Search Results

It has been commonly stated that one in ten men have anorexia, bulimia or another type of eating disorder. Recent figures from the NHS Information Centre suggested the real figure is actually much higher, with 700,000 men being registered as having an eating disorder, a quarter of the total number of people affected. While it is difficult to be exact in terms of numbers, it is clear that there are many men who hide their eating disorder and do not seek help. Many men feel anorexia or bulimia are a ‘female’ condition and this shame is combined with the guilt and secrecy common to all eating disorders. Eating disorders in men typically develop between the age of 14 and 25 but people can also be affected at other ages. If you need support, please don't hesitate to contact our caring team . How do eating disorders develop in men? Eating disorders in men have many of the same causes as eating disorders in women. There will certainly be a number of different causes and these may include childhood trauma, family difficulties, stressful life events, low self-esteem, personality factors and genetic predisposition. Eating disorders in men can be expressed in a different way to eating disorders in women – men and boys may be more preoccupied with having a muscular physique than losing weight. Male eating disorders are often closely linked with exercise and initially appear to be healthy, masking the underlying problem. For example, sudden weight loss may seem the result of a training programme for a sporting goal. There is also evidence that men are facing similar pressures to women in terms of conforming to an unrealistic body shape and increasing numbers of men and boys feel dissatisfied with their own bodies. Risk factors Some of the same risk factors known to apply to women seem to also apply to men and there are others which are more specific to men. In common with women, the most important factor is unresolved distress and trauma, which is expressed in an eating disorder. But some groups seem to be at a greater risk: Men who have been overweight, bullied or teased about their weight. Taking part in a sport which demands a specific body shape, for example athletes and jockeys are at a higher risk. A study carried out by the national charity Beat found 20 per cent of men with eating disorders are gay, making up twice the proportion of gay men in the population as a whole. Men working in a job or profession in which an idealised body image is very dominant. Male models, actors, and general entertainers seem to be at higher risk than the general population. Male eating disorders Eating disorders don't discriminate. Everyone who is affected by an eating disorder like anorexia, bulimia or OSFED deserves support and specialised treatment. At Schoen Clinic, we don't discriminate. We understand how important men's mental health is. At Schoen Clinic Chelsea , our leading London mental health clinic, we welcome individuals of all ages for highly specialised eating disorder treatment. Find out more about becoming a patient here. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

Author: Dr Bradley Powell , Chartered Clinical Psychologist, Schoen Clinic Chelsea You’ve got friends. A job. You go to the gym. Maybe you even have a partner. So why do you still feel… off? Welcome to modern male loneliness. It’s not about being alone. It’s about feeling emotionally miles away from the people around you, even when you're in the thick of it. I see this every week in the therapy room: men who look like they’re winning at life but feel like something is missing. It’s not that they don’t have people, it’s that they don’t have connection . A client told me recently: “I’ve got meetings all day, I work with a team, I’m dating. But I haven’t had a proper conversation in weeks.” Why Do So Many Men Feel Lonely in Cities? Loneliness in men is more common than most people realise, especially in cities like London. A 2022 study commissioned by NIVEA MEN and Talk Club found that one in three men regularly feel lonely , but nearly half had never spoken about their feelings. And in a city that never stops moving, that emotional disconnection can creep in fast. You finish work, scroll for a bit, maybe go to the gym, and suddenly it’s 10pm. You’ve “done stuff,” but not really connected with anyone. Multiply that by a few weeks or months, and it starts to affect your mood, motivation, even your sense of identity. City life doesn’t help. London’s full of people, but good luck finding someone to talk to. Friends are scattered. Everyone’s busy. By the time work’s done, the idea of travelling 45 minutes to see a mate can feel like a mission. And unfortunately for many men, those close connections aren’t even there to begin with - a 2019 YouGov survey highlighted a stark truth: one in five men say they have no close friendships . I’ve felt it too. Most of my University friends live in South West London. I live in Notting Hill. Technically close. Practically, a pain. What helped? Voice notes. Halfway meetups. Planning the next catch-up while we’re still together. Reframing the distance as an effort worth making. The Hidden Signs of Loneliness in Men Loneliness doesn’t always sound like: “I’m lonely.” More often, it sounds like: “Everyone else seems to be getting on with it,” or“I don’t want to be a burden.” It looks like: Scrolling instead of sleeping Stacking your calendar with plans but having no one to really talk to Defaulting to another gym session, another beer, another evening that feels quietly... flat It’s not that you need more people - it’s that you need more connection . Why Modern Life Makes Connection Harder for Men Men’s mental health  is shaped by more than just biology or mood. Cultural messages around “coping”, “keeping busy” and “not needing help” play a big role. We’re taught that independence is strength, but it can quietly become isolation. Social media  gives the illusion of closeness, but it rarely satisfies the deeper human need for genuine interaction, especially for men who may feel pressure to appear like they’re doing just fine. W hen Loneliness Starts to Feel Like Something More Loneliness isn’t just uncomfortable; over time, it can start to affect your mental health. I often see men where the conversation starts with “I just feel off” and gradually uncovers something deeper: low mood, trouble sleeping, loss of motivation, or a constant sense of flatness. That can be mild depression , or something heading in that direction. The problem is, male depression doesn’t always look like sadness . It can look like: Irritability or anger Withdrawing socially Losing interest in hobbies Zoning out with screens, work, or substances Feeling stuck or numb And because it doesn’t match the stereotype of “ depression ,” it often goes unnoticed or untreated. Is It Loneliness or Burnout? Sometimes the symptoms of loneliness overlap with something else: burnout . If you’re feeling emotionally drained, unmotivated, or like you’re running on empty even after rest, burnout could be part of the picture. This is often the case for men who work long hours or carry hidden emotional loads. Burnout doesn’t just happen in the office. I see it in new dads, carers, founders, freelancers and anyone pouring out energy without time to refill the tank. And when you’re burned out, making social plans or reaching out can feel like