 Hello! Today I am talking about adults and eating disorders because I've been asked to talk about it quite a lot of times and I've been, I don't know, scared or anxious or something. It's a tough one because a lot of it's drawing on my personal experience and as you know I work really hard to kind of break down the stigma of talking about mental health and feel we should be really open and honest about it but that's quite hard. But it's Eating Disorders Awareness Week here in the UK and I thought if not now then when? So adults and eating disorders. This video will go a little bit all over the place because there's lots of different things that I want to think about and as ever my thoughts are evolving as I go. If there are things that I don't answer, if there are questions you still have after this then do leave them as a comment and I'll look to address them in a future video. Also when I put this video together I will leave some timestamps to help you jump to relevant parts of the video if you don't want to watch the whole thing. So look down in the description on YouTube if you want to jump to a specific part. Okay so let's start off with adults and eating disorders. Now the first thing is just to point out that adults can suffer with eating disorders. We can be affected. Eating disorders are not simply a teenage thing. So the teen years are a peak age of onset and lots and lots of treatment and research and everything is geared towards teenagers because these are where eating disorders often get picked up and it's often where they begin and if we're able to have good input at that point then it can arguably prevent someone from having an eating disorder throughout the life course. However not all eating disorders start in the teen years. I mean mine started younger but for some people it can start much later so I have a very good friend who is really really struggling with anorexia. She will know who she is and I'm thinking of you and this was something that came on much later in life in her 30s having not had an eating disorder in the past as far as I'm aware. So it can come on at any time and we know they can affect right through the life course so it's really important to understand that. It is possible to have an eating disorder at any point throughout your life. The next thing to be aware of with adults and eating disorders is one of the things with teenagers and eating disorders is they've got all these people around them who are perhaps aware that this is a possibility and looking out for them and picking up warning signs and perhaps urging them into support and treatment if that seems necessary. As an adult you don't have so many kind of keepers and caregivers in your life and it might be that you are in a relationship you have a family of your own at this point and perhaps they might raise the alarm if there are concerns or perhaps you've got friends or colleagues who might pick up on these signs but it's a bit different you know when you're a kid at school you've got these kind of supportive adults in your life whose job is kind of to look out for you and so they might pick up these signs early they might you know feel the need to do something and it's quite clearly their role if a young person is suffering their parent knows it's my job it's my responsibility to do something about this. However if you're an adult the lines are a bit blurred I mean is it appropriate for your partner to say that they're concerned should your colleague try and raise the alarm if they're worried about you. Lots and lots of questions here and so it might not get picked up and the other thing is that if you have had these difficulties over a long period of time you might become really really good at masking them or hiding them it might be that you're ashamed or embarrassed about these behaviors or that you've had these behaviors and these thoughts and these feelings for so long that they don't even seem unusual to you anymore so an example here for me would be it's only in the last 18 months or so that I've stopped being really regularly sick I used to be sick through anxiety a lot and it kept my weight really you know artificially low and I didn't realize that that wasn't a normal thing and I guess if I'd really thought about it I'd have known it's not normal to be sick anytime you feel anxious because you're full but I don't you know it literally happened for decades and the more you do something the more habitual the more normalized it becomes and so you don't worry about those behaviors anymore this is true for other things too not just eating disorder behaviors it can also be true of self-harm type behaviors of kind of forms of self-neglect it can also be true also some of the thoughts and feelings that come along with things like depression or anxiety lots and lots of things can become normalized and the longer this has gone on for the harder it can be to break that cycle but also the less likely we are to recognize that this is a problem because it's been such a long time so yeah so it can be hard to like make those initial steps so I guess one thing here is trying to give permission to you if you're concerned about an adult you think they might have an eating disorder it's okay to start that conversation and you know it might be really awkward you might not know what to say you might be worried that you're you know treading over a line that's not appropriate you might be met not necessarily with open welcoming arms this might be a tricky conversation it might be met with sadness or anger or kind of yeah you might be pushed away but it's a really important conversation to have and sometimes the way that that is initially met is something that will mellow over time and someone with an eating disorder might become more open to the idea of having support and input from you as a friend as a partner as someone else who cares about them so yeah adults can suffer with eating disorders we're not so likely to get it picked up because we don't have people with a clear defined role of kind of parent in our lives so those things are important the next thing is that as an adult with an eating disorder depending on kind of what our lifestyle is and where we are in our kind of life then we might work