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Teenage Domestic Abuse: An Epidemic of Violence

isolation

Domestic abuse is an important topic in general, and it’s an important topic for me. So although this website is primarily for eating disorders, I wanted to talk today about that topic, in particular domestic abuse experienced by teenagers and young adults. I know that the demographic for this site is primarily young women, and so this subject is pertinent for many of those who visit it, especially as girls and young women between the ages of 16 and 24 experience the highest rate of intimate partner violence — almost triple the national average, and the severity of intimate partner violence is often greater in cases where the pattern of abuse was established in adolescence. Terrifyingly, a 2005 NSPCC and Sugar magazine survey showed that 40% of teenage girls would consider giving their boyfriend another chance if he hit them, and one third said that cheating justified the use of violence. In light of these horrifying statistics, I wanted to write this for both young people experiencing intimate partner abuse, and for the parents of abusers and of victims.

Anyone who hasn’t experienced abuse may be unfamiliar with the warning signs. Young people especially have often not been exposed to much, if any, discussion of abuse – in particular emotional and verbal abuse. Sexual and physical abuse is a topic most young people will have at least some knowledge of, but emotional and verbal abuse is on the whole more subtle and therefore there isn’t so much awareness or education about it. Emotional and verbal abuse are just as important to be educated about, as they can be just as mentally damaging, and are also a red flag for the development of physical abuse in the future. If someone had taught me about domestic abuse and the dangers and damage of it, maybe I could have avoided years of emotional, verbal, and physical abuse when I was a teenager. Maybe I could have been convinced to take a step back and assess the situation with educated eyes, and maybe I would have been able to walk away from day 1. Although I am aware that all events in our lives shape our future and I wouldn’t change my life now for a second, I wish I hadn’t had those experiences. I wish I hadn’t had that relationship. I wish I didn’t have those memories. There is no way to benefit from an abusive relationship; no positive outcome; no happy ending. Any good experiences with that person will always be overshadowed by the the reality of the nature of the relationship. My abuser was abusive from the very beginning, but I didn’t recognise his behaviour as such (I wrote a bit about my experience with domestic abuse here).

The types of domestic abuse someone can experience are as follows:

Physical abuse
Emotional abuse
Psychological abuse
Sexual abuse
Financial abuse

I will be focusing mainly on emotional abuse (which includes verbal abuse) and will also be talking some about physical and sexual abuse. You can view examples of all types of domestic abuse here.

Statistics have shown that nearly 1.5 million high school students nationwide experience physical abuse from a dating partner in a single year. One in three adolescents in the U.S. is a victim of physical, sexual, emotional or verbal abuse from a dating partner, and 27% of teenage girls in the UK aged 13-17 had experienced sexual violence in their relationships. One in nine female respondents had experienced severe physical violence; and almost three quarters of girls had experienced emotional abuse.

Where young adults are concerned, nearly half (43%) of dating college women report experiencing violent and abusive dating behaviours. It is also apparent that college students are not equipped to deal with dating abuse – 57% say it is difficult to identify. One in three (36%) dating college students has given a dating partner their computer, email or social network passwords and these students are more likely to experience digital dating abuse. One in six (16%) college women has been sexually abused in a dating relationship. (statistics from here).

So what does domestic abuse look like, especially in a situation with teenagers and young adults?

Is your boyfriend very jealous and possessive of you?

Does he get angry when you want to spend time with your friends or demand that you spend all your time with him?

Does he check your phone, email, Facebook and twitter accounts?

Does he try and get you to defriend people on Facebook, take down your photos, or stop you messaging your friends?

Is he always calling, texting or BBMing you to check where you are and who you’re with?

Does he tell you what to wear or how to do your hair?

Does he laugh at you or put you down in front of other people?

Does he get aggressive? Does he hit, shove, slap or kick you?

Does he threaten to harm you – or himself?

Does he call you names?

Does he pressure you to have sex when you don’t want to, telling you that “everyone is doing it” or that you would do it “if you really loved him”?

If you are frightened of your partner, or feel that you have to change your behaviour because you are scared of his reaction, you are being abused.

What can I do?

If you are being abused, it may help to remember the following:

If you are in immediate danger, call 999 (or whatever your emergency services number is). The police have a duty to investigate and help you stay safe

You are not alone. Refuge helps many young women and teenage girls who are experiencing abuse. We can help you too

The abuse is not your fault. Your partner may blame you for his behaviour – perhaps saying that you “made him hit you” – but he alone is responsible for his actions

Abuse is never ok. You deserve to be with someone who respects you and makes you feel safe

You don’t have to deal with this on your own. Try and talk to someone you trust – perhaps a friend, teacher or parent. Or call the Freephone 24 Hour National Domestic Violence Helpline, run in partnership between Refuge and Women’s Aid. We’re here for you 24 hours a day, 365 days a year. All calls are confidential
Computers and mobile phones can be used by abusers to monitor and stalk partners.

The above was from here.

