84 00:10:34,080 --> 00:10:41,280 So I think I'm going to move on now to have a little think with you about. 85 00:10:41,280 --> 00:10:47,520 Let me just share the results. There we go. See, you can see that 80 percent to me. 86 00:10:47,520 --> 00:10:56,670 So let's have a think about what you can do in that situation, how to get help for an eating disorder. 87 00:10:56,670 --> 00:11:07,140 So involving your GP is the safest and usually the most helpful step for getting help with an eating disorder. 88 00:11:07,140 --> 00:11:12,690 If you're a student at university, then they may be able to help, too. 89 00:11:12,690 --> 00:11:16,860 I don't want to just make a few points about this process. 90 00:11:16,860 --> 00:11:25,080 Firstly, it's normal to be in two minds about seeking help, and that's for a variety of reasons. 91 00:11:25,080 --> 00:11:31,470 So in some cases, some aspects of the eating disorder might be valued, 92 00:11:31,470 --> 00:11:41,910 or you have maybe a sense of stigma or shame around disclosing that you have an eating problem or doubts about whether you deserve help. 93 00:11:41,910 --> 00:11:51,660 And a specialist in eating disorders will be familiar with that and can really help you to make an informed sort of choice about change. 94 00:11:51,660 --> 00:11:59,130 So I would say don't let that put you off going to your GP and starting that process. 95 00:11:59,130 --> 00:12:09,570 Secondly, try to make an appointment as soon as possible, because really intervening early gives you the best chance of recovery. 96 00:12:09,570 --> 00:12:19,530 You may wish to make a sort of double or longer appointment with your GP so you can have a bit more time to discuss these difficult matters. 97 00:12:19,530 --> 00:12:24,000 And if your GP suspects that you have an eating disorder, 98 00:12:24,000 --> 00:12:34,680 the recommendation is for the GP to refer you on to a community with specialist eating disorder service. 99 00:12:34,680 --> 00:12:42,630 And it's useful to think in advance about your different areas of concern and the impact that it's 100 00:12:42,630 --> 00:12:48,840 having on your life so that you can be sure to really express that when you go for your appointment. 101 00:12:48,840 --> 00:12:57,030 Often times it's helpful to have a list to hand, and you may want to ask someone supportive to go with you. 102 00:12:57,030 --> 00:13:08,850 There are times where it's particularly urgent or more pressing to go to a GP, and these include if you've sort of feeling very distressed. 103 00:13:08,850 --> 00:13:21,090 Lots of areas of your life are being affected. The problem's getting worse or has been ongoing or dramatic weight loss or being a low weight. 104 00:13:21,090 --> 00:13:31,800 And please don't give up. If you feel like your problem hasn't been understood, it may be worth going to see another GP. 105 00:13:31,800 --> 00:13:39,700 And what do you do if you're in that situation where you want to try and help someone else with an eating disorder? 106 00:13:39,700 --> 00:13:46,720 So this is advice for people who have a friend or a family member with an eating disorder. 107 00:13:46,720 --> 00:13:54,220 So firstly, it's helpful to try and have a kind of supportive approach and listen to 108 00:13:54,220 --> 00:14:02,320 somebodies concerns without really focussing everything on eating right in shape. 109 00:14:02,320 --> 00:14:08,860 And it's best to take a sort of concerned and interesting's intrusted stance because people 110 00:14:08,860 --> 00:14:17,740 can be sort of feel criticised or uncomfortable about somebody else trying to take control. 111 00:14:17,740 --> 00:14:27,580 And because mealtimes can be highly stressful. It's best to try to have conversations away from me at all times. 112 00:14:27,580 --> 00:14:34,750 And it is helpful to try and learn more about eating disorders so that you can support someone else. 113 00:14:34,750 --> 00:14:38,140 That doesn't mean you have to be their therapist. 114 00:14:38,140 --> 00:14:46,300 And probably those more detailed discussions about shape and why actually are best left to professionals. 115 00:14:46,300 --> 00:14:51,220 And it's important to look after your own needs as well. 116 00:14:51,220 --> 00:14:59,650 And the final point is it's really important to how to make somebodies life about things other than food and wine. 117 00:14:59,650 --> 00:15:05,860 So you could suggest that you sort of engage in social activities or hobbies together. 118 00:15:05,860 --> 00:15:09,490 Really show interest in that person as a whole. You know, 119 00:15:09,490 --> 00:15:18,820 aside from what's happening with their eating weight in shape and try to just avoid lengthy discussions about things like dieting and shape or why, 120 00:15:18,820 --> 00:15:26,320 even if it's about someone else. So what treatments are available? 121 00:15:26,320 --> 00:15:34,330 Well, the National Institute for Health and Care Excellence have reviewed the research on treatments, 122 00:15:34,330 --> 00:15:44,580 and they've concluded that basically there will be different types of treatment depending on the eating disorder you have. 123 00:15:44,580 --> 00:15:52,960 But there are all types of talking therapy or a guided self-help programme. 