Anorexia has gathered considerable media coverage over recent years. BBC’s Louis Theroux: Talking to Anorexia, saw the presenter drop his usual deadpan act as he met the women spending their lives in London’s largest eating disorder facility. Netflix’s To the Bone, saw a jaded 20-year-old anorexic played by actress Lily Collins (who too suffered from the disorder as a teenager) find inspiration to recover thanks to unorthodox psychologist Keanu Reeves. On top of this, the body positivity movement and discussions surrounding body image have never been more writhe in the media as they are now.
With such mainstream attention, you wouldn’t be blamed for believing that our society has a firm grasp of how this eating disorder manifests itself and therefore how to treat it. Yet, while feature films, documentaries and airtime discussions can be credited for attempting to expose the ugly truth of an illness long misunderstood as being a product of vanity, critics argue anorexia remains to be one of the most misunderstood mental illnesses of our time; causing dire consequences for those who suffer from them.
Journalist and TV presenter Mark Austin has spoken out about the difficulties he experienced when his eldest daughter Maddy developed anorexia. In his recently published book And Thank You For Watching, the Sky News reporter admitted he didn’t understand the illness, and how at the time he felt it was ‘crass, insensitive, selfish and pathetic’ of his daughter. He wrote how out of desperation for her to ‘snap out’ of the disease, he would try and force feed his teenage daughter. When that inevitably failed, he, now with regret, told his daughter: ‘If you want to starve yourself to death, just get on with it.’ As an anorexia survivor, I can say first hand that this family narrative, no matter how loving and secure, is not uncommon.
The treatment available under the NHS doesn’t appear to be providing any more stability to sufferers. Last month it was reported by The Guardian that since 2016, the severe shortage of NHS beds and specialist eating disorder staff has forced over 100 severely ill patients to be sent from their homes in England to Scotland for treatment. This is not only costing the NHS millions of pounds annually, but increasing feelings of isolation among patients, which, as confirmed by mental health experts, reduces patients’ chances of recovery, which only means more money spent.
A nationwide survey by UK eating disorder charity Beat reported that those suffering from an eating disorder, particularly young girls and women who make up 90% of those diagnosed in the UK, feel let down by the system. Findings showed how 30% of sufferers are not referred for specialist treatment by their GP after the first initial appointment. Reasons for this include not being underweight (part of the diagnostic criteria for anorexia nervosa) despite the fact that figures show early intervention for eating disorders have a faster recovery rate. If and when they do receive treatment, 34% have reported feeling misunderstood by their healthcare professional.
So where do they turn to?
If you type in the hashtag ‘edrecovery’ (eating disorder recovery) into the search bar of photo-sharing app Instagram, you will find nearly a total of three million results. Much like its predecessor ‘pro-ana’ (pro-anorexia), images of young women’s emaciated bodies can be found, but they are few and far between. Instead, such photos are overridden by snapshots of ice cream, pizza and other ‘fear foods’. The accompanying captions declare a desire to recover, which is further accompanied by comments of praise and support by those who are also striving to rid themselves of this pathological fear of eating and gaining weight. Together, they call themselves the ‘recovery community’.
A member of this online community is 23-year-old Laura from Swansea. She recently began inpatient treatment after four previous hospital admissions for anorexia, which she says developed two years ago following a difficult divorce. Ironically, Laura said she first discovered the online community after discovering that her sister was following Slimming World accounts for weight loss. “I wondered if there were any anorexia accounts too, for weight gain and recovery,” she recalls.
After immersing herself into the online community, Laura eventually decided to create her own account to receive support. Now, with over two-thousand followers, she has created a gallery of inspirational quotes; photos of the food she eats in accordance to a rigid meal plan, along with numerous before-and-after pictures of her decline into self-starvation. “Instagram has become a community where I can express my feelings,” she confides. “There have been occasions where I have had a really bad day and people on here have pushed me to keep going. Without them, I just wouldn’t have eaten all day.”