really particularly hard to mask the eating disorder to protect those around us so for example myself as a mother as a wife as someone who was employed it felt really important to me not to let other people in on what was going on I didn't want to impact on my children negatively I didn't want my husband to worry about me I didn't want my employers to think that you know I was any less of an employee and so I had lots of reasons to kind of try and say face if you like and in fairness I think also for me at the beginning of this kind of major relapse there was also quite a lot of lying to myself so I was essentially lying to everyone around me but also myself but this was because the stakes were really high I had a great job that I loved I had great friends I had a wonderful husband fantastic kids and I didn't want to lose any of that and it's quite scary to admit that you know things are going badly badly wrong so you might find you know this isn't just me this is something that I think adults find particularly that you're really motivated to mask so when you are younger and you have something like an eating disorder yes sure you might try and hide it but that's usually about protecting the eating disorder behavior that you don't want to give those behaviors up that it's kind of it can really kind of warp your your thinking and you try and protect it but as an adult those motivators are a bit different it might be partly about protecting the disorder behaviors because something about those behaviors are meeting a need but there's also this need to appear okay to the world because you need to do that in order to keep getting your paycheck in order to you know not risk having your children taken away from you in order not to lose someone who is perhaps an important part of your life so there's a lot of masking that might be going on and it can take quite a while to unlearn that behavior of masking everything and to begin to be more open and honest with what's going on so it can take a while to like delve beneath the surface there so yeah I think masking is probably something that happens more with adults not to mean it doesn't happen with with younger people too another really significant area I think we really have to think about when thinking about adults with eating disorders in particular is those of us who have got children in our lives so in my instance I have two daughters and I know many other people who have eating disorders as adults who have got children either directly or perhaps nieces and nephews and that kind of thing but essentially you're a trusted adult in the life of young people and then this comes with a huge fear of what if I pass these behaviors on like the fear that you have as a parent that you're gonna mess your kids up by the way that you think and be and do is is massive and not to be underestimated at all and one of the things I think we really need to do when we are supporting adults in recovery from eating disorders is actually to teach them how to do parenting how to act around food and weight and shape and exercise in a way that is healthy for their kids so I'm really lucky because I teach about this stuff all the time and actually throughout my eating disorder I have always known what I need to do in front of my kids and that doesn't mean so I've got it perfect not by any means but I've kind of been able to fake it to a certain degree I think and that's been really important to me and actually for me in recovery one of the major motivators for eating a wider variety of foods and eating healthily and well actually just eating has been being able to sit down as a family with my kids and to eat healthily with them and to enjoy food with them it's been a really really big motivator but it can be a massive stick to beat ourselves with if we know that we are not able to eat well to eat healthily to make good choices if we know that we have a really negative body image or our self-esteem is really long really worried about what are we role-modelling to our kids so I think guidance and support in how to support our kids how to parent around this stuff is really helpful and helpful to do that like as a family and for partners to be involved with that and that kind of thing too I think it can't be underestimated how stressful this is and it might not be a primary concern that people come up with but you know it I know it it nags I think the other thing is it's really important actually to share with people how resilient kids are because again I think that we worry that we're marking our kids up when we have these issues and this is going to be irreversible and the thing I've learned actually is my kids have been amazingly resilient and this is a story here time and time and time again and when you look back and you reflect on this period their memories of it are so different than mine so one of my kids recently said to me mom I wouldn't ever want you to be in hospital again because you know I wouldn't want you to be that ill but it was so cool when we got to ride around in your wheelchair and we got free hot chocolate it was brilliant and I just kind of thought wow it's really cool actually that that's the bit that you took away and that you know even in that really dark difficult time there were some moments you know little happy moments that my kids were able to pick out from that and the other thing is that you know at its most basic I knew that my kids always knew they were loved so even when I was two weeks to do anything other than lie in a bed my kids would come and visit me and they would get in the bed and lie with me and they knew that I loved them and of all the things that you can give to your kids your love is the one that is irreplaceable and most important and yeah the time I spent a lot of time beating myself up about what am I doing to my kids I'm not home I need to you know need to get myself sorted so I can go and be a parent but you know what they're brilliant and they have bounced back remarkably and this is something we do see kids are remarkably resilient the other thing is the need to set like realistic expectations when it comes to parenting and I think this is something that should be actively explored with any adult who's suffering with