124 00:15:52,960 --> 00:16:01,360 So you can see one of the treatments that's common across the eating disorders is a cognitive behavioural therapy, 125 00:16:01,360 --> 00:16:05,860 which is a specialist treatment for eating disorders. 126 00:16:05,860 --> 00:16:16,060 If you have believe in AVOs, sell or binge eating disorder, you may be working through a self-help programme with some guidance. 127 00:16:16,060 --> 00:16:22,750 And there are other treatments as well that are recommended for anorexia nervosa. 128 00:16:22,750 --> 00:16:28,760 And so there are different pathways to treatment. And if you don't have one of these disorders, 129 00:16:28,760 --> 00:16:37,480 what NICE recommends is that you receive the treatment that's closest to the particular eating problem that you have. 130 00:16:37,480 --> 00:16:45,520 So even if you don't quite meet the threshold for anorexia nervosa, if you have similar difficulties, 131 00:16:45,520 --> 00:16:54,850 you'd be more likely to get the anorexia nervosa treatment in terms of other sources of help and support. 132 00:16:54,850 --> 00:17:01,180 I really want to highlight Bayt, too, on the National Eating Disorder charity, 133 00:17:01,180 --> 00:17:06,910 and they provide a lot of help and support for people with eating disorders. 134 00:17:06,910 --> 00:17:12,130 If you were to go on to their Web site and you also have the option of a sort of search 135 00:17:12,130 --> 00:17:19,150 box where you can specify your location and you'll be told about an eating disorder, 136 00:17:19,150 --> 00:17:26,950 services, NHS and private and other sources of help in your area. 137 00:17:26,950 --> 00:17:30,880 There are other useful resources as well. 138 00:17:30,880 --> 00:17:40,480 I mentioned about the nice guidelines. So I think it's worth taking a look at those if you want to find out more about the recommended treatments. 139 00:17:40,480 --> 00:17:42,080 There are other initiatives. 140 00:17:42,080 --> 00:17:52,960 So, for example, by South London and mostly they have a campaign and an end to a sort of overall approach for early intervention. 141 00:17:52,960 --> 00:17:58,000 And our our research group, in collaboration with colleagues in Italy, 142 00:17:58,000 --> 00:18:09,670 have developed a sort of specialist Web site to provide information about CBT, the treatment for eating disorders. 143 00:18:09,670 --> 00:18:19,580 And then, of course, there's this important issue of what to do if you've already been to your GP, but you're waiting to get more help. 144 00:18:19,580 --> 00:18:30,710 So first of all, I'd say do keep in touch with your GP or the service that you've been referred to and update them. 145 00:18:30,710 --> 00:18:41,800 If there's any sort of changes, you may want to consider self-help books for you or the people that are supporting you. 146 00:18:41,800 --> 00:18:51,950 And there's there's a book here I mentioned which is suitable for people with eating disorders and a book for carers of people with eating disorders. 147 00:18:51,950 --> 00:18:57,380 We're currently researching a digital a digital self-help programme. 148 00:18:57,380 --> 00:19:07,850 If you're unable to find NHS treatment and you're in a position to help to pay for it, I know that many people on there are private alternatives. 149 00:19:07,850 --> 00:19:18,140 And you can have a look on the beat website or some of the professional bodies which regulate therapists. 150 00:19:18,140 --> 00:19:29,360 The other thing to think about is whether there are things in your environment which might be helpful or unhelpful during that waiting process. 151 00:19:29,360 --> 00:19:32,990 And that includes your kind of social media environment. 152 00:19:32,990 --> 00:19:45,470 So often it's helpful to try and unfollow any accounts which promote a sort of thin body ideal or kind of very strict diets, 153 00:19:45,470 --> 00:19:57,200 and instead to try and follow campaigns which talk about how we can value ourselves in different ways aside from our eating and our bodies, 154 00:19:57,200 --> 00:20:08,700 such as the one that Jamala Jamail is running. So I'm aware that this talk might have been difficult for some of you, 155 00:20:08,700 --> 00:20:15,720 either if you're experiencing an eating disorder yourself or have people close to you all. 156 00:20:15,720 --> 00:20:23,370 And so I suggest is at the end, once we've had the discussion that you take a moment to just readjust to going 157 00:20:23,370 --> 00:20:31,080 back into your daily life and engage in some kind of helpful coping activity, 158 00:20:31,080 --> 00:20:36,240 such as listening to a piece of calming music or speaking to a friend. 159 00:20:36,240 --> 00:20:43,620 But I've also put here the contact details for B as well. 160 00:20:43,620 --> 00:20:51,670 Thank you. All right. Thank you very much indeed, Rebecca, I'm sure that was very useful for everybody listening. 