another job on the list. But often, connection is exactly what helps you recover. So What Actually Helps? Here’s what I see helping in therapy and in my own life: Join something that happens weekly. A gym class, run club, local sports league or volunteering group. Don’t put pressure on day one, just show up. Familiarity builds over time. Be the planner. Set the group chat in motion. You don’t need a reason. Just the intention to keep the connection going. Send the first message. If someone crosses your mind, text them. Don’t overthink it. A simple “Fancy a catch-up?” is often all it takes to reopen the door. Be a bit more honest. You don’t have to pour your heart out. But skip the auto “Yeah, all good” now and then. Even a “Work’s been a bit full-on lately” can shift the energy and make room for something real. Loneliness Doesn’t Mean You’re Weak It means you’re wired for connection and not getting enough. Modern life won’t fix it for you. But small moves can. Whether that’s a voice note, a message, or a moment of honesty, every little action counts. Every time you reach out, you’re building something stronger. You’re not failing. You’re human. Need Support? If loneliness or emotional disconnection is starting to impact your wellbeing, talking to a therapist can help. Check out this related blog post for men's mental health . At Schoen Clinic Chelsea, we offer confidential, compassionate support for men struggling with loneliness, low mood, or emotional burnout. Learn more about therapy with Dr Bradley Powell or contact us to book a consultation today. Dr Bradley Powell, Chartered Clinical Psychologist, Schoen Clinic Chelsea About the author Dr Bradley Powell  is an award-winning Clinical Psychologist at Schoen Clinic Chelsea with over seven years of experience supporting children, adolescents and adults. He specialises in treating anxiety, depression, low self-esteem and neurodevelopmental conditions such as autism and ADHD. Combining evidence-based therapies with a warm, personalised approach, Dr Powell helps individuals better understand themselves, overcome challenges and build long-term resilience.

“Just five more minutes!” — sound familiar? If your child reacts with frustration or tears when you ask them to put their phone down, you’re not alone. According to Ofcom’s 2024 Online Nation report, nine in ten UK children aged 8–15 own a smartphone, and nearly half of parents say it causes tension at home [1]. Phones can connect, educate and entertain — but when scrolling starts to replace sleep, play or family time, it may signal problematic smartphone use (PSU). At Schoen Clinic Chelsea , our child and adolescent specialists help families spot early signs of digital dependence and rebuild balance. How to Recognise Problematic Phone Use “Phone addiction” isn’t a formal diagnosis, but PSU describes compulsive use that interferes with daily life. Common warning signs: Distress or tantrums when devices are removed Late-night use and tiredness at school Loss of interest in hobbies or social play Declining grades or attention span Mood changes linked to online feedback A large meta-analysis found that children and teens with high PSU scores were significantly more likely to experience anxiety, depression, and poor sleep [2]. Why Phones Are So Hard to Put Down Every ping or “like” gives a tiny hit of dopamine — the brain’s reward chemical. Because a child’s prefrontal cortex(the part that controls impulses) is still developing, it’s easy for reward loops to take over. Cambridge University researchers showed that frequent social-media checking in early adolescence alters brain sensitivity to social rewards [3]. That’s why social notifications can feel impossible to ignore. When Screen Time Affects Mental Health 1. Anxiety and Mood Changes Constant alerts and comparisons can fuel social anxiety and irritability [2]. ➡️ Read more about generalised anxiety disorder and social anxiety . 2. Poor Sleep Blue-light exposure delays melatonin, disrupting body clocks. Studies show that using devices in bed shortens total sleep and reduces quality [4][5]. ➡️ Learn how our disordered sleeping specialists can help. 3. Concentration and Learning Even silent phones near children reduce attention and memory [6]. During homework, encourage a phone-free desk. 4. Low Mood and Withdrawal When online contact replaces in-person connection, loneliness and low mood can develop [7]. ➡️ See our depression treatment page. Practical Ways Parents Can Help a Child Develop Healthy Screen Time 1. Set Clear but Realistic Boundaries Agree daily screen-time limits together Use device settings to block apps after bedtime Keep rules consistent for everyone — children copy adults 💡 Tip: most experts recommend ≤ 2 hours of recreational screen time per day for school-aged children. 2. Create Tech-Free Zones No phones at mealtimes or during family activities.Keep devices out of bedrooms overnight.Replace screens with games, reading or walks. 3. Talk, Don’t Threaten Instead of “You’re addicted to your phone,” try: “I’ve noticed you find it hard to switch off — what makes that difficult?” Collaborative language builds trust and uncovers stressors such as bullying or academic anxiety.If emotions run high, family counselling can help. 4. Replace the Reward Removing screens isn’t enough — children need positive alternatives: Sports or arts boost dopamine naturally Reward progress with experiences, not extra screen time Celebrate effort and consistency Therapists at Schoen Clinic Chelsea help young people rediscover meaningful offline activities that build confidence. 5. Model Healthy Digital Behaviour Children learn from what they see. Avoid scrolling during meals Leave your own phone outside the bedroom Schedule personal screen-free time Small acts of consistency speak louder than lectures. 6. Watch for Red Flags Seek professional support if you notice: Ongoing low mood or anxiety Sleep problems or fatigue School refusal or falling grades Withdrawal from family and friends Aggression when limits are enforced These can signal wider emotional or developmental issues such as anxiety, depression, or sleep disorders, all treatable with early intervention. When to Seek Professional Help If phone use is harming your child’s wellbeing or relationships, expert guidance can help. At Schoen Clinic Chelsea , we offer: Consultant Psychiatry for assessment of mood, sleep and attention Clinical Psychology for anxiety and behavioural change Family Therapy to rebuild communication and boundaries Reach out in confidence via our contact page . Simple Family Digital-Balance Plan Step Focus Example 1 Awareness Track weekly screen time together. 2 Boundaries Introduce bedtime & mealtime phone-free rules. 3 Balance Add one offline hobby or family activity. 4 Replace Reward healthy habits with experiences. 5 Review Adjust rules monthly as your child matures. The Bottom Line Phones are part of modern childhood—but without limits, they can crowd out rest, learning, and emotional growth. By setting boundaries, modelling good habits, and seeking early help when needed, families can support healthy digital development. If you’re worried about your child’s mood, sleep or screen habits, the team at Schoen Clinic Chelsea can help every step of the way. Frequently Asked Questions 1. What’s a healthy amount of phone time for children? Around two hours of non-educational screen time daily, with devices off an hour before bed [4][5]. 