an eating disorder who's a parent because when we suffer with an eating disorder quite a common issue that we have is this perfectionist tendencies so particularly in anorexia but sometimes the other eating disorders too we can be quite perfectionist we have these unrelenting standards so the same things that drive us to want to be the very thinnest or the very fittest or to eat the very least and want to achieve really highly and we see this come across other domains of our life as well so in younger people we see it come across academically in adults often it will happen in work you know we'll be real workaholics and always want to work to a really really high standard and those same things apply in our parenting too and actually we often will think that if we are not parenting at the highest possible level if we're not living up to all the Instagram and Pinterest ideals of parenting that we're failing and actually nobody is living up to those standards and we know this we know this of course we do on a like intellectual level we know that people share the idealized versions of their life but that's the version we want to be living that's the version we feel we should be living and if we're not doing that perfectly every day we will beat ourselves up so we need to learn it's not appropriate to have these standards we're not going to live up to them and not living up to them is not akin to failure and that's something that really really needs to be explored what does parenting really look like what are the normal ups and downs of parenting how forgiving should we be of ourselves what do we actually need to do in order to be a good parent I think generally having some input around parenting could be really really constructive to enable us to be more forgiving of ourselves and just allow us to be a bit freer and have more fun in our parenting and not feel that it has to be perfect all the time I mentioned in the last point a little bit around unrelenting standards and how the perfectionist tendencies that can sometimes come with eating disorder can translate to other domains of our life and this again is something to be aware of in adults with eating disorders so this is something that I struggled with myself and I've spoken to many other people for whom this was the case where those unrelenting standards did translate to the workplace or it can be study as well so you are not ever giving yourself a break you're working maybe crazy hours you are trying to be at this level all the time only the very best is good enough you feel like you have to be on top of everything constantly and actually what tends to happen and I found this quite a bit talking to people who have yes similar experience of adult eating disorders you generally really good at what you do because you work really hard you put so many hours in you're probably barely sleeping and like prioritizing work perhaps above like everything else and you have that kind of often if particularly with like anorexia you have this nervous energy all the time and if you put that into work like actually in the short time you reap these massive benefits of doing really well so like you know people often assume I'm older than I am because I achieved a lot in my career quite early on and people used to joke and say how do you get so much done how are you so productive and I used to joke and say well I don't sleep and I'm really obsessed with work and people go haha well done and actually you'd receive quite a lot of praise for it but working a 90 or 100 hour week to the exclusion of all else and beating yourself up when you don't achieve the highest standards all the time that's not healthy and actually when I kind of finally entered into therapy and everything fell apart and we had to build it back up again one of the important things I had to do I had to learn to redevelop my relationship with food but I also had to learn to redevelop my relationship with work my therapist picked up pretty early that my relationship with work was as dysfunctional as my relationship with food and actually as harmful as well and that was really tough because a bit like in the early stages of an eating disorder sometimes when you're really controlled around food or people notice that you've lost weight or you look stronger and fitter those kind of things you can get really really positive feedback and it's the same with work you do really well you seem to work really hard working really long hours and not sleeping much is something that people praise I don't know why but they do and so you get really positive feedback and so recalibrating that and going hey do you know what I'm gonna work just a reasonable amount I'm gonna work to live not live to work and I'm gonna say good enough is good enough and and yeah it's that's hard but yeah so again I think that's something to be aware of because I think again sometimes we find that when we remove one unhealthy coping mechanism so the food maybe you might stop binging or purging or restricting or whatever your unhealthy relationship with food is sometimes we find that other things jump in so that can be kind of drug use or alcohol misuse or self harm but equally it could be this relationship with work so again I think this is a really important thing for us to have a look at critically and go you know when working with adults and supporting adults with eating disorder what's the relationship with work like is it healthy how can we help to recalibrate that and next thing to think about for adults with eating disorders is the impact I'm thinking particularly with anorexia here but the impact of having a starved brain when you have adult responsibilities so one of the really tricky things when you don't eat properly is that you can't think properly and often sleep disorders come alongside eating disorders also so you might have a undernourished and underrested brain and it's basically like having the cognitive capacity of a small child but you perhaps have you know a family and a job and all these responsibilities that you have to be keeping up with and you're trying to do that whilst basically having like the cognitive function of like a five or six year old or something with really black and white thinking and very