161 00:20:51,670 --> 00:20:56,820 And thanks to everyone for sending in well, everyone who sent in questions prior to this week, 162 00:20:56,820 --> 00:20:58,960 we're not obviously able to go through all the questions, 163 00:20:58,960 --> 00:21:06,580 but we've tried to organise them in a way that will allow us to address many of the concerns or questions or comments that were raised. 164 00:21:06,580 --> 00:21:09,190 So as we go into that, I'd like you introduce. 165 00:21:09,190 --> 00:21:17,590 I'd like to introduce you to our panel members, Dr. Robin Murphy, associate professor here in the Department of Experimental Psychology, 166 00:21:17,590 --> 00:21:24,000 and also Dr. Debbie Walla Walla, who has been a GP in central Oxford NHS practise for the last 30 years. 167 00:21:24,000 --> 00:21:30,070 And both have got some really useful insights and experience to bring to this topic. 168 00:21:30,070 --> 00:21:37,210 So to get it started, obviously, Rebecca was talking about how to get help for eating disorders, 169 00:21:37,210 --> 00:21:41,080 but also some of the barriers that people can face in doing so. 170 00:21:41,080 --> 00:21:44,660 And one of the issues that was raised ahead of this, 171 00:21:44,660 --> 00:21:50,410 this session was that many people with eating disorders might believe that there are not enough for treatment. 172 00:21:50,410 --> 00:21:53,230 So we were keen to hear your thoughts on this. 173 00:21:53,230 --> 00:21:59,440 You know, how you would respond to this and when and to hear your thoughts about when do you think people should seek help. 174 00:21:59,440 --> 00:22:07,050 So, Debbie, can I come to you first on that? Yes. I think Rebecca was saying. 175 00:22:07,050 --> 00:22:12,500 There's often a huge ambivalence in wanting to seek help. 176 00:22:12,500 --> 00:22:16,510 And that will hold people back. 177 00:22:16,510 --> 00:22:25,490 The trouble is that the longer the eating disorder continues and the more entrenched it becomes and the more difficult it is to treat. 178 00:22:25,490 --> 00:22:30,850 And we know that there's no strong evidence that people who get treatment quickly 179 00:22:30,850 --> 00:22:35,960 and are more likely to make a better recovery and a longer lasting recovery. 180 00:22:35,960 --> 00:22:42,640 So we'd really encourage people to seek help as soon as as soon as possible. 181 00:22:42,640 --> 00:22:47,700 And I think in a minute, Robbins is going to talk about how do you know if you're real or not? 182 00:22:47,700 --> 00:22:59,330 And I just say from a GP perspective, and I think the main stumbling block is often we don't know if it's actually making the diagnosis, 183 00:22:59,330 --> 00:23:03,260 actually sort of realising that the person in front of you has an eating disorder. 184 00:23:03,260 --> 00:23:06,410 And that's the problem that they're coming in with. 185 00:23:06,410 --> 00:23:14,750 But once we've made the diagnosis and discussed it with a patient, then we we're really keen to get you help straight away. 186 00:23:14,750 --> 00:23:19,550 You know, we wouldn't sort of say, well, let's wait for a while and just see how it goes. 187 00:23:19,550 --> 00:23:24,080 If it were if it's a binge eating problem or something that hasn't been there for that 188 00:23:24,080 --> 00:23:31,290 long and we probably recommend some form of evidence based self-help to start with, 189 00:23:31,290 --> 00:23:36,830 then we signpost you to that and support you through the process. 190 00:23:36,830 --> 00:23:46,130 But if it's a more complex eating disorder, perhaps anorexia nervosa and perhaps complicated by other mental health problems, 191 00:23:46,130 --> 00:23:53,660 then we'd want to refer you really immediately and then we would refer you to the specialist eating disorders service. 192 00:23:53,660 --> 00:23:57,220 And that's what's recommended by Nice. Yeah, no. 193 00:23:57,220 --> 00:24:02,240 Well, I just wondered what you felt about this. How well am I really ill. 194 00:24:02,240 --> 00:24:05,940 That question. Yeah. Yeah. Thank you. Thank you, Debbie. 195 00:24:05,940 --> 00:24:10,010 And and thank you, Rebecca, for the for the excellent talk. Very clear. 196 00:24:10,010 --> 00:24:18,860 So I'm an experimental psychologist and I'm interested in that point that in answering this question that Rebecca mentioned about self-evaluation. 197 00:24:18,860 --> 00:24:28,820 So I think that point that that how do we know whether or not our behaviour is is typical or not is something very difficult in all sorts of contexts, 198 00:24:28,820 --> 00:24:34,340 including whether we have eating disorders. So self-evaluation is it is and is an issue. 199 00:24:34,340 --> 00:24:39,470 And we have to evaluate both our internal physical states, our sensations, 200 00:24:39,470 --> 00:24:43,940 our perceptions of our hunger, for instance, but also what we're thinking about at the moment, 201 00:24:43,940 --> 00:24:51,530 whether these thoughts are our typical, but also whether our interpretation of the outside world and social media is typical. 