2. How can I stop arguments about limits? Set rules together, explain why, and follow them consistently yourself. 3. Can excessive phone use cause anxiety or depression? Yes — large studies link PSU with higher odds of anxiety, irritability and low mood [2]. 4. Should I ban phones completely? No. Gradual limits and positive replacements work better than punishment. 5. When should I get professional help? If phone use is disrupting sleep, school or relationships, contact a specialist [8]. References [1] Ofcom (2024). Online Nation 2024 Report. https://www.ofcom.org.uk [2] Sohn S.Y. et al. (2019). Prevalence of problematic smartphone usage and associated mental-health outcomes among children and young people. BMC Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883663/ [3] Maza M.T. et al. (2023). Frequency of social-media checking and neural sensitivity to social feedback in adolescents.JAMA Pediatrics. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2799812 [4] Brosnan B. et al. (2024). Screen use at bedtime and sleep duration and quality in youths. JAMA Pediatrics. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2822859 [5] Hysing M. et al. (2015). The relationship between screen time and sleep in adolescents: results from a large population-based study. BMJ Open. https://bmjopen.bmj.com/content/5/1/e006748 [6] Liu W. et al. (2023). Effects of cell phone presence on the control of visual attention. BMC Psychology. https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-023-01381-2 [7] Kim S. & Lee H. (2021). Problematic smartphone use, loneliness and depression among youth. Frontiers in Psychology. https://www.frontiersin.org/articles/10.3389/fpsyg.2021.669042/full

Maintaining good mental health is crucial for people of all ages in today's fast-paced world. In England, each year 1 in 4 people will experience a mental health problem of some kind. At Schoen Clinic Chelsea, we understand the unique challenges faced by both adults and young people, offering comprehensive care across four key modalities: Adult Mental Health, Adult Eating Disorders (ED), and Child and Adolescent Mental Health Services (CAMHS), including support for eating disorders. Recognising the Need for Mental Health Support Mental health issues can affect anyone, regardless of age or background. Identifying signs early can make a significant difference in treatment outcomes. Not everyone struggling with their mental health will experience the same signs. Additionally, if you only occasionally experience some of these symptoms, such as stress and anxiety, that does not necessarily mean you have a mental health condition. Generally, if you notice a large shift in personality, day to day habits and mood that doesn’t go away, it can be a good idea to seek help. Here are some indicators that you or someone you know might be in need of support: For Adults Changes in mood or behaviour over a period of time Difficulty coping with daily stresses and social situations Isolating from friends and family Changes in sleep patterns or appetite This can include too little or too much sleep, over- or under-eating Decreased performance at work For Children and Adolescents Sudden changes in academic performance Excessive worry or anxiety Isolating from friends and family Frequent outbursts or extreme irritability Changes in eating habits Difficulty concentrating or sitting still If you notice these signs in yourself, your child, or a loved one, it's essential to reach out for professional help. Remember, seeking support is a sign of strength, not weakness. Comprehensive Mental Health Services at Schoen Clinic Chelsea Our approach combines medication management, psychotherapy, and holistic interventions to address each patient's unique needs. Mental Health Services Using a number of therapeutic approaches, we provide comprehensive private care for a range of conditions, including: Addiction Anxiety disorders Attention deficit hyperactive disorder (ADHD) Autism Spectrum Disorder (ASD) Depression  and mood disorders Obsessive-compulsive disorder (OCD) Personality disorders Phobias Trauma Eating Disorder Services Our specialised adult eating disorder programme offers: Comprehensive assessments Individualised treatment plans Nutritional counselling Group and individual therapy Family-based interventions We treat a number of eating disorders, including anorexia nervosa , bulimia nervosa , and other specified feeding or eating disorders. The Value of Privacy and Discretion At Schoen Clinic Chelsea, we understand the importance of confidentiality in mental health treatment for both adults and young people. Our discreet location ensures that patients can access care without compromising their privacy. We maintain strict confidentiality protocols to protect patient information and create a safe space for healing. A Calming and Peaceful Environment We believe that the environment plays a crucial role in the healing process and that having access to local treatment helps people stick to their treatment schedule. Schoen Clinic Chelsea offers a tranquil setting designed to promote relaxation and well-being for patients of all ages. Our clinic features: Comfortable, private consultation rooms Calm, welcoming common areas Age-appropriate therapy rooms for children and adolescents State-of-the-art facilities for various therapies This peaceful atmosphere helps patients feel at ease and supports their journey towards better mental health. Dr James Woolley on Our Patient-Centric Approach Dr James Woolley , consultant psychiatrist and ADHD specialist at Schoen Clinic Chelsea, shares his perspective on our unique approach to mental health care: "At Schoen Clinic Chelsea, we believe in treating the whole person, not just their symptoms. This philosophy extends across all our services, from treating adults to our work with children and adolescents. Our patient-centric approach means we take the time to understand each individual's unique experiences, challenges, and goals. We work collaboratively with our patients and, in the case of young people, and their families, to develop personalised treatment plans. Our multidisciplinary team ensures that patients receive support from various specialists, creating a holistic treatment experience. We're committed to empowering our patients with the tools and knowledge they need to achieve lasting mental wellness, regardless of their age or specific challenges." A Patient's Journey to Recovery One of Dr Woolley's patients shares their experience at Schoen Clinic Chelsea: "I have struggled with bouts of depersonalisation since the age of 16 and through the work at the Schoen Clinic, I feel I have never been in a better position or have a greater understanding of my condition, which is invaluable." – written by a private patient at Schoen Clinic Chelsea This testimonial highlights the transformative impact of personalised, compassionate care on an individual’s mental health journey. Additional Therapeutic Approaches At Schoen Clinic Chelsea, we offer a range of therapeutic approaches across all our modalities: Individual psychotherapy Group therapy sessions Family therapy Cognitive-behavioural therapy (CBT) Dialectical behaviour therapy (DBT) Play therapy for children Art and music therapy Mindfulness-based interventions Our team stays up-to-date with the latest advancements in mental health treatment to ensure we provide the most effective care possible for both adults and young people. Take the First Step Towards Better Mental Health If you, your child, or a loved one are struggling with mental health, know that help is available. At Schoen Clinic Chelsea, we're committed to providing high-quality, personalised care across all age groups in a discreet and supportive environment. Reach out to us  today to learn more about how we can support your journey to wellness. References Mental health facts and statistics - Mind Signs you may be struggling with your mental health | YoungMinds

