We should let you know that this episode discusses sexual abuse and comes with a trigger warning. It's about trauma, which is an individual’s response to an event or series of events that have deeply disturbed their sense of safety, security, or well-being.  

While research shows a clear intersection between trauma or post-traumatic stress disorder (PTSD) and eating disorders, too few health professionals include trauma therapy in their practice. Why? They’re concerned that by opening the “trauma box” there’ll be a worsening of symptoms or relapse. 

The problem is that this assumption is wrong. Not all people with eating disorders have indeed experienced trauma, but clinicians need to be trauma-informed to support their clients in understanding and addressing what they may have lived through. This is because appropriate discovery with appropriate care will have a positive impact on their eating behaviours. 

Listen to leading clinicians and people with lived experience of both trauma and eating disorders discuss this difficult but important topic, with useful insights on what can help.

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This month we’re talking to a distinguished social epidemiologist and behavioural scientist at the Harvard Chan School of Public Health. Her name is Professor Bryn Austin, and her research focuses on public health approaches to eating disorders.

Our conversation begins with an overview of the web that connects consumer culture, corporate exploitation, and the pervasive influence of diet culture on body image. “We’ve known for decades how harmful the consumer marketplace can be with diet culture, the diet industry, diet pills and supplements, and all the negative body image pressures that come through media, social media and advertising,” she says. “People have been writing about this for decades.”

The problem is we still need to more deeply understand–and do more to address—what corporations are doing to exploit diet culture for profit.

Don’t miss Professor Austin’s wise perspective. Not only does she share her thoughts on the complexities of the body image and eating disorders landscape, but she also discusses the transformative potential of strategic initiatives, including what her Harvard-based laboratory did to protect young Americans from predatory diet-industry profiteering.

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We’re talking about the higher-weight paradox, particularly when well-meaning health professionals can trigger an eating disorder or make one worse. 

Not everything health issue is solved by losing weight, yet that is what people in larger bodies too often hear. Worse, numerous people living with eating disorders remain undiagnosed and untreated because the stereotype of an eating disorder doesn’t fit their reality.   

Melissa says she had an eating disorder from age 12 but wasn’t diagnosed until age 22. In fact, her unhelpful behaviours were encouraged: “All that my doctors cared about was for me to lose weight,” she says. 

Professor Leah Brennan of Latrobe University reports that eating disorders occur across the size spectrum and the prevalence of eating disorders is actually greater in people in larger bodies. 

One problem, says GP Samantha Wyton, is that people in non-typical body shapes and sizes are too often made to feel unsafe and unwelcome in medical settings. 

“We’re taught that obesity is a disease in medical training,” she says. But it’s a lot more complex than that. “We need to embrace the full spectrum of shapes and sizes, because that’s the reality of the human condition.”   

Dietitian Dr Fiona Willer, agrees. “The effect of weight centrism, particularly in primary care, is that people will delay going to the doctor until they can’t avoid it,” she says. And that effectively creates an issue for all their health outcomes, not only body image and eating disorders. 

Listen to Sam unpack this issue with our group of concerned and articulate guests, including their thoughts about how we can and must change.

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At the recent Australia and New Zealand Academy for Eating Disorders conference on the Gold Coast, we spoke to experts about new and groundbreaking insights into eating disorders. This episode is the second in a series of two.  

Dr Simon Wilksch unpacks his work around the significant financial and emotional costs that families face when caring for children with eating disorders and, to improve outcomes, why he recommends that parents and caregivers receive support too. 

Monash’s Courney McLean talks about the complex relationship between vegetarianism, veganism, and eating disorders, and the tool she’s developing to assess motivation for adopting to a plant-based diet. Her work points the way to improved diagnosis and care for vegetarians and vegans experiencing eating disorders.

Belinda Chelius, CEO of Eating Disorders Queensland, explains her evidence-based rationale for including lived experience practitioners in eating disorder treatment, and why lived experience has always provided the infrastructure for EDQs work.