More information of what abuse looks like:

Abusive partners are often jealous. An abuser may equate jealousy with love. They may ask you who you talk to, who you see, accuse you of flirting or others of flirting with you, or become jealous of time spent with others. They may even forbid you to see certain people (or everyone). They may text or call frequently during the day to “check up” on where you are or who you are with. They may drop by unexpectedly, refuse to let you go to college or work, check the car mileage, or ask friends to watch you.

In the beginning an abuser will attribute controlling behaviour to concern for you (for example, for your safety or lack of decision-making skills). As this behaviour progresses the situation may worsen, and the abuser may assume all control of finances (so telling you what to spend your money on or spending it for you) or prevent you from coming and going freely. They may control who you see, what you do, how you spend your time, and what you wear.

Quick involvement is also a sign of abuse. You may have only known or dated your abuser for a brief period of time before getting engaged or even living together. Your abuser will often pressure the victim to commit to the relationship. You may be made to feel guilty for wanting to slow the pace or end the relationship. Pressure for quick (or any, if you are a teenager) sexual involvement is also a red flag.

An abuser may have unrealistic expectations. An abuser may expect you to meet all of their needs. They may expect you to be able to do everything for them and be responsible for making them feel better whenever they feel bad.

An abuser may attempt to isolate you by severing your ties to outside support and resources. They may accuse your friends and family of being “trouble makers.” The abuser may block your access to use of a vehicle, work, or telephone service when you are with them, so you are unable to contact anyone else whilst with them. As a young person it is likely that you live at home and so much of this may not be part of your abusers tactics as this is fairly impossible to accomplish, but they may try to separate you from your friends, and they may try to turn you against the people close to you.

An abuser will often blame others for all problems or for their own shortcomings and are often unable to take responsibility for wrongdoing. An abuser may claim to be being victimised by someone, and it could be you that is blamed for almost anything. However, it is also common for abusers to initially take responsibility for their actions against you, and promise not to do it again, and continue to say this every time it happens (because it always happens again).

An abuser will use feelings to manipulate you. They will blame you for how they feel, and use it to get you to do what they want. They will often say that you are the centre of their world, or their everything, and so attempt to make you feel responsible for how they are and how they feel all of the time. An abusive person is also often easily insulted, and hypersensitive.

“Playful” use of force in sex is also a behaviour that also includes restraining partners against their will during sex, acting out fantasies in which the partner is helpless, initiating sex when the partner is asleep, or demanding sex when the partner is ill or tired. The abuser may show little concern for your wishes and will use sulking and anger to manipulate compliance. It is important to note here that the second example given can be consensual and dominant and submissive roles in the bedroom can be perfectly normal as long as you have given express permission and feel 100% comfortable and interested in acting this out. If you feel at all uncomfortable, this is not okay. Rigid sex roles may be a behaviour. You will be expected to serve. A male abuser may see women as inferior to men, responsible for menial tasks, stupid, and unable to be a whole person without a relationship. Again, rigid sex roles may be a consensual decision, but if you feel at all uncomfortable with it, this is not okay. If a partner has sex with you without your consent, this is rape. If a partner engages in sexual activity with you without your consent, this is sexual assault. Consent means that you have said yes to engaging in sexual activity or sex with your partner. Consent is not consent if it’s under coercion or threat, and you are also unable to give consent when under the influence of alcohol. Consent means saying yes and feeling comfortable with that decision.

Verbal abuse is a big one for abusers. This behaviour involves saying things that are intended to be cruel and hurtful, cursing or degrading you, or putting down your accomplishments. This also includes name-calling.

Having a dual personality; seeming like they can be two people – the nice one and the nasty one. Explosive behaviour, moodiness, being aggressive etc, which can shift quickly to being nice, are typical of people who are abusive.

Threats of violence are a sign of an abuser. This consists of any threat of physical force meant to control the partner. Most people do not threaten their mates but an abuser could excuse this behaviour by claiming “everyone talks like that.”

Breaking or striking objects is used as punishment (breaking sentimental possessions) or to terrorise the victim into submission.

Any force during an argument, which may involve an abuser holding you down, physically restraining you from leaving, or pushing or shoving. Holding someone back in order to make demands, such as “You will listen to me!” is also a show of force. Physical violence also includes strangling, throwing objects at you, throwing you, or pushing you over.

It is important to remember that an abuser will abuse any partner if the individual is involved with the abuser long enough for the cycle of abuse to begin. Circumstances do not make a person an abusive personality. You or your abuser’s environment are not at fault for any abusive behaviour. The responsibility lies with the abuser.

These warning signs came from information from here. What strikes me is that even with how educated/experienced I now am with domestic abuse, I only learned when writing this article that quick involvement is a warning sign for abuse – yet another sign that I missed and only learned about just now, typing this.

It is important to note that not everyone who displays jealousy, or mildly controlling behaviour, or blames others for their mistakes is an abuser, but these are still signs of an unhealthy relationship. Persistent signs of the former attributes combined with any of the other signs are big red flags of an abuser. If you feel that these apply to your partner, please talk to a trusted adult about this and/or call the national domestic violence helpline (website linked) on 0808 2000 247. It is crucial to state that emotional and verbal abuse often leads to physical violence.