There is an emerging understanding of a developmental disorder called Pathological Demand Avoidance (PDA) which can lead to serious eating difficulties, together with many other social, educational and relational problems. If you need support, please feel free to contact our team . A key feature of PDA is overwhelming resistance to the ordinary demands and activities of daily life. Activities such as getting dressed, leaving the house and eating meals are met with complete opposition; regular parenting strategies will not help. The child is likely to seem controlling, dominant and impossible to persuade. In resistance to a demand, they may become suddenly aggressive or go into a form of lockdown. If the avoidance of food becomes a core feature of a child or young person’s PDA, the restriction can become severe and very harmful to physical and mental health. Restrictive symptoms towards food in PDA may appear to have some similarities with anorexia nervosa, but if pathological demand avoidance is the primary profile, this needs to be identified and incorporated into care and treatment. Unlike anorexia , poor body image is not a precipitating or maintaining feature of PDA. Is Pathological Demand Avoidance (PDA) a type of autism? PDA is now recognised as being a sub-type of Autistic Spectrum Disorder (ASD) . However, there are some significant differences: a child or young person with PDA may seem to have social and communication skills which are within normal parameters. There may be little or no appearance of ‘ autistic traits ’ and as such, PDA may persist as a hidden disorder, with parents feeling they are failing and ineffective, while the child’s behaviour becomes increasingly entrenched and controlling. In PDA, it is anxiety that drives the expression of inflexible, oppositional behaviour: unable to process and adapt to their environment, the individual expresses a rigid, overwhelming expression of control. Negotiation techniques, using concepts of rewards and best interests, will be ineffective. What works for people with PDA? At Schoen Clinic , we are experienced in working with young people who have a PDA profile and equally, in undertaking clarifications of the diagnosis for an individual. To test for a PDA profile, the same assessment will be undertaken as for ASD , evaluated by a multi-disciplinary team. If a person has a PDA profile, it is important to recognise the relationship between the disorder and anxiety. For parents, this means reframing the perspective: they are not acting primarily in opposition to you, they are struggling to adapt to their environment and expressing this as a need for absolute control. Supporting a child to feel less anxious will enable them to gradually take a more flexible approach to situations. For professional services (health and education), a person with PDA may not respond well to routine and rules but may be more accepting if relationships improve and their anxiety is reduced. Care, treatment and support need to consider the PDA profile and how it frames a person’s experience of their world. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

Mirror exposure therapy is an approach recognised as being effective in reducing body image distress. It can be used as part of a treatment programme for people with eating disorders who experience high levels of body dissatisfaction. This might be expressed in very frequent body checking in the mirror, or mirror avoidance, due to the high levels of anxiety caused when the individual sees their own image. Mirror exposure works on the same principle as other forms of exposure therapy: when something provokes overwhelming anxiety, rather than avoiding it, if you are exposed to it in a supported way, you become better able to manage your emotions and over time, anxiety will decrease. Feel free to contact our team if you need support. What do we mean by body image? To understand how mirror exposure therapy works, we need to explore the concept of body image, which is more complex than it might seem. There are three components of body image: cognitive, which means your perceptions of your body, for example, a person may look in the mirror and see their own image as being much larger than it really is. The affective component means the emotional experience in relation to their body image, for example, a person may experience an overwhelming amount of distress in response to seeing their image in a mirror. The behavioural component describes actions in response to body image, for example, checking a particular body part repeatedly in the mirror to the extent that it becomes a dominating behaviour, or avoiding mirrors to an extreme extent (which perhaps means an individual is unable to go clothes shopping). Why mirror exposure therapy for body image problems? There are a range of interventions to help address the thoughts, behaviours and feelings around poor body image, using a cognitive behavioural therapy (CBT) based approach. It is recognised, however, that body image programmes which include mirror exposure therapy are more effective than those which do not (Morgan et al., 2014). This is sometimes described as practical body image, with the practical element of the programme being the mirror exposure. It seems that mirror exposure is very important in helping the individual to tolerate and accept their body at a healthy weight. How does mirror exposure therapy work? At Schoen Clinic, we developed the first Practical Body Image Programme for adolescents which has been tested and refined through clinical trials. Mirror exposure is one module of our Practical Body Image programme which is undertaken at the final stage of weight restoration. Young people must be more than 90 per cent of a healthy weight because the programme is about accepting your body when you are at a healthy weight (not normalising being underweight). During mirror exposure therapy, the individual stands in front of a mirror for 30 minutes, wearing tightly fitted clothes. They need to look at the whole body (not ignoring difficult parts or only focusing on one area). Every five minutes, the practitioner will ask the individual to rate the anxiety they are feeling on a scale of 0 to 10. After 30 minutes have passed, the individual is asked to draw a line on a graph showing their anxiety levels. The idea is to support reflection on what increases or decreases anxiety and for the overall experience of exposure to reduce anxiety in the longer term. This is repeated for a further five sessions, occurring twice weekly. Does mirror exposure therapy ever make things worse? Mirror exposure therapy can be very challenging and it is possible that during the programme, a participant may feel worse before they feel better. Practical body image programmes ask participants to expose themselves to things they find very difficult and scary, but in a supported way to reduce anxiety overall in the long term. There needs to be careful supervision to monitor anxiety levels and possible weight changes. Mirror exposure and body acceptance We recognise that some degree of body dissatisfaction is normal and widespread within the general population. Mirror exposure within the Practical Body Image programme is about promoting tolerance and acceptance of the body at a healthy weight which will significantly support the individual in the process of achieving and sustaining recovery from an eating disorder. References Morgan, J. F., et al (2014) Ten session body image therapy: efficacy of a manualised body image therapy, European Eating Disorders Review, 22(1), 66-71. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

