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This video is for teachers to use in schools and services for young people Introducing "Someone said I was fat": A helpful video resource for navigating body image "Someone said I was fat" is an essential video resource designed to support children and young people as they navigate the complexities of body image and the onset of disordered eating. Developed with careful consideration for the developmental stages of young minds, this video is ideally suited for viewers aged 10 to 16, acknowledging that individual growth varies. This impactful video is not only intended for classroom settings but also serves as a valuable resource for youth organizations such as Guides groups. Our aim is to reach as many young individuals as possible, providing them with valuable insights and tools to navigate these challenging topics. Accompanying resources have been meticulously crafted to facilitate meaningful discussions, tailored to different age groups. The narratives within the video are deeply personal, shared by contributors who bravely confronted anorexia during their formative years. Two of the contributors to the film developed anorexia during their first year in secondary school. One contributor explains how she was admitted for inpatient treatment at a time, aged 12, before she really understood what an eating disorder was or had an opportunity to learn about the issues at school. Their stories shed light on the realities of living with an eating disorder, offering poignant reflections on their journeys to recovery. The video is built around the thoughts and reflections of four young people who were treated at Schoen Clinic Newbridge for anorexia. Three are female, one is male and they were all under the age of 16 when they developed anorexia. Schoen Clinic Newbridge is an eating disorders centre in the West Midlands for young people aged 11 to 18. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

Having a child with anorexia impacts the whole family. The mother of a 15-year-old who recently spent six months at Schoen Clinic Newbridge for inpatient treatment shares her experience in the hopes that it will help other parents who may be going through a similar experience. If you need support for your child, get in touch with our caring team today. Schoen Clinic Newbridge welcomes NHS and privately funded patients for highly specialised eating disorder treatment. Private patients can contact our team with ease at che-privateenquiries@schoen-clinic.co.uk The route to diagnosis One of the first things you reflect on is why you, as the parent, did not pick up on problems and act sooner. We did have some concerns about our daughter’s weight, but it is very difficult to judge what this means, (especially as she had grown taller quite quickly and was eating normally at home) and whether there is a possible eating disorder. We live in a big house and it was a particularly cold winter, so my daughter was always covered up in lots of layers. It was the school nurse who first raised concerns, and this started the process of diagnosis and treatment. So the first thing I would want to express to other parents is you should not feel shame or blame yourselves for not noticing or acting earlier. In February 2011 our daughter was diagnosed with anorexia and it became apparent that her thoughts had become anorexic some four to five months before that. She started outpatient treatment in April but continued to lose weight for a further four months. The search for treatment By July, I took four weeks out from work to support our daughter who, by this stage, was too poorly to be at school. We were open to the likelihood that she may need inpatient treatment and were told that about 70 per cent of people diagnosed with anorexia do end up having a period of inpatient treatment at some stage. That helped to prepare us for the possibility and soften any sense that we hadn’t done our best for her and by trying to manage at home. We visited our local inpatient unit in the East Midlands where we live. My husband and I had a strong sense that it was not an environment where we wanted out daughter to be for six months, quoted as the average stay. It was a mixed adolescent psychiatric unit, with young people who had a wide range of different mental health problems and felt cramped and under resourced, with only one small room for family visits shared between 12 patients, and a lack of supportive therapies. While we were away on a family holiday in August it became clear that our daughter would need urgent inpatient care. I felt disappointed not to have been able to provide the support she needed at home. I am a GP and it is in my nature when I see a problem to want to be proactive and sort things out. For me, part of this experience has been finding it is not always possible to do everything yourself as a parent and accepting this without feeling guilty or inadequate. Our local consultant had previously suggested Newbridge as an option for in-patient care. We looked at their very informative website and felt strongly that this was where we would like her to be treated. We made contact with Newbridge immediately on our return from holiday and with the help of our consultant and local healthcare commissioners, she was admitted two days later. Admission and early stages of treatment There was a sense of relief when our daughter went into inpatient care at the start of September. She was very underweight and poorly, we were stressed, frustrated and exhausted. Despite our sadness, we did feel really confident in Schoen Clinic Newbridge in their role taking over responsibility for her care. The day of admission was emotional and tiring. We felt very welcomed and looked after by all the staff we met. It helped enormously that the environment at Schoen Clinic Newbridge is so homely and not institutionalised. From the start, we felt there was a definite plan for our daughter. The services at Newbridge are very well integrated, so she had all the appropriate support and treatments as needed. So, for example, she was not well enough to engage in individual psychotherapy for the first few months, but supportive counselling and dramatherapy were available, which helped to prepare for psychotherapy. Family therapy was established for us right from the start and that was really important to help us all (both parents and two siblings) feel supported and involved. We live 50 miles away from Newbridge, so we would visit twice a week. We would also frequently telephone and I never felt a nuisance, no matter how often I called, and there was great understanding and support when conversations frequently became tearful and emotional for her. The first priority was getting her out of the physical danger zone. Immediately before admission, our daughter’s BMI had fallen just below 13. I would often go into her room at midnight and check her pulse, afraid she might have a cardiac arrest during the night. Once she was in Newbridge and started to gain weight, there was a huge sense of relief. But at this stage, after a month or so, behaviour becomes more difficult because their thinking has not yet changed and they are battling against increasing weight. This can be an emotionally challenging time so having the unit to share the burden of care was invaluable. What worked well? What helped? Family therapy was enormously helpful. We didn’t feel we were being criticised for our foibles as a family being unpicked. It was about supporting the treatment and finding different strategies to apply with our daughter at home. It was good to be able to reflect on experiences and things that had been said, but also good to have very practical advice, mainly through the programme for parents which runs in addition to family therapy. We were also very grateful that family therapy encompassed our other children too and gave them an opportunity to talk and reflect. Our daughter engaged brilliantly with Newbridge’s dramatherapist and psychotherapist. Our experience is that Newbridge has staff of the highest calibre. During the whole six months of inpatient treatment, there was not one member of staff who we didn’t get on with. Everybody has their own personalities and it is inevitable that we all had our favourites. But with every member of staff, there was a consistency of fairness, respect, kindness and sympathy. We were also very pleased with and grateful to the school at Newbridge. Like many young people who develop anorexia, our daughter needed inpatient treatment at a key time in her education, in her case during the GCSE year. The liaison with our daughter’s own school was very good. School at Newbridge gave our daughter an alternative focus to anorexia and something she could feel in control of. Home leave during treatment When we first considered the prospect of inpatient treatment, I found the idea of our child going away for six months very difficult. It seems such an enormous chunk out of their life and your family life. I had been due to take our daughter out to the cinema for the first time off the unit at the end of September. The weather was wonderful and warm, so I asked instead to take my daughter home for a few hours where we could sit in the garden together. She was still pretty poorly but I was so grateful for that opportunity. There was always an enormous amount of consideration and flexibility when it came to home leave, providing it was medically advisable. There was no sense that there was a prescriptive single approach. By the start of October, our daughter would come home every Friday and Saturday night. By December, we felt we had reached another turning point, with our daughter showing some normal social behaviour, such as being able to go out for a meal and having friends over for sleepovers. She was at home for four nights each over Christmas and New Year