As a teenager I felt unable to leave the relationship that I was in, so if you feel that your partner is being abusive but feel unable to leave, I understand. However, I want to tell you that to stay with that partner only prolongs your pain. I know how ridiculously hard it is to leave someone that you are emotionally involved with, but you need and deserve to be in a healthy and happy relationship – and you will find this. It can be even harder when you don’t know what a healthy relationship looks or feels like – you may even be convinced that this is the norm, but it’s not. There are wonderful men/women out there who will treat you in a way that you deserve; in a way that any decent human being would treat another: with respect and care. It may feel like the end of the world at the time to leave someone that you love who is abusive, but time heals, and you can and will move on to bigger and better things. It may feel like it will tear you apart to leave, but I promise you that an abusive relationship will leave far greater scars. The fewer experiences and memories that you have of any abuse, the better. You do not deserve to be put through any instances of abuse, and with time, you will realise how your relationship was only harming you.

Violent relationships in adolescence can have serious ramifications by putting the victims at higher risk for substance abuse, eating disorders, risky sexual behaviour and further domestic violence. Being physically or sexually abused makes teen girls six times more likely to become pregnant and twice as likely to get a STI. Half of youth who have been victims of both dating violence and rape attempt suicide, compared to 12.5% of non-abused girls and 5.4% of non-abused boys. Only 33% of teens who were in a violent relationship ever told anyone about the abuse. These facts and statistics are terrifying. It is also worth noting that abusers are hard to get rid rid of, so the faster you get rid of them, the better. Abusers like to feel in control, and for them it can mean controlling others around them, especially (and often exclusively) their partners. Even when you have ended the relationship, they can harass and attempt to emotionally abuse you from afar. I can tell you this from experience, because my abuser has continuously tried to contact me since we ended for good 6 years ago. People who have any respect for you will move on with their lives and leave you to yours. If you have broken up with an abusive partner and are still experiencing harassment and abuse from them, block them on all social media, block their numbers, tell a trusted adult, and seek advice from the police or citizens advice bureau, especially if they are threatening to harm you or anyone else, or destroy your property.

If you feel that you are experiencing any forms of abuse, please know that it is not your fault. It is not your fault. It is not your fault. You do not deserve it. Even if you do not feel like a victim, you are. Your abuser will not change, however much they try to convince you of that fact, and however much you hope they will. Please tell a trusted adult. Please phone a helpline. Please get help and support. You do not have to be alone with this, and you do not have to be in this relationship. You need and deserve to leave it and you deserve to lead a happy life with healthy relationships.

If you are a parent

81% of parents believe teen dating violence is not an issue or admit they don’t know if it’s an issue. Though 82% of parents feel confident that they could recognize the signs if their child was experiencing dating abuse, a majority of parents (58%) could not correctly identify all the warning signs of abuse (statistics from here). It is so important that you are aware of the relationships that your children are engaging in if they are under the age of 18. Although I was a wilful and determined child and would have probably have continued with my relationship anyway, did I make informed decisions? No, I did not. I wish my parents had played more of a part in educating me about the warning signs of abuse and I wish my school had taught me more about this too. Although my mother did have a short word with my abuser about his behaviour, it of course continued. I wish that my parents had not “respected my wishes”and kept my father from saying anything to my abuser. I wish that they had called his parents and told them what he was doing. I thought that I knew what I was doing at the time, but I was a child, and I transitioned into a young adult finding it almost impossible to separate myself from my abuser. I was an extremely strong and resilient child/young adult, and I could see quite logically that what I was experiencing was absolutely unacceptable, and yet I could not untangle myself from the situation I had become so embroiled in.

So as a parent, what can you do to help?

The following information is taken from here.

There are many reasons why teens don’t tell parents about the abuse. They may be embarrassed or ashamed, and may blame themselves. They may be afraid their parents will make them break up, convinced that it is their fault or that their parents will blame them or be disappointed in them, and afraid of losing privileges. They are often afraid of retaliation from their partner for telling. They may have little or no experience with healthy dating relationships and confuse jealousy with love. They may not recognize that they are being abused. If you suspect your teenager is being abused…

DO give your child a chance to talk. Stay calm. Listen without judging them. Believe them!

Use clear language to describe what you see is happening.

Acknowledge that they are in a very difficult and scary situation. Tell them that you are concerned for their safety and well-being and that you are there for them.

Ask them what they would like to have happen…how can you help them be safe.

Keep the lines of communication open!

Educate yourself—access online resources, read, call Caring Unlimited for information and/or support for yourself!

DON’T try to rescue them. Resist this natural impulse. It will likely shut them down.

Blame them for the abuse or make them feel judged.

Punish them because of an abusive partner.

Criticize their partner—you don’t want them taking energy to defend the person

If you suspect your teenager is being abusive

What you may see:

Jealous or possessive behaviour toward the dating partner

Controlling or bossy behaviour

Guilt Tripping—”If you loved me you would…”

Blaming the victim for everything that goes wrong

Obsessing over the partner’s behaviour or actions

Unreasonable or gender-based expectations of their dating partner

What You Can Do

Ask, “Why do you think it’s okay to treat ______ that way?”