difficult to try and think in depth and process things so everything becomes much much harder but that's coupled with perhaps these unrelenting standards are needing to achieve really highly so that's really tricky and we need to think about that as well during the recovery process that you know as we're refeeding and that cognitive function is kind of gradually getting back about what adjustments we might need to make in terms of our expectations of self or the expectations we place on someone during illness and recovery because it's really hard to do adult things with a child brain basically so again just recognising that sharing a bit about the biology helping people to understand the very simple thing that your brain is tired and it hasn't had enough fuel it's not going to work well and forgiving ourselves that we might not be able to do all the things that we want to to the level that we want or need to be able to do them in the short term we can usually manage but when it's chronic then it becomes much much harder to function at those higher levels. Another thing I want to talk about in terms of adults with eating disorders is one of things I found really tough was being lumped into group therapy with people who were at a completely different stage in their life than me and by that I mean people who were teenagers and don't get me wrong I have made some lifelong friends through treatment however when you have a group of people together and there is such different stages in their lives it's really difficult to create an atmosphere and discussion that feels relevant to everyone in the room so in particular I can remember being inpatient and the discussion would often I never participated this is a whole different thing so I'm autistic and group therapy just was not helpful for me but that's a whole nother video but I would sit and listen although I couldn't participate and the discussion so often would devolve to blaming of parents and how people felt their parents had had a really negative impact on them and that might have been partly about how I was interpreting it but certainly the role of parents was significant and learning to redevelop relationships with parents was a really key thing and the role of family in supporting recovery was really key and I'm sat in there and I'm thinking I am old enough to be your parents and I am a parent and I'm worried about the impact my eating disorder is having on my children already so actually far from being helpful this discussion would often make me feel very very very much worse because I would be sort of hearing this negative discourse about parents whether that was right or wrong or indifferent but yeah the people I was in group therapy with were in such a different place it didn't make sense for us to be in a group together and sometimes it makes sense because perhaps you're learning a skill and you know that skill might be something that anyone could learn at any age so say mindfulness but when it comes to actually picking stuff apart and yeah understanding relationships and stuff I really felt this was not helpful and I can't imagine it would ever be helpful to mix people together in that way maybe you might disagree with this and do leave a comment down below if you think maybe there's something to be said there maybe if I felt able to contribute to that group maybe I could have been the voice of the parent and I could have talked about it from the other point of view and helped to spin that discourse around because again we know that parents are one of the really great supporting factors in helping people to get better from eating disorders and that takes me on to another point so what we know to work in terms of treatment for eating disorders families are a really key part of this and parents in particular having that supporting adult role who can be caring and yet challenging is really important if you're an adult with an eating disorder you don't have parents to do that but maybe have a partner and does the partner then take on the role of parent is that appropriate what does that do to your relationship what does it do to your partner you know what happens there but equally maybe you don't have a partner and then who takes on this role and what can work for you and so yeah thinking about that thinking about the the right treatment pathway if you have a partner or if you're alone and what that looks like and how we can build this support network when we haven't got parents to rely on to fulfill that role again I think thinking carefully about the role of the partner during recovery is really really important and also thinking about the toll that this can take on the partner but thinking about the short term the medium and the long term in terms of your relationship because again I've known lots of partners of people with eating disorders and it can be so so tough for them and often just like parents they really really really want to help that they often don't know what they can and should do in order to help so really clear guidance and support for them would be really helpful so I was super lucky because I studied my PhD under Janet treasure who is like the rock star of the eating disorder world and when I have my relapse then she actually sat down with my husband and gave him some really good input right at the beginning and he was also able to get some counseling input and that kind of thing too and that all really really helped he also had access to my massive library a lot of which is related to eating disorders and so he became very clued up and actually he was a really major part of me being able to get and stay well so the role of partners really really significant and for someone who doesn't have that significant other in their life thinking about well who does form that support network and who can help us in recovery and how do we build those people into our recovery in a meaningful way the next thing is thinking about recovery so moving perhaps from an impatient stay or an intensive program to where you might be expected to manage at home I literally spoke so much the battery ran out on the camera so sorry if the framing changed slightly okay so I was saying we need to have a think about what role as an adult I should be