and by mid January, was able to come home and go to her local school on Thursdays and Fridays, stay with us over the weekend, then return to Newbridge from Sunday to Wednesday. That helped enormously in terms of our daughter integrating back after inpatient treatment, rather than it being a sudden shock at the end of a long period away. Beyond Schoen Clinic Newbridge Our daughter left Schoen Clinic Newbridge at the end of February. We felt very strongly that we wanted our daughter to continue her outpatient care there because she had such strong, established relationships with the therapist and we were not sure whether there would be the same degree of consistency locally. We feel very fortunate to have ongoing outpatient sessions with the psychotherapist and nurse consultant commissioned through the NHS. A couple of months after our daughter returned home, we reached another turning point. Normal life now outweighs anorexia and several days can go by without a thought about the illness coming into my mind or being discussed. If someone had told me last year this is where we would be in little more than 12 months, I would have found it very hard to believe. Overall reflections If you look at the statistics for anorexia, the mortality rates are frightening. The percentages reported of people who achieve full recovery leave you feeling pessimistic. After our experience, my husband and I feel the model of care at Schoen Clinic Newbridge gives you and your child the best chance of over-riding those statistics. I would say to other parents that a supportive GP or healthcare professional is invaluable. Your GP may not be an expert on anorexia but you need someone who will listen to you, support you and arrange for the help you need. You may need to be very pushy before you find the support you need especially as good eating disorder services may not available on your doorstep. Also make sure that you access support for yourself wherever you can – anorexia in the family is extremely demanding and stressful, and keeping yourself well is imperative for your child’s recovery. There is no quick fix for anorexia – its treatment will take time and although there are some things you can do, there is much that you cannot do alone, and the most important thing is getting the right specialist care in place for your child. * Names have been changed in order to protect parent and child’s identities. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

Having a child with anorexia impacts the whole family. The mother of a 12-year-old who spent three months at Schoen Clinic Newbridge for inpatient treatment shares her experience in the hopes that it will help other parents who may be going through a similar experience. If you need support for your child, get in touch with our caring team today. Schoen Clinic Newbridge welcomes NHS and privately funded patients for highly specialised eating disorder treatment. Private patients can contact us directly at che-privateenquiries@schoen-clinic.co.uk The route to diagnosis It was about June when I noticed my daughter had lost weight. It was difficult to judge what to say and how to intervene because she has always been sporty and a healthy eater, with a tendency towards being a little anxious and obsessive. I remember my mother, who hadn’t seen her for a few months, was shocked by the weight loss, whereas for the parent, it is more gradual as you see your child every day. We were already in contact with my daughter’s school because she was struggling to settle into secondary school. I had a chat with the school nurse and she described her as being “fragile and delicate”. But there wasn’t really any guidance about what to do next. We went to see the GP, who simply told her to put on weight. The GP was talking about eating full fat everything and I remember seeing the terrified look on my daughter’s face and realising how far things had gone. She promised to try and I believed we could manage as a family, but she went downhill very rapidly after that. At the end of August, our daughter was admitted to our local general hospital. I thought she would be coming home that day, but she ended up spending two weeks there. They were very concerned about her heart rate and her low blood pressure and she was also feeling constantly cold. The search for treatment She was in the general hospital for two weeks, which was an incredibly difficult, emotional time, I must have spent the whole time in tears. The staff didn’t know how to work with someone who had anorexia and I had to be with her 24/7 as I was the only one able to help her to eat. We were offered a bed in a NHS unit where young people with anorexia are treated alongside young people with many other psychiatric problems. I felt very strongly that I wanted her to be treated at a specialist eating disorder centre and we live close to Schoen Clinic Newbridge. At first, we were told she couldn’t come to Schoen Clinic Newbridge because another NHS bed had been offered to us. But I then spoke to another person in the commissioning team who agreed an assessment could be carried out. The Nurse Consultant came out on the August Bank Holiday to do the assessment and two days later, it was confirmed that she could come to Schoen Clinic Newbridge. It was the best thing I have ever done in my life. I was very pushy – and sadly I think parents often have to be pushy. But my daughter was only 12, still very much a child, and your instinct is very strong about where you want them to be. Admission and early stages of treatment The other girls being treated at Newbridge had made my daughter cards to welcome her. She would go on to have such supportive, understanding friendships with the girls at Newbridge, who were going through the same thing. Of course, the early days and first couple of weeks are difficult and there are a lot of tears. Living nearby, I visited every day and also phoned a lot, but was never made to feel like I was being a nuisance. What worked well? What helped? My daughter accepted meals and snacks from day one. She has a cooperative personality and gelled with the staff very well from the start. From finding her school quite threatening and difficult, Schoen Clinic Newbridge became a comfort zone for her, with other young people who understood her and the warmth and care of all the staff. She engaged well in her sessions with the psychologist – she has a logical, scientific mind and so she valued the sessions and found them interesting. For me, the programme for parents was brilliant. The practical tips were very important, such as how to manage supporting your child with the eating disorder along with the needs of the other sibling and work. I also found it helpful the way that Newbridge staff helped and supported the whole family. I became very focused on supporting my daughter, while members of the wider family found it hard to understand and wondered “Why doesn’t she just eat.” On one occasion, when my father came to visit and my daughter didn’t want to see him, the staff were incredibly supportive and enabled him to better understand what was happening from her perspective. Home leave during treatment By about the six-week stage, my daughter started to have some leave for short trips out and by two months, she was able to come home for an overnight stay. Although she was the youngest girl in the hospital at the time, she became a role model for others because she was so cooperative and was getting on really well with her treatment. It was wonderful to see how her confidence grew through her friendships at Schoen Clinic Newbridge because she had found it hard to settle in secondary school. Leaving Schoen Clinic Newbridge My daughter spent three months at Schoen Clinic Newbridge and came home in early December. We were all very excited knowing she would be home for Christmas but the day she left was very emotional because she had built up such great friendships. Newbridge had been a much-needed comfort zone and now she was moving back into the ‘real world’. Overall reflections We were very, very fortunate and having pushed for treatment at Newbridge, my daughter has made a strong recovery within six months of starting treatment, having spent three months within inpatient care. I am so grateful for the treatment she received and also for the fact that because the treatment was so effective, she only needed to be an inpatient for three months, as I know it can be much longer. I would say recovery is a different process for the child and the parent. I am still very watchful. My daughter’s weight is checked every week and she is very accepting of that. It is important for me, because if I find myself worrying that perhaps she isn’t eating at school, I know I have the fact that her weight is remaining stable. I know that my daughter’s personality means she is prone to anxiety and stress and that will always be the case. But I feel that her treatment at Schoen Clinic Newbridge has given her new skills and a level of maturity to cope with the things that she finds threatening and has equipped her for what lies ahead in life. * Names have been changed in order to protect parent and child’s identities. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