Confront disrespectful behaviour/language. Explain that it’s not OK with you.

Let your child know that controlling behaviours are abusive and will prevent them from having a healthy, happy relationship.

Hold your child accountable. Don’t accept excuses or allow them to blame the other.

Model respectful behaviour towards your partner

Educate yourself and your teenager about controlling behaviours by accessing online and other resources.

The following information is taken from here.

Knowing or even suspecting that your child is in an unhealthy relationship can be both frustrating and frightening. But as a parent, you’re critical in helping your child develop healthy relationships and can provide life-saving support if they are in an abusive relationship. Remember, dating violence occurs in both same-sex and opposite-sex couples and any gender can be abusive.

What Do I Need to Know?

You can look for some early warning signs of abuse that can help you identify if your child is in an abusive relationship before it’s too late. Some of these signs include:

Your child’s partner is extremely jealous or possessive.

You notice unexplained marks or bruises.

Your child’s partner emails or texts excessively.

You notice that your child is depressed or anxious.

Your child stops participating in extracurricular activities or other interests.

Your child stops spending time with other friends and family.

Your child’s partner abuses other people or animals.

Your child begins to dress differently.

What Can I Do?
As a parent, your instinct is to help your child in whatever way you can. This need to help can drive you to quickly react, but sometimes what feels like the right plan of action could stop the conversation before it begins. Here are some tips to keep in mind when trying to help a child who is experiencing dating abuse:

Listen and give support
When talking to your teen, be supportive and non-accusatory. Let your child know that it’s not their fault and no one “deserves” to be abused. If they do open up, it’s important to be a good listener. Your child may feel ashamed of what’s happening in their relationship. Many teens fear that their parents may overreact, blame them or be disappointed. Others worry that parents won’t believe them or understand. If they do come to you to talk, let it be on their terms, and meet them with understanding, not judgement.

Accept what your child is telling you
Believe that they are being truthful. Your child may be reluctant to share their experiences in fear of no one believing what they say. Showing scepticism could make your teen hesitant to tell you when things are wrong and drive them closer to their abuser. Offer your unconditional support and make sure that they know you believe they are giving an accurate account of what is happening.

Show concern
Let your teen know that you are concerned for their safety by saying things like: “You don’t deserve to be treated like this;” “You deserve to be in a relationship where you are treated with respect” and “This is not your fault.” Point out that what’s happening isn’t “normal.” Everyone deserves a safe and healthy relationship.

Talk about the behaviours, not the person
When talking about the abuse, speak about the behaviours you don’t like, not the person. For example, instead of saying, “She is controlling” you could say, “I don’t like that she texts you to see where you are.” Remember that there still may be love in the relationship — respect your child’s feelings. Also, talking badly about your son or daughter’s partner could discourage your teen from asking for your help in the future.

Avoid ultimatums
Resist the urge to give an ultimatum (for example, “If you don’t break up with them right away, you’re grounded/you won’t be allowed to date anyone in the future.”) You want your child to truly be ready to walk away from the relationship. If you force the decision, they may be tempted to return to their abusive partner because of unresolved feelings. Also, leaving is the most dangerous time for victims. Trust that your child knows their situation better than you do and will leave when they’re ready.

Be prepared
Educate yourself on dating abuse. Help your child identify the unhealthy behaviours and patterns in their relationship. Discuss what makes a relationship healthy. With your teen, identify relationships around you (within your family, friend group or community) that are healthy and discuss what makes those relationships good for both partners.

Decide on next steps together
When you’re talking to your teen about a plan of action, know that the decision has to come from them. Ask what ‘next steps’ they would like to take. If they’re uncomfortable discussing this with you, help them find additional support. Suggest that they reach out to a peer advocate through loveisrespect’s phone line, online chat and text messaging service where teens can talk with peer advocates 24/7. To call, dial 1-866-331-9474, chat via our website or text “loveis” to 22522.

But My Child Isn’t in an Unhealthy Relationship
It’s never too early to talk to your child about healthy relationships and dating violence. Starting conversations — even if you don’t think your child is dating — is one of the most important steps you can take to help prevent dating violence. Here are some sample questions to start the conversation:

Are any of your friends dating? What are their relationships like? What would you want in a partner?

Have you witnessed unhealthy relationships or dating abuse at school? How does it make you feel? Were you scared?

Do you know what you would do if you witnessed or experienced abuse?

Has anyone you know posted anything bad about a friend online? What happened afterwards?

Would it be weird if someone you were dating texted you all day to ask you what you’re doing?

Need more tips to get started? Here are some other ways you can prepare to talk to your child about healthy and unhealthy relationships:

Do your own research on dating abuse to get the facts before talking to your teen or 20-something. Start with the information and resources on loveisrespect.org.

Provide your child with examples of healthy relationships, pointing out unhealthy behaviour. Use examples from your own life, television, movies or music.

Ask questions and encourage open discussion. Make sure you listen to your son or daughter, giving them a chance to speak. Avoid analysing, interrupting, lecturing or accusing.

Keep it low key. Don’t push it if your child is not ready to talk. Try again another time.

