«All young people are dissatisfied with their bodies»

Mrs Munsch, what types ofeating disorders are there?

The diagnosis recognises three main forms: Anorexia nervosa, formerly known as anorexia nervosa, bulimia nervosa and the so-called binge eating disorder. Similar to bulimia, the latter leads to uncontrolled binge eating. In contrast to bulimia patients, however, who counteract the amount of food they eat by vomiting or excessive exercise, binge-eating sufferers do not or do not systematically resort to such measures.

Which eating disorder are you most frequently confronted with?

In Switzerland, around one per cent of the total population will suffer from anorexia and a good two per cent from bulimia in the course of their lives. Up to three per cent are affected by binge eating disorder - in the overweight group, up to one in three people suffer from it. At our psychotherapy practice, we also deal most frequently with binge eating, which has only been officially recognised as a mental disorder since 2013.

So is binge eating a new clinical picture?

No, researchers in the USA first drew attention to it 60 years ago. In Europe, scientific circles did not have the disorder on their radar for a long time and it remained largely unknown to the general public. This is problematic for those affected, especially as binge eating is the most common eating disorder. Although it is generally easier to treat than anorexia nervosa, for example, it can have similarly serious consequences if it is not recognised in time.

Namely?

On the one hand, the psychological strain on those affected is comparable; on the other hand, binge eating leads to increasing obesity, especially in people suffering from obesity, which at some point damages the body just as much as morbid underweight. It is therefore important to take a close look early on.

Why are adolescents considered particularly susceptible to eating disorders?

The transition from childhood to adulthood presents major challenges: puberty, i.e. the biological changes that the body undergoes during this time, and adolescence, which refers to the psychological changes.

Puberty has different consequences depending on gender. In the female body, the distribution of fat can change completely within two months. Some are unable to accept their new body shape. This in turn has to do with adolescence.

In what way?

It makes it more difficult to deal with emotional challenges because, to put it simply, the brain is in a state of remodelling. The prefrontal cortex is not fully developed until the age of 24. This area of the brain is home to the so-called executive functions, which are responsible for impulse control, stress and emotion regulation, among other things.

If binge eating is not recognised in time, it can have serious consequences such as anorexia.

They are not yet fully developed during adolescence. This is when some girls use fasting or overeating as an outlet to compensate for stress that may arise due to physical changes, for example. This is why puberty is considered a high-risk phase for girls when it comes to eating disorders.

What about boys?

For them, puberty tends to take place under their clothes and changes are less visible. On the other hand, their impulse control is significantly weaker than that of their female peers. Overall, boys are the more vulnerable gender when it comes to mental disorders. However, these manifest themselves less frequently in eating disorders. However, this only applies to a limited extent to binge eating.

Why?

Because it is a disorder in which impulsivity plays a major role. For every four female binge-eating sufferers, there are two to three males. In contrast, boys and young men are ten times less at risk of developing bulimia or anorexia.

From starvation to stuffing your face: eating disorders take different forms. What do they have in common?

There are factors that can be found in all eating disorders and sufferers of all ages. For example, an anorexia sufferer and an overweight binge-eating patient could not be more different at first glance, but they probably have something in common: problems with correctly perceiving and categorising their own emotions and those of others. And they are unable to regulate stress well. There is another factor that plays a role: so-called affect tolerance.

What is meant by this?

The ability to endure immediate, violent and intensely negative feelings. In such moments, it is crucial that we are able to endure such feelings and calm ourselves down to the point where we can think twice: Okay, now let's start again - is my interpretation of this situation really realistic? What speaks in favour, what against? By weighing things up, we gain the ability to act.

How can parents support young people in this process?

By offering them a training ground for appropriate learning experiences - from an early age. Knowledge about emotions plays a key role in this context. The ability to understand, name and categorise one's own feelings is not something a child simply brings with them - they have to acquire it.

Parents can help him by mirroring and verbalising his emotions. The parental ability to respond sensitively to the child's needs is also of central importance in this learning process. However, it is often misunderstood.

Explain.

Being sensitive to your child's needs does not mean sparing them negative emotions, but rather giving them the support they need to cope with these feelings and learn to deal with them. Sure: After a hard day, it may be appropriate to avoid frustration triggers and distract yourself with something nice together. However, a child basically needs the opportunity and space to experience and learn to cope with negative feelings.

In such moments, parents should limit themselves to signalling to the child that they are there - and that they are confident that everything will be okay. However, I must emphasise this: There are also children who have a low frustration tolerance and weaknesses in dealing with emotions - and yet do not develop psychological problems such as eating disorders later on. This requires a combination of several unfavourable circumstances.

What role do social influences play in this?

They alone are not enough to trigger an eating disorder, but they are certainly relevant. For example, social media, which provides round-the-clock access to our privacy - and propagates beauty ideals that make young women in particular feel inadequate. Male teenagers are not quite as susceptible to this, perhaps because they often measure their popularity online by other things, such as their success in gaming.