202 00:24:51,530 --> 00:24:58,470 And all of those factor into a decision about whether or not I my behaviour is not is not typical. 203 00:24:58,470 --> 00:25:03,160 And so in my experimental work, I look at the concept of agency. 204 00:25:03,160 --> 00:25:07,220 So agency is this idea that we can act to make things happen. 205 00:25:07,220 --> 00:25:13,550 We can act to help ourselves. But what we find is that people differ in terms of their their sense of agency. 206 00:25:13,550 --> 00:25:17,870 And and that that that's both a belief in whether I am a Gentech. 207 00:25:17,870 --> 00:25:22,570 Can I change things? Do I have the resources I need to change? 208 00:25:22,570 --> 00:25:24,740 But also, is my agency typical? 209 00:25:24,740 --> 00:25:33,830 So again, I don't know whether or not what I think of as my agency maps onto what Rebecca or or or Cathy or any of you in the audience is your agency. 210 00:25:33,830 --> 00:25:40,290 And and and so that fundamentally interferes with our it's a barrier to whether or not we're going to seek help, 211 00:25:40,290 --> 00:25:43,380 because we may think that we are typical or not. 212 00:25:43,380 --> 00:25:52,850 And and so what we do in some of these experiments and is look at how people agency is expressed and we see these differences, 213 00:25:52,850 --> 00:25:56,750 but also how you can help and train people to become more agentic. 214 00:25:56,750 --> 00:26:03,380 And so one of them, I think the main barriers that comes out of this is that notion that it's actually very, 215 00:26:03,380 --> 00:26:13,300 very difficult to know whether or not you need help because because all we have is our own internal internal sensations. 216 00:26:13,300 --> 00:26:17,730 And key and I just was gonna come back to you, Debbie, because I know that Sam, 217 00:26:17,730 --> 00:26:23,700 obviously we've been talking about the barrier in terms of, you know, feeling confident about whether it's okay to seek help. 218 00:26:23,700 --> 00:26:28,200 Am I in enough a built or also in a moment about actually reaching services. 219 00:26:28,200 --> 00:26:34,860 But I know that you've had expect to make a lot of people from sort of. And I've come across a lot of different barriers that people face. 220 00:26:34,860 --> 00:26:38,580 I wondered if you were to say a bit more about that. Yes. 221 00:26:38,580 --> 00:26:49,290 I mean, Rebecca and her talk touched on people's ambivalence, the stigma that they want to avoid, if possible. 222 00:26:49,290 --> 00:26:57,120 And people would binge eating problems in particular, can live for years with their eating disorder because it's the sort of guilty secret. 223 00:26:57,120 --> 00:26:58,200 They feel ashamed. 224 00:26:58,200 --> 00:27:07,140 They they feel it's self-inflicted, you know, and that they don't deserve help or perhaps they don't want help because they're not underweight. 225 00:27:07,140 --> 00:27:08,430 So, you know, 226 00:27:08,430 --> 00:27:22,680 it's a real shame if people feel that are the blocks of them coming forward and then if your eating disorder is more anorexia nervosa spectrum. 227 00:27:22,680 --> 00:27:28,400 People don't. Well, it's get getting back to this thing that people just don't feel they've got an illness and they they 228 00:27:28,400 --> 00:27:37,770 they I think they are very fearful that they'll lose control or they'll be fools to gain weight. 229 00:27:37,770 --> 00:27:43,050 They don't want to gain weight. If they get engaged in treatment, that they'll be kind of trapped. 230 00:27:43,050 --> 00:27:53,130 Once they go into treatment. I think for students in particular, we've got fitness to study guidelines now, 231 00:27:53,130 --> 00:28:03,220 which are very helpful for doctors and also university tutors when we're trying to make the difficult decision about when a person becomes too ill, 232 00:28:03,220 --> 00:28:06,360 you know, to continue to study safely. 233 00:28:06,360 --> 00:28:13,590 And students who perhaps are really ill and very underweight with an eating disorder may be aware of these guidelines. 234 00:28:13,590 --> 00:28:16,410 I mean, that freely available to read on the Web. 235 00:28:16,410 --> 00:28:23,460 And so that would stop them from coming forward because they'd be worried that they'd be told they can't study and perhaps they have to go home, 236 00:28:23,460 --> 00:28:33,140 perhaps even had to be admitted to hospital. So that's a big barrier. As far as a GP surgeries go. 237 00:28:33,140 --> 00:28:37,290 I mean, I don't know if any of you have tried to contact your GP recently for help. 238 00:28:37,290 --> 00:28:41,930 Not had anything to do with an eating disorder. But the system is under a huge amount of pressure. 239 00:28:41,930 --> 00:28:43,680 And now, particularly with kov it, you know, 240 00:28:43,680 --> 00:28:51,840 we're seeing very few people face to face because we don't want bringing to bring people who potentially positive into the surgery. 