Diabulimia is a term which has come into recent usage to describe people who are suffering from Type 1 diabetes and a related eating disorder. Specifically, it means people with Type 1 diabetes who omit or reduce their intake of insulin to lose weight. This makes diabulimia extremely dangerous: if people with Type 1 diabetes fail to take the correct amount of insulin, they place themselves at risk of many serious complications which can include eye problems (including risk of blindness), kidney problems, nerve damage and even amputations. If you're worried and need support, please don't hesitate to contact our team today. Diabulimia treatment is challenging because of the way it requires multi-disciplinary expertise across medical services which do not ordinarily need to come together. Diabetes professionals may not recognise that a patient’s persistently poor diabetes control reflects hidden diabulimia symptoms. Equally, even if they suspect this could be the case, professionals may feel they lack the expertise and confidence to speak to a patient about their concerns or to raise mental health issues . Warning signs and symptoms Identifying diabulimia warning signs as soon as possible is very important, although this can be difficult because poor diabetes management may be caused by a number of different factors, especially in adolescents and young people. Some reports suggest up to 40 per cent of young women with Type 1 diabetes restrict their insulin with the intent of weight loss. It is also recognised that diabetes control among adolescents and young adults can be poor for other reasons (moving away from parental control to managing themselves; moving away from home and leading less structured lifestyles). The following symptoms, both physical and psychological, could be considered as potential diabulimia warning signs: Severe fluctuations in weight Repeated incidences of hyperglycemia (high blood sugar level) leading to hospitalisation Elevated HbA1c (a blood test which reflects diabetic control) Missing meals or avoiding eating with others Secrecy about diabetes management/avoidance of diabetes appointments A fear insulin ‘makes you fat’ Frequent yeast or urinary infections Drinking abnormally high amounts of fluids Irregular periods or no periods at all Deteriorating or blurry vision Dry hair, skin and dehydration Loss of appetite Preoccupation and anxiety around body image Avoidance of carbohydrates in order to lower insulin doses Health consequences Diabulimia health consequences are serious and multiple, affecting both physical and mental health. The consequences listed below can be caused by diabulimia, although they may also be a result of poor diabetes control due to other factors. Short-term consequences The short-term consequences of diabulimia can include: Fatigue Dehydration Poor immunity, leading to repeated infections Ketoacidosis, a dangerous medical condition in which there are high levels of glucose and the blood. Diabetic ketoacidosis (DKA) often requires admission to the hospital and can be life-threatening. Long-term consequences The long-term consequences of diabulimia can include: Irreversible damage to eyesight (retinopathy) Nerve damage leading to pain, tingling or numbness of the limbs (neuropathy) Damage to the kidneys (nephropathy) Treatment and support Once identified, diabulimia treatment requires a multi-disciplinary approach, addressing the emotional and psychological difficulties the individual is experiencing. Diabulimia cannot be effectively treated within the scope of diabetes management alone. Diabulimia treatment is dependent upon the underlying emotional issues being identified and addressed at the same time as measures to improve diabetes control. Treatment and support must incorporate acknowledgement that diabetes necessitates a greater focus on specific food intake than is ordinarily necessary and this can quickly become tangled with weight and body image issues. Skilled diabetes management and eating disorders expertise are required for effective treatment and full diabulimia recovery, avoiding harmful and potentially dangerous short and long-term health effects. It is important to recognise that people with Type 2 diabetes also experience eating disorders which are serious and debilitating but with a different presentation to diabulimia. Typically, people with Type 2 diabetes are affected by binge eating disorder (with the resulting problem of poor diabetes control and obesity). Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

Compulsive eating is a type of behaviour with food: when a person eats in a way that feels out of control, that has an emotional component and involves eating an uncomfortably large amount. Compulsive eating is not an eating disorder in itself. It can be a recognised feature which is part of known eating disorders such as bulimia nervosa and binge eating disorder. If you need support, please don't hesitate to contact our team at Schoen Clinic. What are the signs of compulsive eating? It may be difficult to identify compulsive eating as a distinct feature compared with the normal parameters of food consumption. We all have favourite foods which we turn to for comfort and food types which we might like to avoid or limit but find it hard to do so. It is normal to feel our eating is not as controlled as we may wish to lose or maintain weight. It is also normal to have certain foods that we turn to for comfort. If you are concerned you may have a problem, consider these signs which indicate compulsive overeating may be present: Eating rapidly and in secret. You may dislike eating in public or socially. Eating beyond the feeling of comfortable fullness; feeling completely unable to stop. Turning to food whenever you experience difficult feelings, moods or situations The urge to eat large amounts of food and/or forbidden food is experienced as utterly overwhelming Looking at feelings and well-being as a whole, these are indications you may be experiencing compulsive overeating: Always trying to diet but unable to lose weight Immense feelings of self-dislike/disgust at eating habits and inability to lose weight Depression and low self-esteem are often present A sense that life would improve if weight could be lost but feeling powerless to achieve this Is compulsive eating the same as binge eating? Binge eating is part of the diagnostic criteria for bulimia nervosa and binge eating disorder and as such, clear measures have been developed to define a binge: Quantity of