What can parents do if their daughter is frustrated because she compares her body with ideal images?

I can well remember when our daughter came home depressed after a beauty contest among schoolchildren. In situations like this, parents have to allow this frustration to be there. There's not much more you can do at that moment.

A child must learn to understand, name and categorise emotions.

You could point out other strengths to your daughter, remind her how well she plays football.

However, the daughter doesn't want to be the best footballer at that moment, she wants to be at the front of the beauty contest. Instead of being dismissive, we should recognise her feelings: «I can understand that you're frustrated.» And then we should give her the opportunity to sit out the unpleasant feeling while we as parents wait and see. Sure: In a second step, you can approach your daughter again and show her that there are other values than comparing yourself to others.

And say what?

You can think about it together: Apart from resentment that her own body is not as slim as her friend's - what else is there in the young person's life? In which moments does she feel good and happy, proud and confident?

It is certainly important to emphasise the child's abilities that have nothing to do with the body - in everyday life, not reflexively to cushion moments of frustration. The parental role model is also important: if I as a mum or dad pick on my own body and make my figure or healthy eating a constant topic of discussion, this shapes the child.

Body positivity, a movement against discriminatory beauty ideals, is very popular on social media. What do you think of it?

The fact is that the majority of us find an averagely slim body more beautiful than a very overweight one. You can't fool yourself. In this respect, body positivity is a double-edged sword. The common body-related ideals that most people emulate are topped off with a moral one: the idea that it is a no-go because it is discriminatory to find a slim body desirable. I find that problematic.

Why?

Because it creates pressure. Then everyone who doesn't feel their body is beautiful and struggles with it has one more problem: they also have to justify their idealised body. The core concern of the body positivity movement, to show bodies in all their diversity, is certainly correct.

Another article about body positivity:

I would prefer this to happen less through influencers who publicise the issue and more without comment, in everyday life, as a matter of course. For example, through advertising that represents people with different bodies. The aim is not for us to constantly talk about body image, but for it to cease to be such an issue at some point.

When does problematic eating behaviour begin?

As a parent, I would keep an eye on whether the child's eating behaviour is adaptable. Are they flexible when pizza is ordered spontaneously or a celebration meal is coming up? Or do they opt out because they can't reconcile this with themselves?

Then I would pay attention to his emotional expression: Does he give me an insight into his emotional world from time to time? As long as I have the feeling that my child can still tell me what's going on in his life, a lot of things are good.

You know: all young people are dissatisfied with their bodies. This is the rule, not the exception. It gets tricky when the child can no longer be distracted from the issue, only engages in performance-related activities, when eating and shopping become the subject of recurring arguments. This is when the issue needs to be addressed.

How?

I wouldn't psychologise, but choose clear words: «You're getting noticeably thinner, I don't like that. I realise that food is taking up too much space in your life. I'm not going to stand idly by and watch.»

As a parent, I can't assume that the teenage daughter will react with understanding. But it is our job to address unpleasant things. In this case, we should definitely be direct, i.e. clearly in the role of those responsible for the child and their health.

What if the daughter doesn't want to say anything at all?

Then I keep at it and follow up the next day: «Have you thought about what I said? How do you see things?» If three attempts at dialogue are unsuccessful and the situation remains unchanged, I would register my daughter with her GP. Depending on how the doctor sees the situation, she will be able to initiate professional help.

Now we've talked about a teenager who is too thin. The opposite is often the case - parents worry because their son or daughter is putting on more and more weight.

Many parents are afraid that they will only trigger a problematic development if they address this.

It is right to be cautious in this respect. Nevertheless, insecurity should not stop us from reacting. Here, too, I would argue from the role of carer: «I don't like the way you eat. I think you should eat less of the high-fat snacks, they're not good for your health in the long term. We shop in such a way that we can support you well in this respect, so I would like you to eat more of what we offer.» The child will probably reply that you might as well tell them they are too fat.

If I, as a parent, make healthy eating a permanent theme, this shapes the child.

What then?

Then I would again emphasise my role as a mother: «Look, this is your body, your area. My job is to make sure that you eat a diet that is good for you.»

What else can parents do to help children develop a healthy body image?

Treat food for what it is: Food intake, social exchange, enjoyment, for some even art or aesthetics. We should teach children about this diversity. And show a lot of tolerance: food is also used to cope with stress, and up to a certain point that's perfectly fine. One contemporary phenomenon that I criticise is the over-focus on healthy food. Parents shouldn't go overboard with this.

What do you mean by that?

In the educated middle and upper classes, it is good manners to eat healthily and do sport. This is not wrong, but it also provides fertile ground for rigid behaviour: Physical activity and healthy, «non-harmful» foods then become the top priority. As parents, it is certainly our job to feed children well on average and to ensure that they get enough exercise - but the constant focus on this is harmful.