An audit of meal preparation and social eating sessions at Schoen Clinic Newbridge has shown a consistent improvement for participants. Get in touch today. The Schoen Clinic Newbridge Occupational Therapy (OT) team run a range of sessions to support meal preparation and social eating. Using a graded approach, young people begin by preparing simple meals, then progress to main meals (according to age and ability). Social eating is also supported, initially by having lunch outside the unit in a café, then may include going to a restaurant for an evening meal. Schoen Clinic Newbridge is widely recognised for its innovative and broad group programme and OT expertise focusing on the practical and behavioural aspects of treatment. All young people at Schoen Clinic Newbridge can access these groups: Breakfast Club and Snack Out (open groups) and Lunch Club and Come Dine with Me (by assessment, set duration). An audit has been carried out to assess the effectiveness of these interventions. Eating and Meal Preparation Skills Assessment (EMPSA) tool was used, with assessments carried out before and after treatment to measure the individual’s ability and motivation for 12 aspects of meal preparation and eating, from planning and preparing food to eating out socially. Janet Tighe, lead occupational therapist at Schoen Clinic Newbridge (FKA Newbridge House), commented: “The results are extremely reassuring, with almost all young people reporting an improvement in several aspects of their ability and motivation following intervention. “Additionally, comments from young people indicated they found the groups encouraged independence, challenged their fears and increased confidence, in addition to being reported as enjoyable by many.” The EMPSA requires the young person to rate their ability and motivation in 12 tasks, on a 10-point scale where ‘0’ indicates no ability or motivation and ‘10’ indicates total ability or motivation. Twenty-five individuals completed the EMPSA before and after treatment. There was a statistically significant average increase reported for both motivation and ability. Professor Hubert Lacey, head of research at Schoen Clinic Newbridge, commented: “We are extremely proud of the OT resource and our innovative group programme; this is one of the unique features of Schoen Clinic Newbridge. Equally, we are committed to the principle of auditing everything we do, so we know what works, what needs to be refined and in what way. The results of this audit are particularly pleasing, showing significant improvement in both ability and motivation. Young people have regularly told us that they value social eating and meal preparation groups, finding them helpful and enjoyable. Now, with this audit, we have a clear, quantitative measure of benefit.” Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

Understanding the link between gender identity and disordered eating. If you need support, please don't hesitate to contact our caring team today. The majority of us identify as one gender or the other based on our biological sex. This isn't always the case, though. A person is considered transgender if their gender identity differs from the gender society typically associates with the sex they were assigned at birth. People who identify as a different gender than the one they were given at birth are referred to as "transgender." People whose gender identity matches the gender they were given at birth are referred to as "cisgender." People who identify as nonbinary, agender, genderqueer, Two-Spirit, or any other non-binary gender fall within the transgender category. The relationship between the experience of transgender people and eating disorders is not yet fully understood as research into the subject has been limited. Various studies have shown that eating disorders are more common in the LGBTQ+ community than in the general population, but few have explicitly examined how common eating disorders are in the transgender community. Often studies will group transgender people with gay, lesbian, bisexual, and queer people, but due to the distinction between gender identity and sexual orientation, this can result in a confusion of findings. Transgender people can be of any sexual orientation. In our service at Schoen Clinic Newbridge, we have experience of working with young people who have an eating disorder together with a gender identity which is different to their assigned identity from birth (or expressed difficulties with their biological gender). Through our work with a small cohort of patients, we can make some observations about issues raised and the treatment pathway. Are eating disorders common in transgender people? There has been minimal study on transgender communities, with the majority of studies on eating disorders and disordered eating focusing on cisgender women. However, nearly 300,000 college students in the United States (including students who identified as transgender) were involved in a comprehensive study regarding eating disorders and coping mechanisms that was published in the Journal of Adolescent Health [1]; in the findings, transgender college students reported having disordered eating at a rate that was around four times higher than that of their cisgender counterparts. Additionally, compared to their cisgender peers, the transgender adolescents who took part in the survey reported considerably greater rates of compensatory behaviours (like using diet pills). Transgender vs. cisgender eating disorder figures Percentage of college students reported receiving an eating disorder diagnosis in the last year. [1] 0.55% cisgender heterosexual men 1.85% cisgender heterosexual women 2.06% cisgender sexual minority men 3.52% cisgender sexual minority women 15% transgender Reported eating disorders were higher amount LGB (lesbian, gay and bisexual) people than straight (heterosexual) people, but the figures are significantly higher in transgender people. Why are transgender people at higher risk of developing an eating disorder? Eating disorders are difficult illnesses with several underlying factors. There are a variety of reasons why a transgender person could develop an eating issue, such as: Managing their stress or trauma as a result of the violence or prejudice they have endured due of their transgender identity Attempting to provide each or both genders certain qualities Attempting to follow a male or female "ideal" The Journal of Adolescent Health claims that there is a logical explanation for why eating disorders are a greater problem for transgender people than cisgender people, namely the fact that body dissatisfaction is one of the strongest predictors of developing an eating disorder while gender embodiment or presentation is crucial for many transgender people. Although not all transgender people want to transform their bodies, some do so through hormone replacement treatment, gender confirmation surgery, or other procedures that give them more masculine or feminine traits. However, some transgender people begin with dieting and exercise as the less expensive and intrusive choice, and this can result in harmful, disordered habits as they strive to achieve their desired look. Puberty, identity and eating disorders Puberty delay In the UK, the current average age for the onset of puberty is age 11 for girls and age 12 for boys (with a pattern of average onset becoming progressively younger over time).  Puberty is defined as delayed in girls if there is no menstruation by the age of 16 and no breast development by age 13. In boys, puberty is considered to be delayed if there are no signs of testicular development by the age of 14. One of the many different causes for puberty to be delayed is anorexia nervosa. This is because, in a state of severe undernourishment, the body chooses which functions are essential to life, shutting down less critical functions. The hypothalamus, the part of the brain which regulates functions suppresses the hormonal fluctuations which regulate sexual development and puberty. In girls, this is expressed by what is described as primary amenorrhea (periods not starting by the age of 16), or in girls who have started to menstruate, secondary amenorrhea (periods are missed for three consecutive months). In boys, the impact on puberty and sexual development may not be as easily recognisable but is likely to manifest in the delayed or slow progression of puberty, reduced sexual drive and poor height gain. It is widely recognised that the onset of adolescence and puberty is a time of change, search for identity and often, increased anxiety and conflict. If gender identity is difficult and being explored or challenged, this may be expressed in the adolescent’s relationship with food. A young person may deliberately restrict food intake to delay puberty because of gender identity issues. The precise causal relationship between gender identity, food restriction and anorexia nervosa will vary for each individual and require careful assessment. For other young people, the connection may be unclear; there is disordered eating and difficulty with food as part of other challenges the young person is experiencing, and these challenges may include gender identity. A specialised treatment approach It might be daunting for many transgender people to seek treatment for an eating problem because it's likely they've previously suffered some type of trauma, or prejudice for being themselves. It might be difficult to even locate a behavioural healthcare professional who upholds their fundamental rights, such as using their proper name and pronouns. People who identify as transgender have the right to care that addresses their unique issues since eating disorders impact everyone differently, regardless of gender identity. At Schoen Clinic we treat every patient as an individual, tailoring treatment to the unique needs of each person. It is important to note that during an ongoing eating disorder unless a gender identity has been well established within the young person before the development of the eating disorder, a key principle is that any new decisions about gender identity should not be taken at a low weight because cognitions are impaired. Our focus is to provide wide-ranging, personalised support for the young person as they weight restore. References [1] Diemer, E. W.; Grant, J. D.; Munn-Chernoff, M. A.; Patterson, D. A.; and Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 57(2), 144–149. doi:10.1016/j.jadohealth.2015.03.003. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