playing in terms of things like planning and preparing my own food and eating should I be eating supported and that kind of thing so when we are working with teenagers then we would be hoping they'll be returning to an environment where supporting adults would be helping them with the process of eating and planning and that kind of thing but as an adult then you know I might be left to my own devices here it might be again that we involve a partner or another significant person but it might be that we're returning to our own home and we just need to think carefully about what that looks like in terms of recovery and yeah what's appropriate there and what is an appropriate amount to expect of ourselves because it's very very difficult when you get to the point where you are in charge of your own meals and you are given responsibility for that because the eating disorder bully jump straight in they're going hey no one will know no one will know if you cheat no one's gonna know and the temptation to do so is incredible and certainly for me that was a significant issue that kept on resulting in relapse because I would say hey leave me alone I want to be responsible for this myself I'm an adult you can't tell me what to do let me get on with this hey look I've been eating and it was all lies and yeah so actually actually you know when it came to it in the end I had to really allow my husband to have a more significant role and I had to get to a point where I was really really honest about when things were working and when they were not and when I needed extra support and all that kind of thing but essentially I needed parenting through the early stages for sure and still every now and then you know I will have to say to my husband it's a really tough day could you eat with me and we can do it in a really nice way we just you know just have a normal meal together and it doesn't have to be him breathing down my neck making sure I eat but I just sometimes know that if I were left to eat on my own that I might not manage to do that or it would be significantly harder so yeah having to think about what this looks like for a adult as opposed to a teen where you don't have those parental figures there to support you another thing to think about and I kind of mentioned this a bit earlier is when we're working with adults with eating disorders is actually going back to basics and beginning to understand what is normal so sometimes adults who are being treated for eating disorders might have had eating disorder thoughts feelings or behaviours like throughout their whole life and perhaps they're only getting treatment now either because things have got worse or maybe they finally feel able to make a change but it's possible this has been going on for a really incredibly long time and they've completely lost sight of what's normal like what's normal in terms of you know what I should weigh what should a portion look like how much should I exercise how do people do life you know there's so many things that we might have been doing in a distorted way for a really long time so I think yeah having that permission to go back to basics and really explore what does normal look like what what is okay what should I be aiming for is is really really key so for me an example here so I gave the example earlier about how I used to be sick a lot but the other one was I had a complete misunderstanding about what healthy weight should be for my height and that was clearly at some point you know I've made a decision on this or you know been given a target by psychiatrists probably when I was you know like 12 or something and I stuck with that amount and then in adulthood going through like recovery intensively this time and sitting with a nutritionist and the dietitian and the psychiatrist and the psychologist everyone all on board with me and actually realizing we need to revise what normal looks like here because the weight that you've been maintaining all your life is like a stone lower than it needs to be and that's a big thing to come to terms with so yeah again like recalibrating looking at normal understanding what's normal what's okay exploring that so I think much rambling later I might be at the end of what I have to say about that I mean I'm sure there are many more things I could say and and hopefully you'll have questions or other experiences you want to share and do leave them as a comment because now I've started talking about it having not done that so much I feel like I could talk more but I don't know what you want to hear so yeah do ask stuff do share your experiences your ideas as well what do we need to be thinking about when supporting an adult with an eating disorder versus a child or young person I really hope it was helpful and I think to be honest whatever topic I'm talking about and whatever age group I'm talking about it always comes back to the same thing if you are the person supporting the most important thing you can do bar none is just to stop and to listen because an adult with an eating disorder they might not have all the answers but if you sit and you listen and you support them through really actively listening and letting them tell their story you can begin to untangle it together and lots and lots of these different things will begin to come out and by listening by really taking time to understand that individuals journey their story then we're in the best possible position to help them there is no one-size-fits-all solution so yeah granted hopefully this video gave you some ideas of things you can consider when supporting adults but you know the person who is the expert in the person that you're worried about is the person who you're worried about so talk to them listen hear what they have to say let them tell their story thank you so much for watching I hope it was helpful do leave comments or drop me a line if you've got suggestions for future videos or questions or comments or anything and if you found this in any way helpful please do subscribe I'm trying to work really hard to create better content for you and I'm releasing it on Tuesdays and Fridays and I it means a lot to me when you subscribe I do notice every single new subscriber so thank you okay speak to you soon bye