241 00:28:51,840 --> 00:28:57,180 So nearly everything is done on the telephone. And if you ring up for an appointment in the morning, first of all, 242 00:28:57,180 --> 00:29:01,620 if it's an eating disorder you're wanting to disclose, you're probably feeling quite anxious about it. 243 00:29:01,620 --> 00:29:07,980 And then you're told, well, the duty doctor will ring you back and you may not know who that doctor is. 244 00:29:07,980 --> 00:29:13,870 So it's a bit of pot luck, you know, as to how that initial assessment is going to go. 245 00:29:13,870 --> 00:29:22,490 And I mean, many jeepneys will be very well, very lovely in a warm and open and sympathetic. 246 00:29:22,490 --> 00:29:25,770 I'm delighted, you know, that you have phoned in. 247 00:29:25,770 --> 00:29:33,420 But, I mean, we all know that, you know, some doctors don't have that sort of manner and perhaps they're feeling very pressured, perhaps there. 248 00:29:33,420 --> 00:29:40,770 Oh, my goodness. I don't know how to deal with this. So if you're unlucky, you know, you may have a false start. 249 00:29:40,770 --> 00:29:50,370 And I think if that happens to you, don't lose heart and just ring back the next day or ring back and speak to another doctor. 250 00:29:50,370 --> 00:29:59,640 Rebecca was saying the same because, you know, we are here very much for you and we do want to try to get your help as quickly as possible. 251 00:29:59,640 --> 00:30:04,290 So, yeah, just see if the system doesn't work for you the first time. Try again. 252 00:30:04,290 --> 00:30:12,690 There's one other thing I wanted to mention, which is because people find it so difficult to present directly with our eating problem, 253 00:30:12,690 --> 00:30:21,940 they will often come in and see the doctor or phone in at the moment with with problems that are actually secondary to the eating disorder. 254 00:30:21,940 --> 00:30:30,690 So typical things would be tummy troubles, you know, irritable bowel syndrome or constipation, tummy ache, 255 00:30:30,690 --> 00:30:39,840 loose motions, or they may have period problems, irregular periods or periods have stopped completely. 256 00:30:39,840 --> 00:30:43,710 They could be feeling very anxious or depressed and present with those symptoms. 257 00:30:43,710 --> 00:30:52,440 And so the GP will cottoned on to those. And very often then you go down a route of investigating and even referring sometimes on to a 258 00:30:52,440 --> 00:30:58,170 gastroenterologist or a gynaecologist when we're missing completely what the real problem is, 259 00:30:58,170 --> 00:31:02,280 the underlying problem. And then so there can be a big delay there. 260 00:31:02,280 --> 00:31:10,930 I think if if patients are aware of that, then perhaps they can help a GP to get to the diagnosis more quickly. 261 00:31:10,930 --> 00:31:19,150 And then, of course, when we move on, there are barriers. Even when you've been referred as we're going to touch on now where the long waiting times. 262 00:31:19,150 --> 00:31:22,780 Yes, absolutely. Thank you. But it sounds like key messages. Yes. 263 00:31:22,780 --> 00:31:30,260 Try to be as a parent as you can about the various symptoms related to anything and to really possessed. 264 00:31:30,260 --> 00:31:34,510 And I think, you know, if you don't feel a rapport with the first GP, 265 00:31:34,510 --> 00:31:42,940 you talk to your perfectly entitled to ask to speak to another doctor, you know, and and it's and it's easy to do, actually. 266 00:31:42,940 --> 00:31:46,940 So don't let that be a stumbling block for you in getting help. 267 00:31:46,940 --> 00:31:51,490 Yeah. Great. Thank you. Very helpful advice. Yes. So I asked you touched on there. 268 00:31:51,490 --> 00:31:59,110 Obviously, some people did raise in advance of this session that they can sometimes be long waits for eating disorders, services. 269 00:31:59,110 --> 00:32:03,540 And so really the question was about where can people get support in the meantime? 270 00:32:03,540 --> 00:32:09,440 But also they can we anticipate changes in service availability for eating disorders going forwards. 271 00:32:09,440 --> 00:32:13,910 So, Rebecca, maybe I could come to you, first of all. Yes. 272 00:32:13,910 --> 00:32:19,050 Thank you. Thank you, Cathy, and I've enjoyed hearing from everyone as well. 273 00:32:19,050 --> 00:32:33,270 So I mentioned a little bit in my talk about other sources of support whilst of waiting for treatment, including staying in contact with your GP. 274 00:32:33,270 --> 00:32:39,630 Looking at the resources available on beat and self-help programmes. 275 00:32:39,630 --> 00:32:51,900 And in terms of changes in service availability, back in 2015, 2016, there was a guide. 276 00:32:51,900 --> 00:33:02,400 There was some sort of guidance put in place which said that for children and young people that they shouldn't have to wait too long for treatment. 277 00:33:02,400 --> 00:33:13,110 And they actually specified the services needed to see them within one week for urgent cases and within four weeks for non urgent cases. 