The issue of exercise can cause a lot of worry and uncertainty when an individual is recovering from an eating disorder. Overexercising is often a feature of anorexia, carried out compulsively as a tool in weight loss and maintenance of the disorder. Get in touch with our team today. Eating disorder inpatient hospitals provide an environment where exercise is very precisely managed. Zero exercise will be allowed at low weight and further into treatment when exercise is slowly introduced, it will be gentle and carefully managed activity. At Schoen Clinic, young people join Leisure Group, which enables them to gradually begin yoga, before moving on to other physical activities (undertaken in conjunction with body image work). How should reintroduction to exercise be managed? Once a young person leaves inpatient care and returns home, it isn’t possible to control exercise in the same way. “This is something parents are very concerned about as they prepare for discharge,” explains Gill Williams, Newbridge nurse who runs the Programme for Parents. “We advise it is much better for young people to take up organised activities and team sports because these are structured activities within specific time frames and there are social benefits in being part of a team or group.” The structure nature of team practices and organised activities makes it more feasible to plan and agree on additional snacks to compensate for the energy used and to ensure the exercise is contained within clear limits. “We would be much more concerned about a young person in recovery going running alone,” explains Gill. “There is the risk of runs getting longer and more frequent and no benefits of socialising with others.” If a young person prefers going to the gym to team sports, see if you can join them at the gym so their exercise is not a lone activity without time limits. Exercise after discharge from eating disorder treatment Normally, it is the compulsive approach to exercise which may still need to be considered after discharge. “Think about the motivation an individual has for exercising,” explains Sue Taylor, HCA, who also works on the Programme for Parents at Schoen Clinic Newbridge. “Your daughter or son might say – ‘It makes me feel better’. This is exactly the role of sports and exercise for many, many people. But if the individual feels bad and guilty and bad if they don’t exercise, that is an indication they still have a problematic relationship with exercise.” All sports and activities are not the same in terms of risk for individuals in recovery from an eating disorder. Endurance sports such as long-distance running and triathlons present a raised risk because of the very high levels of energy and dedication they demand (and how this can be expressed in a person predisposed to eating disorders). Aesthetic sports such as dancing and ice skating are at higher risk for young people in recovery because of their potential to maintain body image anxiety. But it is widely agreed that even though exercise presents challenges for the recovering anorexic, it isn’t possible or advisable for individuals to permanently avoid exercise. “Often, sport and exercise is a big part of young people’s lives before they became ill,” explains Sue. “Sport and exercise became a tool of anorexia while they were ill, but in recovery, young people are often very keen to enjoy exercising again.” Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

How can you support someone when you can’t be there for them physically? Loneliness. At some point in our lives, we’ve all had to experience some form of it. Whether you’ve moved home, started a new school or college, suffered the loss of a loved one, gone through a relationship breakup or experienced any other situation that’s left you feeling alone, we’ve all felt it. And, despite there being over 7.9 billion people in the world, it’s still possible for us to feel alone in a crowd. It’s not a pleasant experience, so we must do all we can to ensure those we care about don’t feel alone. In today's hectic society, being there for one another has become a difficult undertaking. Everyone is consumed with their troubles, life or work and it’s often impossible to be physically there for someone who needs to be cheered up. A personal story by a member of the Schoen Clinic team... How to support someone when they feel lonely So what can you do if you can’t physically be in the same place as someone experiencing loneliness? Well, to explore this more I’ll indulge you in a brief side-story. I grew up with my family in North London. I have two older brothers, both married and divorced with children, my parents divorced when I was a young child and my dad remarried. Skip ahead to 2022 and it’s now been about 8 years since my entire family moved home in the same direction, away from London and towards the Suffolk coast. I’m the only one who stayed behind because I love the city so much. After all, there’s no place like home and London, where I live with my husband, is my home. When it comes to loneliness though my main concern is my mum. She has plenty of grandchildren (the current total is 7) to keep her occupied, but as a single mother of 3 boys she always put us first and never found ‘the one’ for her. I do worry that she might get lonely sometimes and since we’re so far apart, I always make sure to check in with her regularly, usually by FaceTime so we can see each other. Since the pandemic, this method of communication has become a real blessing. Yet in the grander scheme of the global pandemic, communication, physical connection and human contact have ultimately been altered in ways we never would have thought possible a mere decade ago. National and international lockdowns introduced the term ‘self-isolation’ to common vocabulary and at a time when we needed to be with loved ones more than ever, the opposite became the reality. In-person meetings ceased, face-to-face gatherings were outlawed and the combined mental health of our communities suffered for it. Research by the Mental Health Foundation found that a quarter of adults (25%) in the UK reported feeling lonely during the pandemic. The figure was even higher for the younger generation with 38% of people aged 18-24 and 34% of people aged 25-34 consistently reporting feelings of loneliness throughout the pandemic. Even now as we emerge on the other side, the zeitgeist has changed and we haven’t completely reverted back to levels of pre-pandemic human contact. Many of us are understandably still anxious about Covid-19 and there are also the vulnerable, many of whom continue to remain shielded. But just because it’s more difficult to make connections with people in person, does that mean we shouldn’t bother trying at all? Definitely not. So without being physically present, what can we do to assist someone (loved one or not) in getting through a period of loneliness? Well, as I previously mentioned, FaceTime (or video calling) is my preferred method for keeping in touch with my mum - you can of course try calling your loved one by phone. But as fewer people use mobile phones for actual phone calls each year, and the younger generation preferring text or ‘DMs’ to traditional calls, one way you can potentially reach out effectively is via text message. In this article we’re going to dive into some strategies and give you the tools you need to hold meaningful discussion with someone in need, via text - be that WhatsApp, iMessage, text message or any other text based communication. Effective messaging by text is a transferrable skill you’ll be glad to have under your belt, so take note. Strategies for holding meaningful conversation via text 1. Give them your undivided attention First and foremost, devote all of your focus on them for a period of time. Despite the fact that the communication is conducted by text, it can be quite obvious if someone isn’t really paying attention. If they’ve contacted you and you aren’t available at that specific time, set some time aside, let them know when you’ll be available and stick to the agreed time. Another point worth mentioning is that this shouldn’t be a one-time talk. Loneliness is a sensation that persists even after a few conversations with others. Loneliness quite aptly doesn’t simply go away on its own. Someone feeling lonely needs to know that someone cares about them. As a result, try to let them know that you will always be available to them (or at least most of the time), and regularly check in with them to see how they’re feeling - or to let them know that you’re still there for them. It’s also really important to take note of their circumstances and if there is any worry or concern of potential harm, highlight the option of seeking expert help. 2. Avoid sending scripted texts There are plenty of motivational quotes online. There are endless online pages of inspirational quotes available but despite their prominence, they may have lost their meaning and significance over time through over-exposure. Sending your friend or loved one the same overused inspirational phrases may not have the desired effect and could lead them to believe you aren't really paying attention, or that you don’t really care. For want of a better phrase, it may make the interaction sound scripted. When someone is feeling low, they’re in a negative mindset which makes them more likely to be emotionally sensitive. So, especially if it's someone close to you, try to be real in your texts. Use your own experiences and encounters with them. Make every effort to be unique and avoid becoming repetitious. When you're depressed or stressed, reading the same thing again and over might become irritating, and the individual may distance themselves, or become closed off to the communication. This wouldn’t be the desired outcome so it’s important to consider each of your responses carefully. 