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We have normalised eating disorders

More than one in five older teenage girls in England suffers from an eating disorder. Credit: Getty

November 23, 2023 - 7:05am

Six years ago, I gave up drinking alcohol. I use an app on my phone to track it every now and then, and add another bad habit to relinquish: “problematic eating”, “hating my body”, or something along those lines. Within a few days, I always delete it. I know what not drinking is; when it comes to food, though, “problematic” and “unproblematic” are harder to define. 

According to a new NHS report into the mental health of children and young people, over 20% of older teenage girls now have a diagnosed eating disorder. It’s a staggering statistic, behind which lies an incredibly wide range of deeply distressing and at times life-threatening behaviours. I’m reluctant to compare it to the more everyday distress women like me experience around food (that which the writer Candida Crewe has dubbed “normal-abnormal”). I used to have a formal ED diagnosis and now, thankfully, I don’t. Even so, I feel a connection to these sufferers. When so many young women are struggling so much, it says something about the toxic air we all breathe. 

Various theories are being put forward to explain this week’s horrifying figures. Tom Quinn of Beat has said this shows eating disorders are “far more common than most people realise”. While he is rightly reluctant to point to one reason in particular, he suggests the impact of Covid-19, and the isolation and lack of monitoring experienced by many teenagers during lockdown. It’s appalling to think that, left to their own devices — or exposed to the messages they receive through their screens — so many will self-destruct. 

The disorders captured by the report do not just include anorexia and bulimia, but also other conditions included in the International Classification of Disease. When I see statistics such as these, there is a part of me that wonders, then, whether diagnostic expansion is also a factor. It is a sign of progress, for instance, that a very low weight is no longer viewed as necessary “proof” that one has a significant eating disorder. At the same time, while greater recognition of all the ways in which disordered eating manifests itself might increase the number of those being diagnosed, this does not make the overall numbers any less depressing. These are people we simply might have missed in the past. 

There’s a value in seeing the extent of the problem, though one could argue that 20% does not even cover it. Eating disorders are incredibly complex because they relate to our relationship with food and our sexed bodies, things which are always socially, culturally and politically loaded. 

At a time when more professionals are starting to ask questions about the function and purpose of mental health framings, perhaps we should even be considering the limitations of diagnostic labels for classifying such relationships at all. Right now, the crisis is surely too urgent to dispense with standard diagnostic practices. We should, nonetheless, recognise how porous the boundary between those formally diagnosed and countless other women might be. Indeed, understanding this porousness can form part of recovery. 

You cannot — as I have found with my app — simply opt out of a challenging relationship with food or how the world perceives your body, and you cannot control the latter by an act of will. You can only find people with whom you feel safe to inhabit the only body you’ll ever have. Alas, such things can’t be prescribed on the NHS.

What this latest 20% statistic shows us isn’t just that a particular cohort of girls is in crisis, but that severely disordered eating is in many ways socially and culturally embedded. Care must be taken in treating girls’ concerns seriously without making them feel they are uniquely, irrevocably broken. The situation is more complex than that. Even if — and hopefully when — they recover, it will remain so.


Victoria Smith is a writer and creator of the Glosswitch newsletter.

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R M
R M
7 months ago

It is very difficult to balance the medical imperative to treat and support people who suffer from a mental illness which can destroy lives with the equally urgent need to avoid pathologizing every instance of mental discomfort or unhappiness a person might suffer in their lives. Ultimately it benefits no-one except the pharmaceutical and wellness industries to define ourselves as psychologically sick all the time.
This is especially so in the internet-age when social capital is readily gained by presenting as a victim or sufferer. I wouldn’t pretend to be an expert, but I do have a teenage daughter and witness first hand how faddish contagions influence her peer group. From innocent fashions (a while back it was wearing school ties outside of jumpers) to dance crazes (Mrs Maisel) to despicable online pile-ons, these girls get so much of their reality from social media that bad ideas can propagate among them like an unchecked virus.
(In answer to the inevitable question: we use time limits, app and content blockers, and – we hope – constructive discussions about what is safe and appropriate online behaviour to try to help her navigate this world. But of course, there is little we can do if – for example – a classmate shows the other girls bad content.)
I don’t know the answer to all of this. Social media is not going away and extreme draconian restrictions on young girls (and indeed boys) are unlikely to either work or be healthy for them in the long run. Children have to grow up and then live in a super-connected world, pretending it doesn’t exist or can be kept away forever is unrealistic.
But I think it is always worth highlighting that it so often seems to be girls and young women who are bearing the psychological brunt of this tsunami of shit we call the internet. Its sadly no real surprise that this manifests in such high numbers of them reporting poor mental health in the circumstances.

Andrew D
Andrew D
7 months ago
Reply to  R M

Well said. Tsunami of shit indeed

Graham Strugnell
Graham Strugnell
7 months ago

It isn’t just girls. I get tired of the assumption that only females experience body dysmorphia, over exercising and food obsession. One in five anorexics is male. Please end this sexism, as if only women suffer in this world.