278 00:33:13,110 --> 00:33:19,170 So this was a sort of standard put in place for children and young people. 279 00:33:19,170 --> 00:33:27,570 And it was very much influenced actually by campaigning that people dead, including Bayt, 280 00:33:27,570 --> 00:33:36,240 who played a key role in really saying, look, people can't just wait for treatment for this period of time. 281 00:33:36,240 --> 00:33:44,810 And so this this sort of guidance was put in place. And it's taking time for those sort of changes to filter through. 282 00:33:44,810 --> 00:33:47,400 But actually, that's that's really helpful. 283 00:33:47,400 --> 00:33:59,100 And I think what the NHS are now doing as well is they're piloting in a few specific areas using that guidance for adult eating disorder services. 284 00:33:59,100 --> 00:34:05,940 So I think there is a big push towards early intervention and recognising how crucial that 285 00:34:05,940 --> 00:34:11,520 is for eating disorders and how unacceptable is really for people have to have to wait. 286 00:34:11,520 --> 00:34:17,130 Many people have to wait several months at least for treatment. 287 00:34:17,130 --> 00:34:25,140 And I would encourage people to keep kind of campaigning and lobbying their MP because it's really difficult to do, 288 00:34:25,140 --> 00:34:29,820 especially if you're affected by it, because it's very emotionally exhausting. 289 00:34:29,820 --> 00:34:37,110 But I think it does make a difference. And I know other campaigns have been in place, for example, 290 00:34:37,110 --> 00:34:46,110 around making sure that medical staff are better trained so that they can actually recognise and understand eating disorders, 291 00:34:46,110 --> 00:34:53,140 so that we can sort of help with those kind of initiatives, the initial barrier to help seeking. 292 00:34:53,140 --> 00:34:57,040 So I think, you know, there are barriers, 293 00:34:57,040 --> 00:35:05,430 but I think we need to think together as professionals and also other sort of patient groups about how to overcome those. 294 00:35:05,430 --> 00:35:11,550 And I think we are making some progress. Kate and Debbie, did you want to add anything to that? 295 00:35:11,550 --> 00:35:18,650 I mean, I completely agree with Rebecca, and I feel terrible that people are having to wait so long. 296 00:35:18,650 --> 00:35:22,840 I mean, I think it can be for longer than months at the moment in Oxford. 297 00:35:22,840 --> 00:35:29,910 You know, it's I think the waiting time at the moment is every year for especially psychological treatment as an outpatient. 298 00:35:29,910 --> 00:35:34,230 I mean, I think I would say if you're in that position on the waiting list, 299 00:35:34,230 --> 00:35:39,360 please keep in touch with your GP and you may need to be a bit proactive about that. 300 00:35:39,360 --> 00:35:46,680 We're not terribly good at remembering to ring people regularly, particularly the moment with kov it. 301 00:35:46,680 --> 00:35:52,560 But if you could perhaps get in touch with the GP every couple of months and ideally you should actually come in and 302 00:35:52,560 --> 00:35:59,820 have a quick physical chat be weighed and you may need blood tests and things depending on what the eating disorder is. 303 00:35:59,820 --> 00:36:05,250 But if we find that your weight is dropping rapidly or your condition is deteriorating, 304 00:36:05,250 --> 00:36:11,460 then we can right back to the specialist and appeal to them and ask to expedite your treatment. 305 00:36:11,460 --> 00:36:21,180 And similarly, the eating disorder service will usually contact patients every three months or so just as a want to monitor them. 306 00:36:21,180 --> 00:36:28,000 And as a safety net for the same reason. I think that certainly happens in Oxford. 307 00:36:28,000 --> 00:36:35,910 Great. Thanks. Thanks very much. So we had to. Obviously, we've talked talked a lot about treatment, importance of getting treatment. 308 00:36:35,910 --> 00:36:43,500 One of the questions that we asked was really about what the likely hit is, that people can actually ever make a full recovery from Levithan. 309 00:36:43,500 --> 00:36:51,440 Everything they thought of, say, Rebecca, I know you picked up on this a bit in your toe, but I wonder if you could say a little bit more about that. 310 00:36:51,440 --> 00:36:56,770 Yes, of course. And I think it's an important question. 311 00:36:56,770 --> 00:37:09,470 Well, what kind of we we tend to say is that in terms of getting better, that you should be aiming for full recovery. 312 00:37:09,470 --> 00:37:16,730 So sometimes when people say, you know, I've had treatment and did it was it was it was quite helpful. 313 00:37:16,730 --> 00:37:21,290 But, you know, for the last 10 years, I'm sort of still having problems. 314 00:37:21,290 --> 00:37:27,110 And maybe I just need to accept this is the way things are. 315 00:37:27,110 --> 00:37:33,620 I would say that actually eating disorders, they don't have to be chronic in nature. 