food consumed in a binge is described as: “an amount of food that is definitely larger than most people would eat” (American Psychiatric Association, 2013) Feeling out of control during the binge Binge behaviour occurs at least once a week for a period of three months It could be argued that binge eating, particularly as part of a diagnosis of bulimia or binge eating disorder, is a more specific classification than compulsive eating. A binge requires the food consumption to be large (although what is large for one person may be normal for another), as well as the accompanying feelings of loss of control, shame and secrecy. Compulsive overeating is more focused on the feelings around the eating behaviour, rather than the amount consumed in a single episode. Compulsive overeating could be present in an overall pattern without the presence of single, large binges. In practice, many clinicians suggest the difference between definitions is slight: individuals present and talk about experiencing binges, compulsion and food addiction. The key, common characteristic is the underlying feelings of loss of control, disgust and secrecy and the link between food consumption and difficult emotions. How is compulsive eating treated? If you feel you may be suffering from compulsive overeating, an assessment may be very important, particularly if you have accompanying, harmful purging behaviours of bulimia nervosa. At Schoen Clinic, we offer private assessments for individuals of all ages and run one-to-one Cognitive Behavioural Therapy programmes for people with bulimia. There is a strong evidence base for the effectiveness of this approach. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

In a world where appearance often seems to hold paramount importance, the line between self-perception and reality can blur, leading to a condition known as body dysmorphia. This psychological disorder, characterised by an obsessive focus on perceived flaws in physical appearance, affects individuals across diverse backgrounds. Understanding body dysmorphia entails delving into its intricate manifestations, exploring effective treatments, and addressing questions surrounding the condition. In this blog article, we shed light on its symptoms, causes, diagnosis and available treatments and answer commonly asked questions to raise awareness and support for those grappling with this challenging disorder. Please don't hesitate to contact our team if you need support. Body dysmorphia is the term for a condition that causes an individual to be overwhelmingly focused on perceived flaws in their appearance. This is a distorted perception – evident to the affected individual in a very different way than everyone else. There is compulsive checking of the imperfections or flaws which causes high levels of distress and disruption to the individual’s life. For example, the person may become socially isolated because they fear responses to their perceived flaws or become overwhelmed by repeated actions to hide perceived flaws. Body dysmorphia may be expressed as mirror checking repeated so often as to disrupt normal life and negative comparison with others, often on social media. Is body dysmorphia an eating disorder? Body dysmorphia is not about overall weight, shape and body image. A person with body dysmorphia may be highly distressed about perceived flaws in their face or skin, for example, but eat normally, without concerns about weight, shape or body image. As such, body dysmorphia is not in itself, an eating disorder. However, some forms of body dysmorphia can be a trigger for the development of an eating disorder. How is body dysmorphia diagnosed? Body Dysmorphia, also known as Body Dysmorphic disorder, is a recognised mental health condition described in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). According to these key guidelines, these are the features of body dysmorphia used to make a diagnosis: The individual is highly preoccupied with perceived flaws which are not apparent to others There is a repetitive behaviour component associated with the perceived flaws, for example, very excessive mirror checking Diagnosis will consider the individual’s insight and response to reassurance: people with a mild disorder can be distracted and reassured to some extent. Those with more severe body dysmorphia will be wholly convinced of the imperfection and overwhelmed by it. How common is body dysmorphia? Body dysmorphia can occur at any age, but most commonly develops during adolescence. According to the DMS-5 data, the average age when body dysmorphia developed is 16 to 17. The condition affects males and females roughly equally, at around 2.5 per cent and 2.2 per cent respectively (American Psychiatric Association, 2013). What causes body dysmorphia? The causes of body dysmorphia are not fully understood. There is likely to be a range of possible factors and higher-risk groups. These include: There is a link between Obsessive Compulsive Disorder (OCD) and body dysmorphia. Some clinicians believe body dysmorphia is a form of OCD. Studies have shown people with OCD themselves, or with OCD within their close family are more likely to develop body dysmorphia There is a theory that body dysmorphia is linked to chemical imbalances in the brain, particularly in low levels of serotonin Trauma and distressing experiences, such as bullying, can be a trigger for the development of body dysmorphia There is a link between perfectionism and body dysmorphia How is body dysmorphia treated? There is a good evidence base for the use of Cognitive Behavioural Therapy (CBT) as a way of treating body dysmorphia by challenging the distorted perceptions underpinning the disorder. If there are impacts such as depression, this may need to be treated with medication. For some people, body dysmorphia will be interlinked with an eating disorder and in this situation, a full assessment is required and treatment programme that addresses all aspects of the eating disorder, including body dysmorphia. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

About Avoidant Restrictive Food Intake Disorder (ARFID) ARFID is a relatively new term, which stands for avoidant restrictive food intake disorder, now officially recognised and described in diagnostic criteria. It involves the avoidance of a large number of foods to the extent that there is nutritional deficiency and health impairment. There is an intense fear of many foods and this usually results in social disturbances, such as being unable to join friends for school dinners or meals out. The symptoms of avoidant restrictive food intake disorder, can seem very similar to a better-known eating disorder, anorexia; notably low body weight, weight loss and emotional disturbance. However, there is a critical difference: unlike anorexia, the driver of the disorder is not anxiety about body weight, shape and image. The three main causes of ARFID are low interest, sensory difficulties, and fear/trauma. These are explored in the next section. The positive news is that now avoidant restrictive food intake disorder is firmly established as a diagnosis (included in the 5th edition of the American Psychiatric Association’s classification of disorders, called DSM-5 or DSM-V), it is increasingly better recognised and understood. With this improved awareness and diagnosis, those affected are more likely to benefit from