3. Express your gratitude and appreciation to them Sharing how you’re feeling, especially when it’s at a point of low mental health can be challenging. When someone confides in you and expresses their sentiments and concerns, you must do all possible to make them feel at ease. One of the best ways to do this is to show your gratitude for their decision to open up to you. “Thank you for telling me” and “Thank you for having the courage to open up to me” are two good examples. When they read the text and realise how grateful you are, it provides a feeling of validation and an understanding that their feelings aren’t a burden to you. This helps to create a safe space and connection and will encourage them to open up to you more next time. 4. Make a conscious effort to listen more than you speak It's better to let someone talk more while they're opening up to you since they need to express themselves. As a result, try to pay attention (you’ll know the phrase “a good listener.” Well in this case, you’ll need to be “a good reader”). If you want to do it well, remember that a deep text discussion is all about balance. If you chat too much, people could believe you're not paying attention and if you don't text enough, they might think you're still not paying attention, so be careful. 5. Don’t make it a one-time conversation As I mentioned before, it’s important to check in regularly to see how they’re feeling. You must continue to maintain regular communication with the individual, even after they have expressed their thoughts. If you don’t, or if you forget, it could seem to them that you didn't care in the first place, making them feel they shouldn't have confided in you perhaps. So, text them now and then and keep an eye on them. But do it without making it brutally clear that you're doing so in response to that one chat. Instead, act genuine and send them a witty message, enquire about their day, or invite them to lunch or dinner. Doing this shows that you genuinely do care and think of them when you’re not there. 6. Validate their feelings and avoid judgement When someone shares how they’re feeling with you and you respond by disagreeing with them, you’re dismissing them and invalidating how they're feeling. If you start correcting them or judging them for how they feel, they may stop venting and their negative thoughts may begin to play on their mind once more - more so after the communication has ended. To avoid this, wait until the appropriate time to discuss (rather than imposing) your views and opinions on a topic. 7. Make sure they don't feel like they're bothering you This is probably the most important point on this list. When a person is vulnerable, it is quite easy for them to shut down. They might feel like no one cares about them, no one wants to listen or no one will understand. Coming forward and admitting how they’re feeling can be daunting, and the fear of rejection, especially during a state of low mental health can be overwhelming. They may feel that they are a burden to you, that their sentiments might upset you and that they shouldn't bother you in the first place. Even if you sincerely care for them, their brain will tell them differently. Do your best to communicate that you genuinely want to support them through this time and you’re not just responding to be polite. So there you have it: some guidelines for comforting someone through text when they’re feeling lonely. As I said at the start of the list, these are transferrable skills so it doesn’t have to apply only to people feeling alone. If anyone is struggling with depression, low-mood or anxiety these suggestions can all be helpful. Equally if a friend or loved one comes out to you as LGBTQ+ these are all tips that can be useful. The true magic is in the specifics, which you'll have to find out for yourself because they're unique to each individual and scenario. It all comes down to paying attention, truly listening and being there for them. I hope you found this helpful and employ these techniques when you next need to communicate with a loved one in need. Now, I’m off to FaceTime my mum. Written by a Schoen Clinic employee for Mental Health Awareness Week, anonymised for privacy. If you or someone you care about is experiencing a mental health problem, our specialists are here to help. Please don't suffer in silence, reach out to our expert team. Our Chelsea outpatient clinic in London specialises in exactly these kinds of problems. Call their friendly team today on 020 3146 2300 or email che-privateenquiries@schoen-clinic.co.uk

As the festive season approaches, it's important to recognise that for individuals and families coping with an eating disorder, the holidays can bring unique challenges. At Schoen Clinic, we understand the complexities surrounding this time of year and are committed to providing support and guidance to navigate through the festivities with care and compassion. In this blog post, we'll delve into practical strategies for planning, preparation, and communicating with relatives, offering valuable insights to help make the holiday season a more manageable and enjoyable experience for those affected by eating disorders. If you need support, don't hesitate to get in touch with our team. Preparation Supporting a family member with an eating disorder at Christmas presents multiple and very complex challenges. It is important to prepare for this and to acknowledge how different members of the family feel about Christmas, including their fears, hopes and concerns. For the individual who is coping with anorexia at Christmas, there is likely to be raised anxiety about the super-abundance of food at this time of year and an increased pressure, compared to other times of years, to eat with other people and to eat food they might otherwise avoid. Parents are likely to be feeling the pressure to create a happy, or even perfect day (social media can be particularly unhelpful in this respect). Parents may find themselves reflecting on how different Christmas is now the family are coping with an eating disorder, compared to previous years, when children were younger. These concerns and conflicted feelings can become an ‘elephant in the room’: parents carry on with Christmas preparations, hoping all will go well, unwilling to share anything which could be seen as ‘negative’. However, it is much better to talk through and acknowledge worries of eating disorders and Christmas at an early stage. What preparation is helpful if you're coping with eating disorders at Christmas? Family members should try to talk about how they are feeling about Christmas openly and honestly in advance. Try to avoid comparing this Christmas with previous years. It may be helpful to avoid or adjust social media interaction, particularly if this is something that makes you feel pressure to have a ‘perfect’ Christmas. Emphasise your own traditions around Christmas, for example, going to get a Christmas tree and decorating it, shopping together, going for a walk or to a Christmas market. These traditions can be comforting and enjoyable and they also help to take the emphasis away from a big Christmas dinner/the consumption of food. Relatives A significant aspect of Christmas is the emphasis on getting together with relatives and friends. When someone is struggling with an eating disorder at Christmas, this presents a particular challenge. If they have not seen relatives for several months or longer, they may feel anxious simply about seeing them and particularly about comments they may make (however well-meaning). An individual with an eating disorder is likely to feel particularly anxious about eating with people whom they do not share meals with regularly. Who to invite, for Christmas Day or at other times, can become a significant source of conflict. The individual who is coping with anorexia at Christmas may not want relatives to visit because of the difficulties this could present. Other family members may feel anorexia or bulimia already compromises family life in many ways and for also Christmas to be changed is not acceptable. If you are caring for someone with anorexia or bulimia at Christmas, you may find yourself in the middle of this conflict. Advice for relatives when you're coping with eating disorders at Christmas Perhaps invite only close relatives or friends to your Christmas meal, which is likely to be a major pressure point. Consider who your child feels most comfortable with and it is worth bearing in mind, if your child has not seen a particular relative for a significant period of time, they are likely to feel anxious (will they comment on changes to their appearance?) Consider getting together with wider family and relatives in a way in which food (particularly sitting down for a meal) is not the primary focus, for example, going for a short family walk together, or a more informal ‘drop-in’ ​​​​​Talk to your relatives in advance about what may help and what may not be helpful. Explain that any comments about appearance, even “you look well” could be misinterpreted by a person with an eating disorder (to suggest weight gain/fatness) and it is best to avoid any comments about appearance. It is also best to avoid any comments about anyone else’s appearance and certainly to avoid discussion about New Year's diets. Comments about how much food is being eaten are also unhelpful (“I’m stuffed”/ “Aren’t you doing well”). If relatives feel worried that they might ‘say the wrong thing’, reassure them that people with eating disorders usually welcome talk during mealtimes as a distraction. General talk about all subjects not related to food/body image/eating disorders is helpful. Straightforward statements like “I’ve been really looking forward to seeing you” are a positive way of starting a conversation. Relatives may need to be aware that the young person may be less chatty than they have been on