Finally, Dr. Renee Denham, a child and adolescent psychiatrist based in Brisbane, describes the interplay between attention deficit hyperactivity disorder (ADHD) and restrictive eating, and how we can identify and help those kids affected.  

These conversations reveal the multifaceted nature of eating disorders and the innovative approaches being taken to address them. 

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The key to understanding any mental illness is to listen to those who have been through it. Not only can the voices of those with lived experience of an eating disorder help those who are currently impacted, but they also, importantly, serve to educate the health professionals who will provide care. 

The evidence is clear: Services that are co-designed with those who know their own situation will always have the best chance of success.  

That’s why the voice of lived experience is being embedded in most new treatment initiatives, including the recently launched and much heralded National Eating Disorders Strategy of 2023 – 2033. 

Our guest, Shannon Calvert, experienced a longstanding and severe eating disorder and through the ups and downs of her own journey has since dedicated her life in recovery as a much needed voice and advocate for others. 

“Through my own recovery, there were health professionals that didn’t want to do eating disorders or didn’t know how to do eating disorders. It was too complex, too challenging for them. That shifted my perspective in terms of how we can do things differently", she says.    

Today, Shannon collaborates with all parts of the sector -- health professionals, researchers, and policymakers to develop person-centered, compassionate and integrated health care for better outcomes for everyone. 

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We snuck into the annual Australia and New Zealand Academy for Eating Disorders (ANZAED) conference to illuminate the future of eating disorder diagnosis and care. We recorded on-site at the conference, where we asked various speakers to give us a taste of their research for the sake of all those who’d be interested but couldn’t be there.

Segment 1: Reviewing current treatment approaches
Dr. Anthea Fursland, a distinguished clinical psychologist for the past 40 years, shares a candid perspective on the strides made in treatment, especially for Anorexia Nervosa, but offers insights about the gap between new understandings and legacy approaches to care.

Segment 2: NDIS engagement for people with eating disorders
Hilary Smith, a National Manager at the National Eating Disorder Collaboration (NEDC), talks about what may be required and what we still need to know for people with eating disorders to access support from the National Disability Insurance Scheme (NDIS).

Segment 3: Body dysmorphic disorder and cosmetic surgery
The point where body dysmorphic disorder and cosmetic surgery intersect is where researcher Dr Toni Pikoos does much of her work. She’s been deeply involved in crafting new, enforceable guidelines to protect the psychological safety of patients. 

Segment 4: The possibility of laws to protect body image
Marilyn Bromberg is an Associate Professor of Law at UWA and an expert on laws that discourage content researchers understand to negatively impact body image. While there is some precedent in other parts of the world, we can do more in Australia. 

Segment 5: Dealing with an eating disorders crisis and emergency care
Mental health occupational therapist Genevieve Pepin presented on “Eating disorders, carers, and the emergency department: A recipe for disaster.” It’s a carer’s worst nightmare, and Genevieve tells us just how bad it can get and how we can make the experience less traumatic for families.

This is the first of two episodes covering the conference. Look out for Part 2 in October 23. 

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According to the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V–also known as the psychiatrist’s bible–there are only four official diagnoses for eating disorders. Though experts expect that number to double in the next edition, the reasons someone might develop or maintain an eating disorder are as variable as the number of people affected.   

This is because eating disorders are not just a set of behaviours. They are a way of coping with difficult things.  

Psychologist and former Butterfly Helpline Manager, Juliette Thomson, specialises in a person-centred, holistic approach to recovery. “An eating disorder is often the tip of an iceberg,” she says, “Underneath, there is likely a lot more going on for a person about themselves in their lives.”  

To help someone struggling with an eating disorder, a therapist will seek to understand their psychological and social reality. That’s why there shouldn’t be a one-size-fits-all approach; people need treatment plans tailored to their own situation. In addition, insists Juliette, you don’t need to be certain that you even want to recover, as a good therapist should support you wherever you’re at.  

Listen to Juliette explain why she tells clients that recovery may be the hardest thing they’ll ever do in their life, and why it will also be the most rewarding.