Be supportive and non-judgemental so they know they can come to you for help if their relationship becomes unhealthy in the future.

Admit to not knowing the answer to a particular question. This response builds trust.

Reinforce that dating should be fun! Stress that violence is never acceptable.
Discuss the options your child has if they witness dating abuse or experience it themselves.

Remind your son or daughter they have the right to say no to anything they’re not comfortable with or ready for. They also must respect the rights of others.
If your child is in a relationship that feels uncomfortable, awkward or frightening, assure them they can come to you. And remember — any decisions they make about the relationship should be their own.

Find ways to discuss gender equality at A Call to Men.

Contact Break the Cycle to find out if there are dating violence prevention programs in your community. If not, work with Break the Cycle to bring abuse prevention to your local school or community group.

Remember that it is not easy to leave an abuser. From the outside it will seem like such an obvious choice to make, but it is much more difficult on the inside where you are emotionally involved with the person. This may be their first relationship and so may also not know any different. This could cause them to underestimate the effects of the abuse and they may even be unaware of the damage it is causing them. Educate. Support. Suggest. Be there to encourage them to leave but don’t force them to. Always hold the abuser accountable. If any episodes of violence occur within your household, always call the emergency services.

Abuse is widespread. It is an epidemic, and this is not okay. Help break the silence.

Eating Disorders and Willpower: An Absurd Association

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Willpower. It’s something that we associate with strength. It is something that we admire in others, and it’s something we want for ourselves. And in this day and age, it is problematically associated with dieting and weight loss. The association even extends to restrictive eating disorders. I want to tell you how wrong it is to think that the two are synonymous.

I want to firstly consult the dictionary. Let’s take a look at the definition of “will”:

Will
noun
1. the faculty by which a person decides on and initiates action.
“she has an iron will”
synonyms: determination, firmness of purpose, fixity of purpose, will power, strength of character, resolution, resolve, resoluteness, purposefulness, single-mindedness, drive, commitment, dedication, doggedness, tenacity, tenaciousness, staying power, backbone, spine; More
2. control deliberately exerted to do something or to restrain one’s own impulses.
noun: willpower
“a stupendous effort of will”

A person with an eating disorder does not decide to have one. They do not have any power or control when developing or having an active eating disorder. They do not initiate action: the eating disorder does. They have no say in the matter whatsoever. So using “will” in the context of eating disorders is absurd.

Let’s also have a look at the definition of willpower itself:

noun
1. control of one’s impulses and actions; self-control.

Again, there is no control when it comes to an eating disorder. There is certainly no self-control. In actuality, it is the opposite that is true: someone with an eating disorder is completely out of control. They are not deciding to abstain from food or drink. They are not deciding to compulsively exercise. They are not deciding to vomit their meals into toilets and trash cans. They have no control over their ever dwindling intake, the inability to eat ice cream, or the ten miles they feel they must run. The severe mental illness that they are suffering from is running the show, not the person with the illness. Eating disorders are not a choice, and to insinuate that someone with an eating disorder has willpower is to insinuate that they have a choice.

You might be someone who has previously considered an eating disorder to be a choice, and are looking for an explanation of how it is not. Let me first stress: eating disorders have a genetic link. This means that if you do not have the genes to develop an eating disorder, then you will not develop one. If you have the eating disorder gene (which is being researched: the specific gene has not been identified as of yet, and it is most likely a combination of genes, not just one) then it is possible to go through life without triggering it into action. However, if environmental factors trigger the gene (and the triggers are plentiful: dieting, bullying, death of a loved one, abuse, parents divorcing, illness, fasting – you see how these can be both emotional or physical triggers), then you will develop an eating disorder. Genetics load the gun, environment pulls the trigger, the saying goes. So genetics have an important part to play in the development of an eating disorder, and you don’t get to choose your genes.

Here are some examples of how it works inside the mind: if you had to choose between eating a highly restrictive amount of calories and living with aching hunger, or feeling like tearing your own skin off, would you comply with your eating disorder or your hunger? If you had to choose between exercising until you felt like you might vomit and pass out or feeling so disgusting in your body that you would consider killing yourself, what choice would you make? If you had to choose between not eating a slice of pizza that you desperately crave or feeling like such a failure that you punished yourself by cutting you body multiple times in multiple places, what would you choose? And when you see those options, does it really look like much of a choice any more? Each option is torturous and punishing, but one always gets you closer to the goal of losing more weight, or at least attempting to. You’ll feel better when your body is perfect, the eating disorder says. You’ll feel better if you barely eat. You will be more in control, it lies, and there are so many lies it will tell to keep you from fighting against it.

The more the illness pervades the mind and the sufferer responds to the eating disorder, the more things like food and weight become a source of anxiety. Each time you respond to the voice telling you not to eat or you will feel something unbearable, the more the message in reinforced in the brain. You see, when you avoid something that makes you anxious, the more the brain is told that it is something to be anxious of because it is being avoided, and the more anxious you become of it. Another sneaky way the eating disorder survives is to completely distort the perception of the sufferer, so that their body looks to them to be completely different to what anyone else sees, and in a lot of cases, the thinner they become, the fatter they feel. This way the eating disorder continues to dictate the actions and thoughts of its host (and yes, that is what you feel like: just a host to a demon that is making you diminish in size inside and outside day by day).