Adrian Smith
Adrian Smith
7 months ago

Indeed, we must not forget about the boys. However there are many factors which means mental illness impacts girls more than boys – we can see this clearly in the explosion of girls wanting to become / thinking that they are boys, to cite just one more example of a recent mental health issue that impacts girls more than boys. Those who try to pretend that gender incongruence is real and natural, rather than a mental health issue it truly is are mostly harming girls, but we must not forget about the boys sucked in by it too.

Allison Barrows
Allison Barrows
7 months ago

The first time I ever heard of bulimia was from my roommate’s little brother, who was on his high school wrestling team. Binging and purging was a regular and accepted practice for keeping to the stringent weight requirements of the sport. I later learned that lots of male athletes in other sports did this, too. When the season was over, so was the vomiting.
This author has written before about her anorexia (she was quite a mean girl, as she admitted in one article), and now we learn she has a drinking problem. Will we later be told she’s also struggling with her “gender” identity? Some people are emotionally fragile. Rather than helping those who suffer, the “helping” professions help themselves, and the problems thus become a lucrative crisis.

R M
R M
7 months ago

Will we later be told she’s also struggling with her “gender” identity?

Given Victoria Smith’s published views on sex and gender, I think that’s very unlikely.

David Morley
David Morley
7 months ago

When the season was over, so was the vomiting.

Surely that’s not bulimia then.

Rasmus Fogh
Rasmus Fogh
7 months ago

When I see statistics such as these, there is a part of me that wonders, then, whether diagnostic expansion is also a factor

Absolutely.

In fact when any such number (eating disorders, sexual assault, racist slurs, …) hits 20% of the population, should we not stop talking about ‘disorders’ and instead discuss why this is part of normal life, and how we should deal with that fact?

Dominic A
Dominic A
7 months ago
Reply to  Rasmus Fogh

We, the people, need to better understand naming/diagnosis – what it does and does not imply (as you say they are often very much a part of normal life… whilst also being sub-optimal – literally a disorder). They do not make you special; we may need to curb the ideas that a diagnosis justifies special dispensations, or should form a big part of your identity, or that it’s successful treatment will somehow save you, or deliver you to the mythical sunny uplands of Normsville.

Rasmus Fogh
Rasmus Fogh
7 months ago
Reply to  Dominic A

Fighting the over-diagnostication might be better – it sounds close to impossible to avoid “the ideas that a diagnosis justifies special dispensations“. After all, if a doctor says you are sick, surely you are entitled? Regrettably, it looks like a case of all-or-nothing. Either everubody with a diagnosed eating disorder (or Autistic-spectrum disease) getes special consideration, or nobody does (not even the minority who definitely needs it).

Dominic A
Dominic A
7 months ago
Reply to  Rasmus Fogh

In the UK at least, money is the great decider – you don’t get much treatment on the NHS unless you are ‘climbing up the walls’. The problem here is more likely under-treatment and to a lesser extent under-diagnosis by stressed professionals desperate to contain their caseloads (maybethe NHS is going to have to be an emergency service only, if costs and expectations keep climbing). Much of the over-diagnostication is either non-professional or from private practitioners – i.e. ‘motivated reasoners’. Good luck telling private payers and private pracititioners what they are allowed to do.

Rasmus Fogh
Rasmus Fogh
7 months ago
Reply to  Dominic A

Money or not, a diagnosis does get you special treatment, attention, consideration, extra time for exams. A (second-hand) quote from a student with ambitious parents to his tutor: “Which diagnosis would it be most useful for me to have“?

Last edited 7 months ago by Rasmus Fogh
Dougie Undersub
Dougie Undersub
7 months ago

Rather like the tax regulations, the handbook of mental illness diagnosis gets thicker and thicker with every new edition.
https://www.psychiatry.org/psychiatrists/practice/dsm
The psychiatric/psychology profession seems intent on medicalising every possible way of feeling a bit sad and fed up. It must be resisted.

Dominic A
Dominic A
7 months ago

It does; but it may be that the harm of this plays out better in a newspaper article than in clinical reality. The DSM is really an American tool, mostly for health insurance reimbursement, research, and as a guide to treatment options. It’s not much used in clinical practice in the UK/Europe (we look to the much slimmer ICD).

There has been a similar kind of process with medical innovation/labelling over the centuries – ‘all those fancy latin names, it’s just a cold’; ‘in my day you took an aspirin and got on with it’ etc. Similarly, the over-reaches, over-treament in medical matters are often driven by the American system (take a look at their spending…I had more healthcare $ spent on me in my first 2 years of living in the US than in my previous 30 in the UK); or by individuals obsessing over health (mental or physical), parents demanding diagnoses of neurodiversity, journalists & historians diagnosing the famous etc.

Martin Smith
Martin Smith
7 months ago

Just so, and in alliance with a pharmacy eager to patent ‘medications’ for every new ‘condition’ ‘discovered’, or even developing medications in advance of the ‘discovery’ of the condition it all too conveniently ‘treats’.