Nineteen-year-old Alice from London created her recovery account in April 2016 to encourage her to eat what she considers ‘scary foods’. This was showcased in a post (receiving 705 likes) of her apple flavoured cereal bar that she had eaten after she had ‘already’ eaten an apple as part of both her breakfast and lunch. For Alice, eating the same fruit more than once in a day is something she finds anxiety-inducing.
Alice says she tries to provide an alternative form of support for other ‘edrecovery’ members on Instagram who do not have access to professional care. “There are lots of people who aren’t seen as ‘sick enough’ to receive psychological treatment, so are able to receive reassurance and support on here,” she says. “I answer people’s questions and try to post about difficult issues a lot of us have experienced, such as getting your period back in recovery.” In cases of anorexia, a low weight results in insufficient levels of reproductive hormones to regulate the menstrual cycle, causing women to temporarily lose their period, known as amenorrhea.
Sophie, 19, from Cambridge, is currently an inpatient and documents her eating disorder recovery in addition to her struggle with borderline personality disorder. However, she remains frank about what she considers to be the ‘disordered’ nature of these accounts: “If I’m honest, I think it’s disordered to post our food intake and photos of our body. Even if none of the girls admit it.”
Yet, Sophie still considers the Instagram community to be a more viable resource for support, even while receiving professional help. “My doctors are too clinical and they don’t have as much empathy as the girls on here. They just sort meal plans and weigh you, whereas people on here support you when you need help with your thoughts.”
In the UK, those seeking treatment for their eating disorder remain on the waiting list an average of six months. The current NHS target for waiting times for eating disorder treatment is four weeks, but a report this month reveal they are increasingly falling short of this target. As a result, Instagram has become a form of intervention for some while they are waiting for professional intervention. “I have spoken to people who have been on the list for two years,” says Laura. “I think a lot of people who are on such long waiting lists try to seek help in the meantime on here.”
When speaking to these women, it appears that their social stats have influence over how worthy they consider themselves of recovery. For Alice, the amount of ‘likes’ and followers she continues to accumulate on her account is a form of encouragement in her recovery. “I only post a meal if I manage to eat absolutely everything, so it helps me to finish everything on my plate,” she says. “[Instagram] helps to convince myself that recovery is a good thing and is what I want. Sometimes it’s hard for me to believe that.”
Such a statement is unnervingly similar to the long-held idea of social media being a determinant of a person’s self-worth. Speaking to a Beat representative, social media should not be seen as a long-term solution or a replacement for professional treatment. “While sufferers can benefit from sharing their stories on these accounts, eating disorders are complex and need concrete treatment and support, which they might not get from social media. Professional support services are a regulated solution to the situation.”
Laura admitted that the inability to filter out certain types of content has had a negative impact on her recovery. “A person may post that they have only eaten an apple all day, or post what their BMI is and it’s lower than mine,” she says. “It makes me feel like I am not worthy of recovery because I have eaten more than someone else or I weigh more than them.” Yet, Laura remains motivated to recover from anorexia in an aim to use Instagram to provide help and support. “I am looking forward to being recovered and to be able to use this account to help others, to show people that recovery is possible,” she says.
The sense of understanding, solidarity and support that is gained from the online recovery community can no doubt be seen as a huge positive in a time where many feel isolated by their mental health issues. But to rely solely on unregulated peer support will undoubtedly leave gaps of which consistent professional treatment and intervention can only fill. But those who need it are not receiving this type of treatment; arguably due to misguided priorities, poorly allocated funding and a deep-rooted misunderstanding of the importance of identifying and addressing symptoms of eating disorders as early as possible.
There are understandable risks in a vulnerable group of people relying on social media as an aid in recovery. However, from speaking to these women, there appears to be a level of care that is absent from traditional treatment facilities. Perhaps the government, health professionals, families of sufferers and the general public could take advantage of the fact that there lies a window – or screen – into the reality of such a long-misconstrued mental illness. Maybe then the country can begin to allocate the correct resources for our NHS mental health system – for the benefit of the patients and the country’s wallet.