316 00:37:33,620 --> 00:37:38,580 I think that that's assuming that, you know, you haven't fully responded to treatment, 317 00:37:38,580 --> 00:37:47,960 so maybe you haven't had enough treatment or you haven't been able to implement the strategies from treatment for long enough. 318 00:37:47,960 --> 00:37:53,750 Or maybe you need to go back and get this top up or receive another treatment. 319 00:37:53,750 --> 00:37:59,960 What we definitely don't want to do when we help people to get better is to sort of aim for partial recovery. 320 00:37:59,960 --> 00:38:09,500 I think people need to get fully out of their eating disorder because if you're sort of trying to go around with a bit of an eating disorder, 321 00:38:09,500 --> 00:38:13,040 it's likely to just sort of slip, really. 322 00:38:13,040 --> 00:38:23,120 So that that's one thing I would say that I really don't think eating disorders need to be chronic unless they are untreated or inadequately treated. 323 00:38:23,120 --> 00:38:34,280 However, having said that, I think it's worth just being mindful that sometimes eating disorders can be a bit of well, they're often an Achilles heel. 324 00:38:34,280 --> 00:38:44,090 So even if you recover and you well during times of stress and sort of difficult difficulties in your life, 325 00:38:44,090 --> 00:38:51,950 or perhaps you may experience a depression or something like that, then actually the eating disorder might get triggered again. 326 00:38:51,950 --> 00:38:57,880 And you might have a lapse in terms of your reaching and. 327 00:38:57,880 --> 00:39:05,000 But what a good treatment will do is it will prepare you for that so that you can recognise the early warning signs. 328 00:39:05,000 --> 00:39:13,350 And you know what you need to do to sort of get back out of it, if that helps answer the question. 329 00:39:13,350 --> 00:39:23,460 Yeah. Thank you very much. And we also had questions about kind of why that KOPECEK about fate and how this might contribute to eating disorders. 330 00:39:23,460 --> 00:39:31,700 And it really came to hear about your thoughts on this, about, you know, for example, sometimes people use food as a reward. 331 00:39:31,700 --> 00:39:36,680 You know how we talk about seafood in our why this sort of cultural environment. 332 00:39:36,680 --> 00:39:45,780 So many came to hear your thoughts on the role that the wider food culture might have in relation to eating and so to up. 333 00:39:45,780 --> 00:39:49,190 And can we come to you first about that? Yes. Thank you. 334 00:39:49,190 --> 00:39:56,420 Thank you, Kathy. So I think we're all very aware of the relationship between food and reward. 335 00:39:56,420 --> 00:39:59,780 We think of food as being this substance that we eat for a reward. 336 00:39:59,780 --> 00:40:07,460 But but more fundamental than reward and pleasure we get from food is discussed the feelings of nausea, 337 00:40:07,460 --> 00:40:13,550 that food can generate anxiety, the negative sort of nervous feelings that food can generate. 338 00:40:13,550 --> 00:40:19,610 And much of the much of the research that's been done on this in the neuro or neurobiology of hunger shows that that, 339 00:40:19,610 --> 00:40:28,070 for instance, animals need to learn, for instance, that food reduces hunger and they need to learn that food is not disgusting. 340 00:40:28,070 --> 00:40:34,280 So the starting point is that food is disgusting and and being hungry generates anxiety. 341 00:40:34,280 --> 00:40:40,550 And those that the neurobiology of that suggests that effectively what what happens during life is this learning process. 342 00:40:40,550 --> 00:40:45,770 Overcoming those initial tendencies to find food rewarding. 343 00:40:45,770 --> 00:40:50,390 So the general culture thinks of food as this great thing that's on Master Chef, and everyone loves it all the time. 344 00:40:50,390 --> 00:40:54,830 But there is constantly that that background of anxiety. 345 00:40:54,830 --> 00:40:58,850 Animals get anxious without food. Animals show those disgust responses. 346 00:40:58,850 --> 00:41:04,010 So so learning fundamentally about how to how to respond to those feelings. 347 00:41:04,010 --> 00:41:09,710 And just to pick up on on Rebecca's point, I think about we imagine maybe that eating disorders might be like Kovar. 348 00:41:09,710 --> 00:41:12,170 It's a virus that if it goes if we treat it, it goes away. 349 00:41:12,170 --> 00:41:19,820 But psychological disorders aren't like that, primarily because we have memories and we will always remember that feeling that we had, 350 00:41:19,820 --> 00:41:24,770 you know, that negative feeling, that experience that we had, whatever the context in terms of with food. 351 00:41:24,770 --> 00:41:29,660 And that will always be a possible trigger or might be triggered by particular things. 352 00:41:29,660 --> 00:41:31,010 So as Rebecca was saying, 353 00:41:31,010 --> 00:41:38,120 when there's always mindful that that time these things are not eliminated because we have memories in our memories for these things, 354 00:41:38,120 --> 00:41:41,540 some are imposed. If I know we're getting near the end. 355 00:41:41,540 --> 00:41:45,110 But the wider context, I think it's just interesting to think about Kofod, 356 00:41:45,110 --> 00:41:50,460 because in these animal models, what's been shown is that animals will demonstrate. 