I could go on, but let’s get back to willpower.

Meghan Trainor caused uproar with her incomprehensible comment about her apparent lack of willpower to “go anorexic”.

I wasn’t strong enough to have an eating disorder. I tried to go anorexic for a good three hours. I ate ice and celery, but that’s not even anorexic. And I quit. I was like, ‘Ma, can you make me a sandwich? Like, immediately.’

Her comment is one of such extreme ignorance that it makes my blood boil. For one, strength doesn’t come into eating disorders. Strength is something of value. It is a brilliantly positive trait to have; something you use in the face of hardship; to get through something or to defeat it. It is something that you use to fight and beat an eating disorder, not something you use to continue its existence. It does not take strength to have an eating disorder: it takes sickness and misery and intense self-hatred. It takes strength to recover. Secondly, you cannot “try to go anorexic for a good three hours”. Anorexia is first and foremost a mental illness (like all other eating disorders), not something that you can just “try” and then stop because you get a bit too hungry. “Trying” is not part of an eating disorder. You would never in a million years “try” to have an eating disorder if you understood what it entailed. It’s not about having the willpower to “go anorexic”. Any eating disorder is a disease that creeps up on you and slowly invades your mind bit by bit until it has wormed its way into every part of it, and then suddenly you realise that you are drowning in it and there is no conceivable way out. You don’t just “go anorexic” for three hours and then choose to stop. Need I say it again: there is no choice. And no, funnily enough eating ice and celery for three hours only does not mean you have a serious and deadly disease.

Willpower is inextricably linked to choice, and we know that eating disorders are not a choice, so the two cannot be thought of in conjunction with each other. Ever. To talk about eating disorders requiring willpower undermines the helplessness and hopelessness that someone feels whilst being under the control of such a powerful and deadly disease. To talk about eating disorders requiring willpower – a positive trait we all want – undermines the sheer anguish and torment someone suffering from one has to experience every second of every day. To say eating disorders require willpower is to inadvertently say that there is something that tortured person has that you admire. You are looking into eyes full of pain and saying, “I want what you have.”

Willpower is a positive thing. Having an eating disorder is a living hell. Willpower is strength and control. Living with an eating disorder is being crushed under a dictator that ultimately wants you dead and feeling unable to do anything but obey and walk knowingly into the jaws of death. Willpower is willpower and eating disorders are eating disorders. Let’s not mix up the two.

Refeeding Syndrome in Restrictive Eating Disorder Recovery

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This is an extremely important post for those recovering from a restrictive eating disorder, so please take notice of this, as many of those recovering from REDs are unaware of RFS.

A lot of the text below is taken from the MARSIPAN: Management of Really
Sick Patients with Anorexia Nervosa (October 2010). It is very wordy so I took the most relevant parts to bring to your attention, but you can click the link above for the entirety of the MARSIPAN Guidelines. The text from MARSIPAN is referenced as so.

Firstly, I am going to share with you a simplified version of what refeeding syndrome is and how to recognise it.

Refeeding syndrome symptoms may occur when a person receives a large intake of carbohydrates following a period of starvation.

A severe shift in electrolytes takes place when an individual consumes a quantity of complex carbohydrates after a prolonged period of food deprivation. This in turn, causes fluid imbalances in the body, leading to the potentially fatal conditions of hypophosphatemia and heart failure.

Hypophosphatemia refers to an abnormally low concentration of phosphates in the blood stream. This is linked to the transport and cellular uptake of phosphorus and potassium due to excess insulin secretion. Refeeding syndrome symptoms arise when the malnourished person no longer needs to utilize stored fat and protein, and instead metabolizes carbohydrates. The resulting rapid discharge of insulin causes the drop in serum phosphate, producing the clinical symptoms of refeeding syndrome.

Unfortunately, certain early signs of refeeding syndrome may go undetected as they are somewhat unspecific. However, symptoms such as generalized weakness, seizures, muscle fibre breakdown, white blood cell dysfunction, low blood pressure, respiratory failure, arrhythmias, cardiac arrest, and sudden death have all been documented as part of this serious and even fatal syndrome.

Refeeding syndrome symptoms can be of concern to those recovering from eating disorders such as anorexia, as they are at risk of developing hypophosphatemia when starting to eat again. Medical supervision and monitoring by nutritionists and other health professionals familiar with this condition can help improve the outcome for those individuals struggling to re-gain normal eating behavior. (from here)

Below I share information that goes into far more detail in regards to refeeding syndrome, taken from the MARSIPAN guidelines, and the online Nursing Centre – this is quite complex and detailed information regarding refeeding syndrome in a hospital setting.