previous occasions. The Christmas meal Anyone coping with anorexia or bulimia at Christmas is likely to be feeling anxious about the Christmas meal. Family members are likely to also have worries and concerns about how the meal will be; for the individual with an eating disorder at Christmas and for the family as a whole. It is very helpful to discuss and agree on portions and strategies in advance. At Schoen Clinic Newbridge, we have a Christmas meal early in December. This helps young people prepare and we also share portion sizes (weights and photographs) with the families we work with. Planning and organising your Christmas meal It may be useful to have an agreement such as: parent will plate up the meat and potatoes for the young person and perhaps do the same for others. This way, the young person has an agreed portion of protein and carbohydrate, has a choice of vegetables and is not ‘singled out’ as having their meal in a different way to others. It may be helpful for the young person to sit next to a designated supporter who they trust and knows them well. Some people find it useful to copy their supporter’s portions, which is helpful if people are serving themselves. It is often helpful to have an activity planned for after the Christmas meal as a distraction, such as a board game or watching a film. Eating disorders at Christmas: help & advice In summary, if you have a family member who has anorexia at Christmas or bulimia, these steps may help: Plan and prepare: think through everything, what will help and, importantly, what will be your Plan B if things go off course. Talk though your concerns and conflicts. Don’t try to carry on with your Christmas preparations in the same way as before, hoping for the best. Adjust your expectations. A smaller number of visitors, a few less activities may be helpful. Avoid social media or anything that perhaps projects the ‘perfect’ Christmas. Advice from a parent of a young person with an eating disorder “I think it is really important to prepare and make a plan for Christmas with your loved one, then to be prepared for your plan to go off course. Try to be flexible and be aware of your own expectations; it is probably better to lower them a little. If your teenager needs some time out in their own room it may be better to allow that than to have a big fight. My daughter is in recovery from anorexia and certainly has issues with food still, but she loves Christmas. She loves the traditions and as she moves into her early twenties, she really values the time together with family and that certainly outweighs the food anxieties, even though they are still there.” – Parent of a young person who was treated for anorexia at Schoen Clinic Newbridge. Help is available If you're struggling to cope with Christmas and want to talk to someone, we recommend you call the BEAT helpline, which is open on Christmas Eve and Christmas Day. This is run by trained specialists and BEAT is the national charity dedicated to supporting people with eating disorders and all those affected by them. Adult Helpline: +44 80 8801 0677 Studentline: +44 80 88010811 Youthline: +44 80 8801 0711 This article was compiled by eating disorder experts at Schoen Clinic Newbridge including Rachel Matthews - Director of Mental Health for Schoen Clinic, Professor Hubert Lacey and a parent of a young person who was treated for anorexia at Schoen Clinic Newbridge. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

An expert guide to coping with post-pandemic worry By Dr James Woolley, Consultant Psychiatrist at Schoen Clinic Chelsea The COVID-19 pandemic had an impact on each of us in a variety of different ways. However differently we've responded to the experience, there's no denying that it has been a very challenging time for us all, and research by The Mental Health Foundation found that six out of ten people were anxious about the pandemic and at risk of ‘persistent and severe mental health problems’. It's now more crucial than ever to take care of our mental health and wellbeing. In light of this, we've compiled some simple tips on how to cope with worry, advice for relaxation, and mindset strategies for people who are feeling overwhelmed in life. So whether you're struggling to cope with money, experiencing problems within the family, finding work too stressful or finding anything in the post-pandemic world worrying, we aim to help you navigate how you're feeling and implement ways of alleviating that stress. What can you do on your own to minimise worry? We're seeing many people in this post-pandemic phase at our mental health clinic in London, compounded by economic concerns and world events struggling with high levels of anxiety. A good proportion of these also then have knock-on effects on mood, increasing the risk of depression. Whilst seeing specialists and therapists to fix the situation can be an attractive sounding rapid intervention, some of the most effective strategies are often the ones which you can do yourself at an earlier stage and are within your own hands. Often with high levels of anxiety, worry and stress, much is rooted in a sense of "lack of control" of a situation or external events, so grasping the issues that you do have some influence over can often be highly symbolic in starting to turn things around. If this doesn't help, or if you're finding it too difficult to cope on your own, it's important to seek professional help when you need it. Routine is helpful for good mental health The body and brain respond well to routine, regularity and predictability, so regardless of how you're feeling, sticking to a relatively consistent bedtime, and getting up at about the same time helps to start impose useful structure which otherwise easily drifts. Are you doing things which whilst helping in the short term, in the long run may be exacerbating the situation? For example: Are you getting adequate rest, sleep, and exercise? Is your diet healthy, with regular meal times and trying to minimise unhealthy dietary choices or snacking in between? Are you managing to avoid excessive naps during the day? Are you making time to put in some regular exercise? Are sleep patterns steady? Sufficient social contact can also be beneficial to positive mental health. Are you saying yes to brief contact with friends and family, rather than avoiding them? Although it may feel a lot of effort to socialise even to a minimal degree, for most people it's likely to be better than the tendency to isolate which comes at times of high stress. There's lots of advice out there, and no one-size-fits-all approach. For some, they also benefit greatly from meditation. Others achieve it through the practice of mindfulness. Others find it through connecting to nature in a walk through the woods. According to research by Mind, your mental and physical health can benefit from spending time in natural settings or incorporating natural elements into your daily activities. Negative coping mechanisms to avoid Other unhelpful coping strategies sometimes creep in, such as heavier or more regular consumption of alcohol (or other drugs). This can feel helpful in the short term, sometimes assisting in getting to sleep and reducing anxiety levels, but at the cost of these sorts of symptoms being even worse the next day, as well as having a longer-term depressant effect on the brain. Similarly, try to keep control of caffeine intake. With high levels of fatigue which accompany stress and anxiety, people will often increase their caffeine intake to compensate, but then this drives anxiety up even further and worsens sleep. Keep an eye out for less obvious sources of caffeine such as stimulant drinks, and other soft drinks which are sometimes fortified with caffeine. What's the best thing to do to stop worrying? Anything else you can be doing in order to gain control over the situation is likely to help as well- for example if it is financial concerns, speak with your bank, utility company, or any other organisation which is causing you concern to ensure that your worries are completely in line with the actual situation. Bear in mind that when we are in an anxious frame of thinking, the anxiety itself can skew our thinking patterns and make them less rational. You may be 100% correct about the reality of the situation, but when ruminating about them from an anxious perspective, we are all susceptible to jumping to faulty conclusions, giving excessive weight to "worst-case scenarios", and being generally less able to use the rational parts of our brain to problem solve. So check the reality of situations out with friends, family, or organisations you have relationships with as ways to strengthen your rational decision-making and ability to weigh up the actual situation you are presented with. For some, this is one of the practical benefits of psychological therapy and counselling - connecting with an impartial observer who can act as a practical sounding board to help you keep unrealistic thought patterns in check and to help you devise strategies you can employ day-to-day to tackle them. Expert treatment for anxiety and mood problems in London At our Chelsea mental health clinic, we understand that everyone who comes through our doors experiences mental health problems in different ways. That’s why our treatment is tailored to the needs of our patients and their families and is based on the latest clinical research. If you or someone you care about is experiencing a mental health problem, our specialists are here to help. Learn more about our specialised treatment programme for common mental health problems at our leading London mental health centre, Schoen Clinic Chelsea or speak to our Private Enquiries Manager at no obligation, on 020 3146 2300 Dr James Woolley is a Consultant Psychiatrist BSc(Hons) MBBS MRCP MRCPsych PGDip (CBT) at Schoen Clinic Chelsea. Contact our team today.