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There’s a medication for almost every illness, and that’s true for mental illnesses,
including eating disorders. But how do they work, and how do they help? We’re
launching our fourth season of Butterfly: Let’s Talk with an investigation into
medications used to treat people with eating disorders, including some brand-new
developments that could offer hope.

“Many people with an eating disorder will be prescribed some kind of psychiatric
medication,” says psychiatrist Professor Richard Newton, who has been working in
the sector since the 1980s. “But most of those treatments will be for associated
concerns such as anxiety, depression, poor sleep, hearing voices, obsessive-
compulsive disorder, etc. They’re more adjunct interventions and are not for the
eating disorder itself.”

Having suffered from an eating disorder since age 11, Emma has tried
several different prescriptions. “I was first given a psychiatric medication when I
was 14,” she tells us. “It was an antidepressant, and it helped. It showed me that
there was something chemically not quite right.” Later, she was prescribed
antipsychotics, that she says also helped.

In this podcast, we talk about psilocybin, the psychedelic chemical associated with
magic mushrooms. "Psychedelic drugs offer an incredible way to access an altered state of consciousness that can change how people think about their behaviour,” says neurologist and researcher Dr Claire Foldi. While psilocybin is still
undergoing clinical trials, she's upbeat about its potential for eating disorders.

We also go into depth with Dr Kristi Griffiths, who has studied Vyvanse, a stimulant
traditionally prescribed for ADHD, now being used to treat people with Bulimia
Nervosa and Binge Eating Disorder. “In one randomized study," she says, "People
who took Vyvance over a set period had around a 4% relapse rate. That's a
pretty low rate.”

Listen to our experts and Emma, who believes that she is well into recovery thanks in part to her medications. Perhaps this episode will offer insights for you, your client’s or your loved one’s treatment plan.

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The results from the new Butterfly Body Kind Youth Survey are in, and they’re concerning. More than 1600 young people aged 12-18 took part in the survey, with at least half saying they were dissatisfied with their bodies. About one in three kids say they’re completely dissatisfied with the way that they look.

"The problem is there’s a real cost to young people's body dissatisfaction," says Helen Bird, Butterfly's Education Manager. "A significant number limit their involvement in everyday activities like sports, going to the beach, hanging out with their friends, or going clothes shopping. It’s also impacting their learning. Something like 50% of young people say that their body image has stopped them from putting their hands up in class, focusing on their schoolwork and, for some, even going to school."

In the latest episode of Let’s Talk, our host Sam Ikin talks to Helen, mental health counsellor Stella Ladikos and social worker AJ Williams-Tchen who all work closely with young people and listen to their concerns. He also chats with two high school students who aren’t surprised by the survey results but who make it quite clear that adults and institutions need to be doing a lot more to support them.

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In February this year, ABC dedicated their flagship investigative report, Four Corners, to eating disorders. This was, in part, because of a few Members of Parliament.

The MPs are Teal Independent Zoe Daniel, Liberal Andrew Wallace and Labor’s Susan Templeman. Based on continuous calls for help from their constituents, the three resolved to act for change. To start, they’re co-chairing a new Parliamentary Friends Group for Eating Disorder Awareness to highlight the critical need for more care and support.

“We've been absolutely avalanched in my office by families and people from across the country, saying that it really needs action,” says Zoe Daniel. “And it’s been interesting to have conversations with other MPs. Eating disorders aren't confined to the stereotypical groups.”

Susan Templeman agrees. “I don't think there's an elected office in the country where someone hasn't phoned in at the end of their tether, saying, I don't know what to do. My son or my daughter or my partner is suffering from an eating disorder, and I can't get the help that I need.”

Andrew Wallace was once in a Cabinet meeting where a senior health official assured the Prime Minister that Australia was getting on top of the issue. “I said, sorry, Prime Minister, but I totally disagree with what you've just been told,” he recalls. “We have absolutely no idea how you first suffer from it, why you suffer from it and, importantly, how you best treat it.”

As a carer, Wallace speaks from his own experience, as does Susan Templeman. Eating disorders are mental health issues that do not discriminate. And as more policymakers lean in to educate their political peers, the more hope there will be for real investment in care.  

 

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