targeted and effective therapy and support. Common causes of ARFID The first causal category in ARFID is very low interest/poor responsiveness to food. This can be something which is evident from a very young age (some specialists will give a diagnosis from the age of two, others younger). The second cause is sensory-based food avoidance, which might refer to a strong aversion to particular colours and textures of food or being unable to eat properly because of wider sensory disturbance (noise, light, difficulty sitting). There is a close correlation between ARFID and other disorders such as autistic spectrum disorder (ASD) , attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) . Some studies suggest that a majority of people with ARFID have other sensory or neurological disorders. Difficulties with eating may be the first symptoms to appear or may emerge after other issues have been identified. The third main cause is extreme fear/trauma, for example, an intense belief that eating will cause choking, vomiting or abdominal pain. Although difficulties usually become apparent in childhood, specialists emphasise it is not a disorder exclusively of childhood and that adults can be affected too. Boys are slightly more at risk than girls, probably due to its correlation to disorders like ASD and ADHD, which more often affect boys. What are the warning signs or ARFID? In truth, the majority of parents might describe their children as fussy or picky eaters at some stage and this may cause real concern for them. But can we differentiate between normal patterns of choosy eating (which are usually temporary and do not impair health) and a defined eating disorder? There are two markers which help distinguish someone who is simply a fussy eater from an individual with a serious eating disorder: The individual fails to eat an adequate diet which leads to a nutritional deficiency. There is a clear impairment to their health, well-being and development. Fussy eating is very difficult for parents to deal with and many children eat a much narrower range of foods than their parents would like. But the threshold for having a nutritional deficiency and a resulting impairment to health is high: patients seen in ARFID clinics might only eat five foods or less, together with rigid brand requirements (only a certain type of chocolate spread, for example). In terms of the warning signs, it is important to consider social disturbance as a key symptom: is a child withdrawing socially, because of fear of meals at friend’s houses, at school and therefore avoiding social interaction and normal, enjoyable activities? How is ARFID diagnosed? These are the criteria set out in the DSM-5/DSM-V: Significant weight loss (or failure to gain weight or faltering growth in children); Significant nutritional deficiency; Dependence on oral nutritional supplements; Interference with psychosocial functioning (fear of food leading to social withdrawal and isolation). It is important to gain a really full picture of the patient, considering their development and feeding history, for example, if they have always eaten poorly, any sensory difficulties they may have, family context (consider dieting and cultural practices like fasting), their temperament and social functioning. Consider whether there are any other reasons for their avoidance of food. Are there any body image issues? Are there any medical conditions or medication which might affect their eating? Although some individuals may have very low body weight, like those with anorexia, it is also possible for affected individuals to be a normal weight or overweight. What treatment is there for ARFID? It is really important to properly diagnose ARFID and then to provide treatment and support that is specific to the condition. Because of the way child and adolescent eating disorders services have developed (particularly inpatient hospitals), many young people with avoidant disorders have ended up in hospitals originally designed for the treatment of anorexia. However, treating someone with ARFID as if they have anorexia is likely to make their condition worse and certainly not better. Another challenge in terms of designing therapy and support is that because this is a recently classified eating disorder, there is a lack of evidence base for treatment. Certainly, there are plenty of ‘tools’ which can be used: behavioural approaches such as food exposure and de-sensitisation, parent and family work,  cognitive behavioural therapy , nutritional and medical interventions and approaches to support patients by addressing sensory difficulties. However, specialists in this field emphasise: defining the aims of treatment and targeting your interventions. Realistically, a person with an avoidant disorder who had a limited diet since infancy is not going to progress to a very broad and adventurous diet. The aim might be to achieve a nutritionally sufficient diet (sometimes including a supplement) and some alleviation of the social disturbance caused by the disorder. If you or someone you know needs help with an eating disorder like avoidant restrictive food intake disorder, please get in touch with our caring team today. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

There will always be a number of factors in the development of an eating disorder and each individual will be affected by a unique combination. There is never one simple, single cause, although sometimes there may be one factor in a person’s life which plays a particularly prominent role in his or her eating disorder. If you need specialised support, please don't hesitate to contact our team . An eating disorder, at its root, is the expression of emotional distress and means of managing difficult and painful feelings.  Anorexia  is an eating disorder which typically occurs during adolescence, so emotional difficulties are likely to encompass issues at school, trouble with friendships, parental conflict and struggles coping with puberty. Of course, many young people face these sorts of challenges without developing eating disorders; there must be other factors involved which trigger disordered eating. Do personality types play a part in developing an eating disorder? There are currently a number of studies exploring whether certain personality types may be more predisposed to an eating disorder. The theory is that young people with more rigid thinking styles and perfectionist traits may be more at risk of responding to difficulties through their eating. Young people who develop anorexia frequently express how losing weight provided the sense of control they felt was lacking in every other area of their lives. Other research about anorexia questions whether we should look more closely within the brain physiologically to understand the cause of anorexia and the factors which lead to its persistence for some people. This theory suggests there is a dysfunction within the part of the brain involved with taste, emotion, appetite and pain which explains why someone with anorexia has such extreme and intransigent behaviour. Can social media influence eating disorders? There are often questions about the role of the media, both mainstream and social, as a factor in the development of eating disorders. At Schoen Clinic, we do see some young people who have used pro-anorexia websites which have served to sustain and normalise their eating