Re-feeding syndrome is a potentially fatal condition (World Health Organization, 1999; Winston et al, 2000; Crook, 2001; Casiero & Frishman, 2006; Mehanna et al, 2008) that occurs when patients who have had their food severely restricted are given large amounts of food via oral or nasogastric re-feeding as well as during TPN. It has been noted in outpatients with anorexia nervosa who have suddenly increased their food intake after several weeks of starvation. (MARSIPAN)

For example, someone who has been almost nothing could decide to recover and start eating a regular amount of food straight away. Their serum phosphate level could then fall dangerously and require oral phosphate supplements to correct this abnormality.

Electrolyte disturbances (primarily decreased levels of phosphorus, magnesium, or potassium) occur immediately upon the rapid initiation of refeeding-commonly within 12 or 72 hours-and can continue for the next 2 to 7 days. Cardiac complications can develop within the first week, often within the first 24 to 48 hours, with neurologic signs and symptoms developing somewhat later. (from here)

Re-feeding syndrome is characterised by rapid reductions in certain electrolytes, such as phosphate and potassium, caused by rapid transport into cells, and the resulting cardiac effects can be fatal. Avoidance of the syndrome can be achieved by gradually increasing nutritional intake. There is substantial variation in opinion about the level at which to start re-feeding a patient with anorexia nervosa. Some units follow NICE (2006) guidelines for adult nutrition support, which recommend starting at 5kcal/ kg/day for a patient weighing 32kg. Although the guidance excludes eating disorders, it is considered by some to be relevant to patients with severe anorexia nervosa. However, there is wide variation in its application, some physicians and dieticians applying it strictly and others regarding it as not applicable to this patient group. One of the very few published guidelines in this area from the USA, referring to the treatment of children with anorexia nervosa (Sylvester & Forman, 2008, p. 393), advises: Patients start on 1250–1750 calories, depending on the patient’s intake prior to hospitalization and severity of malnutrition, and advance by 250 calories daily. For patients with very low weight (<70% average body weight), the protocol is altered and caloric intake requirements may be decreased to avoid re-feeding syndrome, and advancement takes place over a longer period. (MARSIPAN)

Sometimes physicians are torn between the risk of re-feeding syndrome, and the risk of further weight loss due to not eating enough which then could mean death. In addition;

One physician in the group suggested that it was perhaps less harmful to risk re-feeding syndrome, which can be monitored and corrected, than brain damage and death caused by low glucose in a patient with hypoglycaemia. It was also commented that if higher calorie levels were thought to be essential (e.g. to correct low glucose), a critical care approach with constant monitoring and correction of abnormalities should be considered. (MARSIPAN)

When it comes to dangerously sick patients with anorexia nervosa, the risks have to be weighed up and a decision reached as to what is more dangerous for the patient who is in a life-threatening condition. On the subject of avoidance of re-feeding syndrome:

Avoidance of re-feeding syndrome can also be encouraged by restricting carbohydrate calories and increasing dietary phosphate. When patients are prescribed oral or enteral nutritional supplements, consideration should be given to the use of high-calorie supplements (e.g. 2kcal/ml) as they have lower levels of carbohydrate and may therefore be less likely to produce re-feeding syndrome. Moreover, the diet should be rich in phosphate (e.g. milk) to help avoid the syndrome. The total fluid intake can easily exceed safe levels, and the recommendation is 30–35ml/kg/24h of fluid from all sources. (MARSIPAN)

Remember that the MARSIPAN Guidelines described above are based in a hospital setting.

As for more understanding on what refeeding syndrome is:

To understand what happens during refeeding syndrome, first review the pathophysiology of malnutrition. Normally, glucose is the body’s preferred fuel, coming from the intake of carbohydrates. As the malnourished body loses access to carbohydrates, it shifts to catabolism of fat and protein. With this shift, the body’s production of insulin drops in response to a reduced availability of glucose. This adaptive change to protein breakdown during prolonged malnutrition also leads to a gradual loss of cellular and muscle mass, often resulting in atrophy of vital organs and other internal structures, including the heart, lungs, liver, and intestines.
Serious complications may occur as respiratory and cardiac function declines due to muscular wasting and fluid and electrolyte imbalances. Metabolic rate, cardiac output, hemoglobin levels, and renal concentration capacity also decrease.
The body is now surviving by very slowly consuming itself…
When a malnourished patient is given aggressive nutritional support, such as PN, a number of events ensue. These are primarily driven by the change in insulin secretion as a result of the shift from protein metabolism to carbohydrate metabolism. The increase in glucose levels, which results from the composition of the nutritional support formula, increases insulin release by the pancreas. This in turn promotes cellular uptake of glucose along with electrolytes, primarily phosphorus, magnesium, and potassium. The result can be a life-threatening depletion of these vital electrolytes. (from here).

Also,

[RFS] is extremely rare but is more likely to occur in a young person with rapid weight loss and a BMI – from here.

As said above, refeeding syndrome is rare. People at risk are generally people are underweight, and have severely restricted for a week or more. However, if you have been eating less than 1000 calories for a week or more, are excessively exercising, or have been purging frequently, you may be at risk of re-feeding syndrome, regardless of BMI. If this is the case please see a doctor to determine the risk of RFS. Depending on your risk you may be hospitalised to be monitored there, you may be monitored by your doctor, or you may be okay to go home and just get your parents or flatmates to keep an eye on you.