Drew Gibson
Drew Gibson
7 months ago

At the other end of the scale (groan!) around 9% of older teens are obese and 20% are overweight. Does this mean that around 40% of young people have ‘issues’ with weight and around 30% have serious problems? I’m raising the question but I’ve no idea where to go with it.

Steve Murray
Steve Murray
7 months ago
Reply to  Drew Gibson

The easy recourse to cheap calories, and the inability of many of their parents to cook properly (possibly due to work and other pressures, such as being obese themselves) plays a significant part in the obesity issue amongst teenagers.
Not becoming overweight when faced with poor diet can become a real struggle for many teenagers – and in particular girls – due to growth and hormonal changes where body fat is changing their appearance. I guess it’s so easy to either go overboard in trying to stop this process – which used to be through excessive dieting but now also manifests itself in the trans phenomenon – or give up entirely and just put the weight on.

Jane Davis
Jane Davis
7 months ago

If you have a social life based mainly on objectification, this is the result. And objectification is a natural human tendency but, unlike, say, racism. assessing people primarily on their appearance is seen as normal and healthy.

Paul Nathanson
Paul Nathanson
7 months ago
Reply to  Jane Davis

That doesn’t quite answer the question, Jane, of why eating problems affect specifically women (in addition to men). Not being an epidemiologist, I can only speculate.” But I suggest that “objectification” is an unlikely cause of any sexual differential.
First, “objectification” is not, and should not be not be used as, a synonym or a euphemism for degradation due to sexual attraction (although feminists insist that it is and apply the word only in connection with misogyny). Humans are by nature attracted physically to some people more than to others. And it is therefore in the interest of everyone to be physically attractive.
Moreover, the very act of sexual intercourse actually requires temporary “objectification.” Human existence would be impossible, after all, if every interaction had to be simultaneously physiological, emotional, intellectual, spiritual and so on. Most interactions, in fact, must be relatively superficial. How else could we do business or have jobs?
And “objectification” is not analogous to racism (ethnic repulsion). The latter is inherently evil, after all, and the former is not. .
In any case, both sexes are “objectified,” sometimes in similar ways (attaining superhuman physical prowess, or at least the look of it, being a counterpart for male people of attaining superhuman beautify for female people) and sometimes in not-so-similar ways (wealth and high status being the counterparts for male people of charm and fecundity for female people).
Eating “disorders” have occurred historically and cross-culturally, though to what extent in other times and places we can hardly know Given the fact that most people have had too little food, I suggest that (what we now call) anorexia was uncommon. Given the fact that elite people have had too much food, on the other hand, I suggest that (what we now call) bulimia was not unknown. (The Roman elite used to vomit after eating several courses and then cheerfully continue with their feasting.) Both conditions and similar ones have often been attributed to religious devotion (monastic or other forms of asceticism) and supernatural causes (such as possession by spirits) rather than to personal emotional problems or political tyranny of one kind or another.

David Morley
David Morley
7 months ago
Reply to  Paul Nathanson

Moreover, the very act of sexual intercourse actually requirestemporary “objectification.”

I found this quite odd. Obviously some sex is like this, and couples play at objectification because one or both find this exciting. But isn’t it normal to be emotionally engaged? If you look into a lovers eyes as they look into yours you are surely not objectifying them. Surely it is just the opposite: you are more fully aware of them as another person than at almost any other time.

Paul Nathanson
Paul Nathanson
7 months ago
Reply to  David Morley

One impulse doesn’t exclude the other, David. Sexual intercourse has many functions. It includes many experiences, emotional, physical, spiritual even mystical. Part of all that, a necessary part, is one physiological process. Many women don’t like to acknowledge that, but many men do.

Last edited 7 months ago by Paul Nathanson
David Morley
David Morley
7 months ago
Reply to  Paul Nathanson

Now I think you’re agreeing with me.

Paul Nathanson
Paul Nathanson
7 months ago
Reply to  David Morley

Yes, David, I do agree with you in a way, as I often do.
My point was only that the sine qua non of sexual intercourse is a physiological reaction or process, which necessarily involves temporary objectification. I see nothing inherently wrong with that. It’s the way we’re built. But it’s hardly an ideal worth striving for. That’s where culture comes in. Partly to support the family as an enduring arrangement for children and thus perpetuate the community, culture interprets, elaborates on and emotionally or spiritually enhances what would otherwise be a purely natural process.

Last edited 7 months ago by Paul Nathanson
Martin Smith
Martin Smith
7 months ago

With very limited food to eat, and very few men to defend them, the young women of today will find the future immensely challenging.

Jenny Caneen
Jenny Caneen
7 months ago

I’ve been teaching since 97 and have seen an enormous increase in official, documented “issues” that students present to the instructor at the beginning of the semester. Of course we want to accommodate all students, but the exponential growth in pathologizing every imaginable problem isn’t helping young people learn how to negotiate the inevitable difficulties of life.

Last edited 7 months ago by Jenny Caneen