disorder. Certainly, the idealised images which bombard young people every day do play a role in anxiety around body image, but it would be too simple to suggest that the media causes eating disorders. It may, in some cases, be a factor in creating a disposition to the eating disorder and or perpetuating it after onset. Family therapy is a cornerstone of the work we do with young people and their families. It is never about pin-pointing blame on families, although very often parents come into the process with great fear that the eating disorder reflects their failure in some regard. Although there may be some cases where, for example, a mother has food and body image anxieties which are transmitted to their daughter, we see many families where this is not the case in any way. Family therapy and supporting family work seek to understand the dynamics within each family and find ways of harnessing the support within each family in a positive way to overcome the eating disorder. Some people go through the whole process of having an eating disorder, having treatment and on to recovery without ever fully understanding the original cause. For some, through psychoanalytic psychotherapy, it is very important to illuminate the cause and use this understanding to move forward to change. For others, often the younger children we treat, therapy is more focused on developing different strategies for dealing with difficult and painful emotions, so there is an alternative to disordered eating as a response. Sometimes families leave Schoen Clinic with an understanding that the cause was a general inability to cope with the pressures that adolescence presented, and that recovery is based on utilising new strategies. One mother, who felt she would never fully understand the root cause of her daughter’s eating disorder, reflected during her daughter’s recovery: “Our daughter now has new and more positive ways of interpreting the world.” Specialised eating disorder treatment is available The cause of an eating disorder such as bulimia may be a little easier to understand than some examples of anorexia . Treatment is based on a Cognitive Behavioural Therapy approach, encouraging the sufferer to understand what feelings trigger the thoughts and behaviour leading to binge eating. Through understanding this trigger point, the individual is better able to develop other ways of thinking and behaving at the stage when disordered eating occurs. In conclusion, the causes of an eating disorder are likely to be complex, not always apparent and will involve an interaction of several factors. It is essential that parents do not blame themselves and that if symptoms of an eating disorder are a concern, medical help is quickly sought because the longer an eating disorder persists, the more difficult it will be to treat. Please reach out to our caring team  at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London  offer highly specialised treatments for children, teens and adults.

In recent years, there has been a surge in the number of people exploring vegetarian and vegan diets. This is widely evidenced through social media sites and the promotion of campaigns such as ‘meat-free Monday’ and  ‘Vegan-uary’. It also correlates with the increasing demand for meat-free food items within UK supermarkets. In fact, consumer statistics show that in 2017 the market for meat-free items increased by 987 per cent. The shift is evident by looking at the vegetarian and vegan food sections in supermarkets and the growing range of non-meat choices on most menus. Correspondingly, specialists working in eating disorders hospitals are receiving increasing numbers of requests to follow a vegetarian or vegan diet. Does this simply reflect the pattern in wider society, or is something else evident? We dive in and answer these queries in this article. Please don't hesitate to contact our team if you need support. Statistics and figures The statistics suggest there may be a correlation between veganism and eating disorders. At Schoen Clinic, for example, 35 per cent of the young people we treated during a specified period, stated they wanted to follow a vegan, vegetarian or pescatarian diet. This compares with just two to three per cent of the UK population as a whole following a completely vegan or vegetarian diet and lifestyle. We considered this difference may reflect the age profile at Schoen Clinic, with higher proportions of younger people following a vegan or vegetarian diet, compared with an all-age population sample. To test this, we undertook a survey with female students at a secondary school, asking pupils of a similar age what their dietary choices were. Comparing the same age group samples, we found Schoen Clinic had four times as many vegans, five times as many pescatarians and double the number of vegetarians compared with the school group. Why are these statistics so different? We need to think about the motivations for following a vegan or vegetarian diet and how this may interact with the psychological influences of an eating disorder. It is recognised that anorexic thinking and behaviour commonly feature; Avoiding high-fat foods Avoiding processed foods and Choosing the lowest-calorie items. Orthorexic thinking, sometimes known as ‘clean eating’ is also regularly seen in those with a diagnosis of anorexia nervosa. This is the belief that food should only be ‘natural and pure’ and any processed food should be avoided and can result in a highly restrictive diet. In other words, the primary motivation for following a vegan or vegetarian diet may be weight loss, calorie restriction or orthorexic notions of ‘healthy’ food, but this is expressed as an ethical diet preference. Our society promotes that we should support the choice of an individual which can make it uncomfortable for parents and professionals alike to challenge the motivation for this lifestyle choice. Of course, it would be an overstatement to say veganism is a specific trigger for eating disorders, or that going vegan or vegetarian inherently increases eating disorders risk. However, there is a danger that a vegan or vegetarian diet can support restriction and weight loss and thus become a maintaining factor for an eating disorder. At Schoen Clinic, we work to return to the dietary norm which was prior to the development of the eating disorder. This allows time to unpick the reasoning for following a vegan or vegetarian diet and addressing this within the treatment plan. Once the young person reaches a healthy weight, further discussions will take place with their treatment team and family around the appropriate diet for the individual as they progress to discharge and the process of recovery. Of course, it is possible to follow a healthy vegan diet if no eating disorder is present. But as the Vegetarian and Vegan societies advises, individuals should not practice restriction unless they are physically and mentally well; a young person who is being treated in an inpatient setting for an eating disorder would not fulfil the criteria of being physically and mentally well until the latter part of their treatment. If you need support for an eating disorder, please don't hesitate to reach out to our teams at Schoen Clinic Chelsea in London. Our caring teams have extensive experience in treating eating disorders and are ready to help you get back to you. Get in touch today.