Clinical psychologist, Bronwyn Raykos, on finding gentle ways to talk about eating disorders

Eating disorders are one of the most life-threatening mental illnesses. Yet supports and services for people experiencing an eating disorder, and their families and carers, remain scarce.

During the pandemic, the number of people with eating disorders increased significantly. The most worrying trend was that this increase was largely due to a dramatic rise in the numbers of young teenagers and children presenting with eating disorders. According to a recent ABC Four Corners report:

‘Eating disorders were already on the rise before the pandemic hit. Now numbers have exploded, especially for young people.

‘Some public hospitals have recorded between an 80 per cent to 104 per cent increase in children with anorexia in the past three years.’

For every person who seeks support, there are many others who suffer in silence. This is partly because secrecy and shame are common features of eating disorders.

Given that more than 1 million Australian’s are living with an eating disorder at any given time, we need to find better ways to have conversations about these debilitating illnesses.

In this interview, clinical psychologist, Bronwyn Raykos, talks about some different ways she has used the Eating Disorders and Other Shadowy Companions cards to have gentle conversations with people about their experience of living with an eating disorder, including their fears, challenges and hopes for the future.

We start by asking Bronwyn to tell us a bit about herself and the work she does

I am a clinical psychologist specialising in the treatment of eating disorders.  I work across child, adolescent, and adult sectors.  I am also a clinical researcher, which means I conduct research aimed at improving treatment for individuals with eating disorders

You mentioned that you worked with people experiencing eating disorders. What are some of the things you wish the broader community understood about eating disorders?

There are a lot of myths about eating disorders. It is very important to understand that eating disorders are not a choice but serious, biologically influenced illnesses. They are not just ‘phases’ that people grow out of and can affect people of all genders, ages, socioeconomic status, and body sizes.

How did you learn about Eating disorders & other shadowy companions cards and what do you like about them?

I have previously been using The Bears cards and was made aware of the new set of eating disorder cards from a colleague so I ordered a set.

I really like the simplicity of the visual images, and how they accurately capture some of the complex physical, psychological, and emotional aspects of having an eating disorder. These include ambivalence about change, the role of perfectionism, social expectations, and hope and optimism for recovery.

Sometimes when our patients are very malnourished, they may struggle with words or conversation so having a visual image may be a more effective way of conveying key topics in session.

At other times, patients find it difficult to express how they are feeling but they might be able to select an image that conveys an internal experience, and this can prompt a helpful conversation.

Can you give an example or two of how you’ve used the cards?

One of my favourite cards is the picture of Ed the Eating Disorder monster with the script, ‘What are you most afraid of?’ Facing fears related to eating, weight, and shape is at the core of treating eating disorders.

Clinicians are also often fearful of components of treatment so facing fears is also something that clinicians needs to do in order to effectively treat eating disorders.

What tips could you give people about when, and how, to introduce the cards into a conversation?

My tips are to just select a few cards (rather than the whole pack) that relate to a core component of the intervention you are delivering.

Use the cards to enhance the core components of evidence-based treatment or provide a visual image that can enhance the client’s learning or memory of your session content.

The cards can be a non-threatening way of discussing difficult topics for patients who find verbal discussion difficult. Younger clients tend to really like them.

If you could give three pieces of advice to people who are supporting someone with an eating disorder, what would they be?

Firstly, it can be very difficult to be in the position of being a support person for someone with an eating disorder, so it is very important that you are looking after yourself and finding opportunities for self-care.

Secondly, find out as much as you can about eating disorders. Websites such as the Butterfly Foundation and the National Eating Disorders Collaboration are good places to start.

Thirdly, attending support groups for family and loved ones of a person with an eating disorder has been shown to reduce distress and improve self-confidence in family and others supports, and is also beneficial for the individual with the eating disorder.

If you are concerned about a loved one, you can start a conversation by letting them know you are concerned.  Encourage them to see their GP as a starting point.