This information has been developed by Schoen Clinic Newbridge’s Working with Families team in collaboration with parents and carers we have worked with. It is written to support members of the wider family to help answer any questions you may have and describe what is helpful when a young relative is with us for treatment. This page is home to information for family members (typically grandparents, uncles and aunties but anyone involved) who wouldn’t ordinarily join family therapy or the Programme for Parents (P4P) but have significant relationships with a young person admitted to Schoen Clinic Newbridge. Get in touch today. It’s not meant to cover everything but to be perhaps a conversation starter and a foundation for understanding. - Jenny Hudson, Social worker and parenting practitioner at Schoen Clinic Newbridge Why does the young person need to be admitted to Newbridge and live away from home? It is a big step to come to Newbridge. Young people are only admitted for treatment with us if supporting them at home is not working well and it is not safe to continue with things as they are. Being a very low weight and a prolonged period of restricting food has significant risks – we need to closely monitor their physical health and support the young person to overcome their eating disorder. I don’t really understand anorexia. What do I need to know? Family members often feel frightened, sad, and unsure of what is happening but don’t want to burden parents by asking questions. Here are some things that are good to understand: anorexia is an overwhelming drive to restrict food intake to lose weight. Even at a very low weight, individuals see themselves as fat. The cause of an eating disorder is always unique, involving multiple factors. It is important to think about eating disorders in emotional terms: restricting food and control of weight becomes the coping strategy for the things they find difficult in life. How can I help? We know that relationships are one of the most important factors in recovery from an eating disorder. Do keep in mind that when a young person is very unwell, their capacity for relationships is likely to be reduced, compared to before the illness. They may seem quiet, flat and disinterested in conversation and may be reluctant to visit or attend family events. Even so, they will value your interest and in knowing you are there for them. Parents will be useful guides for what kind of communication is helpful – a young person might appreciate cards or supportive text messages. I’m worried about saying the wrong thing It is natural to worry, especially if you haven’t seen the young person for a period of time, but here are some useful things to bear in mind. Although it is natural to say to people “you look well,” someone with an eating disorder is likely to interpret this as meaning you can see they have put on weight and this may make them feel guilty. Substituting the phrase with “it is good to see you” can be helpful. Talking about calories, diets and food intake (including your own) should be avoided and during meals, try to find broader topics of conversation (not food related) to talk about. If you find yourself struggling for something to say, think about the young person’s interests and hobbies, the things you used to talk about before they became unwell. They will appreciate you remembering these and showing you are interested in them as a person, beyond the eating disorder. Caring for the carers Eating disorders have a very distressing impact on the whole family. Parents feel anxious, exhausted, and even burnt out. There are ways you can support parents which will be very important in helping them to manage. You may be able to support or spend time with the siblings of the young person in our care. We know that when a sibling is unwell, this is very challenging for siblings and at the same time, they may have less time from parents than normal because of the focus on the unwell child. Siblings may value any time and support you can provide. What can we expect? Treatment and recovery does take time. We need to support the young person to restore weight and develop a normal routine of eating and food choices. At Newbridge, they will participate in individual therapy and group programmes to enable them to make sense of things and learn better ways of coping with difficult feelings than restricting food. They will leave Newbridge at a healthy weight but recovery will be ongoing once they return home and gradually take more responsibility for staying safe and well. Your support throughout will be very important throughout. Schoen Clinic Newbridge For young people (8–18 years old) with eating disorders like bulimia nervosa, anorexia nervosa, and OSFED, Schoen Clinic Newbridge provides highly specialised therapy. Our multidisciplinary team (MDT) of professionals, who are leaders in their fields, collaborates to provide young people with eating disorders with clinically cutting-edge treatment pathways. The MDT method makes sure that every therapy we offer addresses the numerous aspects that lead to an eating disorder. Schoen Clinic Newbridge is proud to be part of the NHS West Midlands CAMHS Provider Collaborative. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

The rise in popularity of social media platforms such as Instagram and TikTok has undoubtedly increased awareness of eating disorders. Many people have built entire online communities to share support and advice for those going through difficult mental health conditions, like disordered eating. At its best, social media helps to de-stigmatise eating disorders by encouraging people to be open about their personal struggles and embrace body positivity. On the other hand, it also opens up the doors to negative content which can, in many ways, be detrimental to the overall health and wellbeing of social media users. In this article, we’re going to look at some of the ways social media can impact eating disorders - and what can be done to protect users. Get in touch with our team today. Living through a lens - filters and edits It’s important to remember that many social media users only share the highlights of their lives. So while it may seem to the consumer that a content creator’s life is perfect all of the time, what is often seen is only a small portion of reality - and even then it could be through a filter. A 2021 study by the City University of London, ‘Changing the perfect picture’ found that 86% of participants said their social media representations didn't reflect their real life. They also said they felt pressure to project a ‘perfect life’. Some of the most common filters used by participants altered skin tone, whitened teeth or took off weight. In addition, many also used social media filters to change their physical appearance by reshaping their nose, jaw and other facial features. Filters can be fun to use from time to time but can also lead to a warped sense of self or body dysmorphia if users become overexposed to them. According to research, young adults using social media filters frequently report feeling less satisfied with their actual face and body. They judge themselves by their own filtered ‘selfies’ in addition to the "perfect" representations of peers and celebrities. This constant comparison to a filtered version of yourself or celebrities can negatively impact self-esteem and body image. Celebrity culture and influencers With the rise in the popularity of social media influencers and aspirational content, problematic behaviour on social media has also risen. Influencers are often a gateway to comparison, which can lead to more damaging thoughts and emotions. There’s a long list of celebrities and influencers who have been ‘called out’ for using filters when selling beauty products or using editing apps or software such as FaceTune or PhotoShop to alter their appearance online. The influencer community also receives regular accusations of promoting eating disorders on social media, particularly through ‘what I eat in a day’ or exercise and diet content. Whilst not all influencers post content creating false expectations for what it means to be beautiful, for those avidly consuming such content it’s often a beauty ideal which can never be achieved. And, what may seem harmless to one person, could be unintentionally triggering those who are already experiencing, or susceptible to developing an eating disorder. In a recent BBC3 documentary, Zara McDermott: Disordered Eating, former Love Island contestant and social media influencer Zara, explored the impact social media influencer content (like her own), had on young people and their relationship with their bodies and diets. Specialised eating disorder hospital, Schoen Clinic Newbridge opened its doors to Zara and the documentary makers allowing exclusive and rare access to some of their teenage patients to share their journeys. Whilst social media content may not always be the cause of an eating disorder, the patients featured in the documentary noted that social media feeds such as Zara’s, filled with bikini pictures, ‘what I eat in a day’ videos and photoshoots trigger a desire to lose weight and disordered thoughts surrounding eating, dieting and exercise. The documentary also took a closer look at TikTok and the speed at which the algorithm can take a user from relatively safe, healthy eating content to dangerous pro-eating disorder, or pro-ana content. But is social media really to blame for the rise in young people experiencing eating disorders like anorexia and bulimia? With an estimated 1.25 million people in Britain living with an eating disorder, TikTok has come under fire with many users stating that it’s fuelling the problem. Research from the Centre for Countering Digital Hate (CCDH) analysed content shown on TikTik’s ‘For You Page’ and found that all users were shown eating disorder content and suicide content, sometimes very quickly. It also found that there is an entire community of eating disorder content on TikTok with more than 13 billion