More and more young people are struggling with mental health problems, including eating disorders. A medic explains what causes them, whether they are curable and how family and friends can help. Berlin (dpa) – Food. We can't live without it, and eating is one of life's greatest pleasures. Yet for many people, preoccupied with their weight and body shape, it's a source of emotional stress that can seriously damage their physical and mental health. Long-term observational studies in various countries show a clear increase in eating disorders, in particular anorexia nervosa, since the Covid-19 pandemic, says Germany's Federal Institute of Public Health (BIÖG). They typically emerge in adolescence and young adulthood, mostly among girls, says the World Health Organization. What's behind the increase in this mental health condition and, more importantly, what can relatives of people with an eating disorder do to help? Here are answers from Dr Stephan Zipfel, medical director of the Department of Psychosomatic Medicine and Psychotherapy at Tübingen University Hospital in Germany: Why do so many young people have an eating disorder? For about the past 20 years, mental illness in general has been rising worldwide among young people, especially in industrialized countries. Possible reasons include megatrends, societal change, social media, war and climate change, write researchers from The Lancet Psychiatry Commission on youth mental health. "These developments lead to rising distress, alienation and loneliness," Zipfel says. "The overall situation, particularly for adolescents, was growing more stressful even earlier, and the coronavirus pandemic, along with accompanying preventive measures such as lockdowns, have caused a marked further rise." Being spatially and socially isolated within one's immediate family during the pandemic led to more stress and conflicts, especially for people who were already stressed, he says. Above all, he goes on, "there were no – or very limited – opportunities to associate with other adolescents, and a lack of in-person contacts with persons of trust outside the home as well as socio-pedagogical workers and teachers." What's more, counselling and treatment services that could have addressed mental health issues early were unavailable. "This created an extremely toxic situation in which the affected persons developed a pronounced eating disorder," Zipfel says. Why do people develop eating disorders? Roughly speaking, it's about control over your sense of control, as Zipfel puts it. "There's a group of people who, if they feel their life is slipping out of their hands, try to get a grip on it again by controlling their eating behaviour, their weight." Also playing a role, he says, is that appetite, in conjunction with body weight regulation, is, via evolution, a very deeply rooted basic need. "Only a small group of people are able to circumvent this basic need. For them, experiencing this control feels good at first." What then happens is that "the person's self-esteem, self-image, increasingly depends on controlling their appetite." Zipfel describes this dependence as "I-syntony, that is, it's connected to – actually almost baked into – the person." At this stage, there's a risk of the disorder becoming part of their personality. How do you overcome an eating disorder? Even severe cases of eating disorders are treatable, Zipfel says. Referencing a follow-up study of a clinical trial on psychotherapy for anorexia (trying to keep one's weight as low as possible) in which he participated, he says 41% of the patients – all female – were classified as recovered five years after therapy ended. "This means they displayed no symptom shift either. Neither were there abnormalities as regards eating behaviour, nor other mental illnesses." The recovery process usually isn't a smooth path, however. Zipfel therefore recommends patients and medical practitioners jointly devise an overall treatment plan early, by discussing the steps necessary to overcome the eating disorder. Techniques that strengthen patients' therapy motivation are especially helpful. But these initial steps, too, can be difficult and painful. "A big reason that eating disorder sufferers are ambivalent about undergoing therapy is knowing it's aimed at making them part with their ability – which stabilizes them – to control these very basic needs to a certain extent." Consequently, they relatively rarely have the desire to address their anorexia. "People with an eating disorder don't necessarily seek help, but rather tend to isolate themselves," says Zipfel. "Dealing with this is a challenge for family and friends." What can family members and friends do for someone with an eating disorder? "It's important they know that they aren't solely responsible," Zipfel says. "If you're a parent, you're naturally in a different position to a teacher or friend. So you've always got to see who can assume what responsibility." Sometimes, he says, friends feel that they're responsible, since the affected person doesn't speak with their parents. But "this would be an excessive burden," he says. What you could do, though, is to say, "Let's go to Ms X or Y, our school social worker, and talk with her." He also recommends counselling centres: "They offer relatively low-threshold services and provide a professional framework within which affected persons can receive initial support." How should you best broach the subject of professional help for the person affected? It's very important to not be reproachful or scolding. Even well-intentioned advice is often rebuffed, Zipfel says. A solicitous approach by someone who has some sort of relationship with the person affected is more likely to be effective. "If you have a relationship – of whatever kind – with them, it's important to first say something like, 'I've noticed you don't seem to be doing well. This pains me, and I'd gladly help you.'" It's not unusual for the person to then brush you off because their eating disorder is often a desperate attempt to solve a problem they think they have, and not something akin to a next-top-model aspiration run amok, Zipfel says. With this in mind, "you can better understand the person's plight and suffering, and then better deal with a nasty reaction." The following information is not intended for publication dpa/tmn lue xxde sw ob arw
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