357 00:41:50,460 --> 00:41:51,480 Lack of eating. 358 00:41:51,480 --> 00:41:58,830 They will starve themselves to death under situations in which there is a relationship between the exercise that they're being allowed. 359 00:41:58,830 --> 00:42:04,110 They can be given unlimited exercise and limited periods of time with food. 360 00:42:04,110 --> 00:42:11,850 And even though there's enough food for them to eat, they will behave in a way that's just that that shows they're being disrupted by those schedules. 361 00:42:11,850 --> 00:42:16,890 And they will not eat enough. And in covered world, obviously, one of their big a big effects. 362 00:42:16,890 --> 00:42:22,200 I've walked into supermarkets where there is no food, where, you know, that we didn't know where we're going to get our food, 363 00:42:22,200 --> 00:42:27,750 where exercise regimes are being being challenged by being only allowed to go out once a day. 364 00:42:27,750 --> 00:42:33,030 But even those small changes in our big changes in our food consumption, on our scheduling of food, 365 00:42:33,030 --> 00:42:38,590 our scheduling of exercise, partly due to this this culture that we're in will have profound impacts. 366 00:42:38,590 --> 00:42:43,350 And so it's not it's not unexpected that people are reporting now that these that 367 00:42:43,350 --> 00:42:47,620 their feelings are are not what they expected and perhaps they need support. 368 00:42:47,620 --> 00:42:51,870 I did that answered maybe two questions there. Thank you. Thank you. Yeah. That's really interesting. 369 00:42:51,870 --> 00:42:56,640 Thank you. Definitely. You know, important to think about the current challenges that people are facing as well. 370 00:42:56,640 --> 00:43:05,160 Just one very brief question. I suppose, given the sort of impacts off of our wider experiences with food and why the food culture, it's you know, 371 00:43:05,160 --> 00:43:10,530 it's not unlikely that people who struggle with eating disorders are going to be interacting with others. 372 00:43:10,530 --> 00:43:16,860 He might be engaging in of dieting or high levels of exercise or restricting certain sorts of food, 373 00:43:16,860 --> 00:43:22,560 which might make it particularly difficult for people with eating disorders to live it amongst. 374 00:43:22,560 --> 00:43:29,250 And Debbie, outputted, if you've got any quick advice that you would give to people in that situation. 375 00:43:29,250 --> 00:43:32,910 I mean, I think it's a really toxic environment, isn't it? 376 00:43:32,910 --> 00:43:40,880 If you got an eating disorder and you're hearing about is how to get rid of that fact that you've put on during a pandemic, 377 00:43:40,880 --> 00:43:47,370 you must do these exercises and things. So you almost caught up in that then they're bound to follow that. 378 00:43:47,370 --> 00:43:51,540 So I think as friends and. Therapists, 379 00:43:51,540 --> 00:44:01,200 we should be helping people really to see that that's really unhelpful for them and not to take those cues and behave in that way because essentially, 380 00:44:01,200 --> 00:44:05,070 you know, it is fuelling their eating disorder. Actually, 381 00:44:05,070 --> 00:44:13,220 that the resources that Rebecca shared earlier for four loved ones of people who are struggling with eating hopefully would be very helpful there. 382 00:44:13,220 --> 00:44:19,720 So thank you all very much for a really interesting and informative discussion. 383 00:44:19,720 --> 00:44:23,670 It's so good of you to give your time. And I'm sure people have found it extremely helpful. 384 00:44:23,670 --> 00:44:29,670 So huge. Thanks. Also, thanks to those people who sent in questions and of course, massive thanks to Halie and Kyle, 385 00:44:29,670 --> 00:44:33,360 who've done lots of work behind the scenes to make this all happen. 386 00:44:33,360 --> 00:44:39,420 Just to highlight again that our next meeting will be on coping with trauma and that will be on the 6th of May. 387 00:44:39,420 --> 00:44:43,680 And we've also rescheduled the last session, which unfortunately we had to move. 388 00:44:43,680 --> 00:44:48,900 That was on overcoming mistrust and paranoia, and that will now be on the 20th of May. 389 00:44:48,900 --> 00:44:54,050 So hopefully we'll be able to join us for those as you leave the meeting. You'll get a chance to give your feedback, please. 390 00:44:54,050 --> 00:44:58,560 Do you share it? Because we definitely look very carefully at it and use it going forwards. 391 00:44:58,560 --> 00:45:07,530 And then final word just to say, please do take the next 10 minutes. So say to up to readjusts before things maybe kick off here again at one o'clock. 392 00:45:07,530 --> 00:45:33,427 If if your is full like that, say please take a moment, take some time, have a look at the resources that have been shared if helpful.