views, across just 56 hashtags. Rachel Matthews, Director of Mental Health at Schoen Clinic UK Group says, “As eating disorder professionals, we know that social media doesn’t cause an eating disorder - but it can fuel the concerns and further entrench disordered beliefs. We are pleased that there has been further research into this area and we support the campaigners working towards tighter controls around social media content. To be able to protect all young people from harmful material.” When does healthy living content become harmful material? For some people, ‘clean eating’ and regular exercise are a way of life and having a healthy balance between the two in an “image-obsessed social media world” is deemed by some, as a way of measuring or demonstrating success. Unfortunately, what often begins as a desire to live more healthily has the potential to develop into an eating disorder like anorexia, bulimia, or other specified feeding or eating disorder (OSFED) as hyper-restrictive diets masquerade as healthy ones. So-called "fitspiration" accounts are also a common trigger for disordered eating, especially in those who are vulnerable. ‘Fitspiration’ accounts are often first seen as a simple way to stay motivated and get healthy, yet the more time spent looking at other people’s “perfect bodies” or “perfect lives”, the more likely it is that such comparison will develop into feelings of inadequacy and potentially something bigger like an eating disorder or depression. This is especially true if you already struggle with self-image or self-esteem issues. As social media has transitioned from a communication tool to a way to document our lives, the concern about the negative impact this could have on self-esteem and body image has grown. A recent study by Stem4, a teen mental health charity, found that 77% of children and young people are unhappy with how they look, with the report acknowledging social media played a significant role in this figure. We know that comparing yourself to others online can cause negative thoughts about your own appearance and may even lead to depression or anxiety, but it’s not always that simple to escape the cycle. Over the years, platforms have tried to control how users view content, however, the efficacy of such algorithm changes is yet to be determined. Updates aimed to reduce users' exposure to thinspo content have backfired with users continuing to experience a lack of control over how much exposure they get to certain topics or hashtags online. Social media and mental health It is incredibly important to be aware of the possible effects of social media on your mental health so you can make informed decisions about how much time you spend on it and what types of content you see. Research shows those who spend a large amount of time on social media are more likely than their peers to feel isolated from others in real life. This sense of loneliness created by social media may fuel an eating disorder or disordered eating. Eating disorders thrive in isolation, with secrecy often playing a big role in a sufferer's daily routine. If you struggle with an eating disorder—or know someone who does—it’s important to be aware of this connection between isolation and secrecy. What you can do to help yourself There are ways to consume social media content more healthily. It begins with increasing your awareness of the daily effects that comparison, body image and filters have on your emotions and wellbeing. Audit your selfies - consider how much time you spend editing, filtering and posting, as well as how it makes you feel. How do you feel before, during, and after editing and posting? Do you continually look for feedback and compare your photographs to others? You should aim towards a future which values your self-worth and is tolerant of your own body image, as it is. Embrace yourself as you are - keep in mind that our "flaws" are what make us unique. Appreciate yourself for all of your traits, not just the ones that can be seen in a selfie and try to practice self-compassion. You can develop genuine relationships with others in real life by developing a supportive and caring relationship with yourself. Be kind to yourself – when you edit a selfie, you're telling yourself—consciously or unconsciously—that you're not good enough as you are. If the likes and comments you seek are related to an image that doesn't accurately reflect who you are, how fulfilling are they? Try caring less about what others think of you - As Jennifer Coolidge (star of the hit Netflix show The White Lotus) recently said, “The secret to confidence is not caring.” Realistically though, your daily life does not have to be impacted by what others think of you on social media. How long you stay there is within your control. According to research, interpersonal relationships in the real world make people happier than those they interact with online. Specialist support for eating disorders Overusing social media and comparing oneself to others can lead to problems with anxiety, depression and self-esteem, or they might exacerbate pre-existing mental health difficulties or fuel disordered eating. At Schoen Clinic, we treat these issues by addressing their underlying cause whilst helping people develop positive coping mechanisms and lifestyle choices. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults.

5 warning signs to look out for We all want the best for our children and sometimes it can be hard to tell if they're struggling with their mental health. If they are struggling, it's important to get them the help they need, but also recognise that they may feel embarrassed or ashamed to talk about what's going on. The good news is, there are signs to look out for so you know when to seek professional advice. 1. They're not sleeping or eating If your child is not sleeping or eating, it could be a sign that they are suffering from a mental health condition. Depression in particular can cause changes to appetite causing the sufferer to gain, or lose weight. This can lead to eating disorders like anorexia nervosa. It’s estimated that around 1.25 million people in the UK have an eating disorder. Depression can contribute towards other eating disorders such as anorexia nervosa, bulimia nervosa, and orthorexia nervosa (an obsession with healthy food), with eating disorders developing as a means of coping or self-medicating mental health issues like anxiety or depression, in an attempt to gain control. 2. They're isolating themselves Isolation is a common symptom of depression and anxiety and it can be difficult to recognise. Your child may be isolating themselves in an obvious way i.e. away from you or other family members, but without telling you why. They may also lose interest in activities they used to enjoy, and not engage with others as much as they used to. This isolation will be less obvious if they’re isolating themselves from friends or activities outside of the home. 3. They're experiencing low mood If your child has a low mood or is more negative than they usually are, this can be a sign of depression. It's important to remember that sadness is a normal emotion and everyone feels sad from time to time. Depression is different from normal feelings of sadness; it's low mood for an extended period of time which interferes with daily activities such as schoolwork or socialising with friends. Symptoms of low mood include: feeling down feelings of hopelessness increased irritability 4. They're acting out, but can't explain why. If your child is acting out, it could be a sign they are struggling with their mental health. Acting out can include anything from getting into fights, to self-harm or drug misuse. The best way to tell if your child is struggling with their mental health is by asking them directly and listening carefully for red flags like "I don't know what's wrong" or "I just feel like I'm falling apart." Acting out (beyond the typical realm of typical teenage behaviour) is not normal behaviour for children and is often a symptom of something deeper going on, needing attention before they begin to struggle even more. 5. They have changed their appearance and behaviour. If your child has changed their appearance and behaviour, it could be a sign that they are struggling with mental health issues. Here are some ways to tell: They may be dressing differently than usual. They could be wearing clothing that is more or less revealing than they would normally wear. One typical sign of trying to hide an eating disorder is to wear baggy clothing. They may be acting differently than usual, for example, by being more outgoing or withdrawn than normal. They may spend more time alone and less time with friends/family as well as express a lack of interest in activities such as sports teams or clubs at school (or even online). If you notice any changes in your child's appearance or behaviour over the course of several weeks then this could indicate something bigger going on beneath the surface – many people who suffer from depression often feel isolated within themselves so won't necessarily show symptoms externally. Seek help and support If you are concerned that your child is struggling with their mental health, talk to them and seek help from a professional. Mental health issues are common and can be treated but often do require specialist help to overcome. It is important to remember to take time with your child when talking to them as they may be feeling vulnerable and may not want to talk to you. If this is the case, try to encourage them to open up to someone else they trust, such as a relative or teacher and seek help from a professional. Please reach out to our caring team at Schoen Clinic if you need support for yourself or a loved one. Our specialists in London, Birmingham and York offer highly specialised treatments for children, teens and adults with mental health conditions or eating disorders. To find out more about Place 2 Be’s Children’s Mental Health Week, visit https://www.childrensmentalhealthweek.org.uk/