You are most at risk in the first 24-72 hours, so don’t panic if you have upped your intake quickly and were not aware of RFS and have been eating a normal amount for a couple of weeks. You will be out of the danger zone by now.

Milky products are also really good for those with lowered phosphate levels, and are easier for the body to absorb.

As said above, there is also a problem with people being over-cautious and not increasing by enough or fast enough. If you are being monitored in a hospital setting, the staff there will decide what your calorie increase rate is. If you are home and have been deemed to be at very low risk, I advise increasing your calorie intake by 250 calories every 2-3 days until you reach 2000 calories. From there it is safe to jump to your 2500-3000+ calories.

As for a more in-depth look at warning signs and symptoms:

First, let’s look at some normal functions of phosphate. It’s needed to produce adenosine triphosphate (ATP), which provides energy for almost all cellular functions. Phosphate is an essential part of RNA and DNA, and it’s needed in red blood cells for 2,3-diphosphoglycerate production for easier release of oxygen to the tissues. Patients with signs and symptoms of hypophosphatemia or phosphate levels below 2 mg/dL require oral or I.V. phosphate replacement.

Refeeding-induced severe hypophosphatemia (serum concentration less than 1 mg/dL) can result in respiratory failure from a decrease in available ATP, which is needed to maintain the diaphragm’s normal contractility. In addition, hypophosphatemia can cause red and white blood cell dysfunction, muscle weakness, and seizures. Other factors that can contribute to hypophosphatemia include vitamin D deficiency and excessive intake of antacids, which block phosphate absorption.

Hypokalemia (serum levels below 3.5 mEq/L) and hypomagnesemia (serum levels below 1.8 mg/dL) are also frequently associated with refeeding syndrome. Mild decreases of potassium and magnesium may cause nausea, vomiting, constipation, diarrhea, muscle twitching, or weakness. A more severe depletion of the serum concentrations of potassium and magnesium can cause dysrhythmias, cardiac dysfunction, skeletal muscle weakness, seizures, and metabolic acidosis.

Your patient with refeeding syndrome may develop muscle weakness, tremors, paresthesias, and seizures… In addition, she may have cognitive changes, including irritability and confusion. (from here)

Please take note of this post. Although rather dry, it is very important.

The Truth About Domestic Abuse

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Today I am going to post about a topic that is not specifically to do with eating disorders. I wrote this article over a year and a half ago, but it is an extremely important subject matter for me, and in general, so I wanted to share it here. Although it isn’t directly to do with eating disorders, there are those who may have had an eating disorder triggered by domestic abuse. I want to state that that was not the case for me, but that some of you that may have unfortunately been the trigger.

Obviously this article comes with a trigger warning for the discussion of domestic abuse.

The Truth About Domestic Abuse

When you hear the words “domestic abuse”, and visualise the abuser, what probably comes to mind is a man. Most likely a man who is working class: a man who has tattoos, bad teeth, sunken eyes, and a haggard face. That, or something similar, anyway. It is this sort of stereotyping that leads us, as a society, to believe that domestic violence only happens amongst certain types of people. This is most certainly not the case, and the issue of domestic violence amongst different races, ages, sexual orientations, religions, and genders needs to be openly addressed so that people are more aware that domestic abuse can happen to anyone, anywhere, at any time.

My abuser was a skinny, sixteen-year-old boy from a privileged background. Unfortunately for me, he was the first boy I ever loved.
His abuse came in many forms. It started almost straight away: the first incident that I can remember happened three months into our relationship, and progressed from emotional and verbal abuse to physical abuse within three months. It started off with intense jealousy and possessiveness: he would accuse me of cheating, and attempt to monitor what I wore, especially when it came to posting photos to my Bebo account. If I uploaded a photograph and my skirt was too short he would phone me in a fury, calling me a slut and demanding that I took the images down. For some reason, I had given him my password to my account, and one of the times that he flew into a rage, he deleted my entire account. He frequently called me a bitch, a liar, and a whore, and did not want me to hang out with any male friends. He constantly wanted to know where I was, who I was with, and what I was doing. He expected me to report back to him on my day and the details of it, especially if it concerned another boy. I also strongly recall a situation where he humiliated me in front of a number of people: we were at college, and there was a day where everyone could take a free chlamydia test. Before me, he had not been sexually active, whereas I had, but we both took a test anyway. After a group of us had taken the test, we were sitting in the corridor writing our details down, and he told everyone that if he had something, it was from me. I was utterly shocked that he had decided to even mention it, let alone in front of a group of people. He also broke my personal belongings, especially those of significant emotional value, when I upset or angered him, and used threats of suicide or self-harm against me.

After six months, the abuse became physical. Over the next two years I experienced being thrown into walls or onto the ground, being pinned to the floor, having objects thrown at me, being spat at in the face, being squeezed until I could not breath, being choked, grabbed, and pushed, and all the while I thought it wasn’t serious enough because he never actually hit me. Half of me fought that ridiculous notion, but it was echoed in the actions of others, especially that of his family, who were of the opinion that it was my fault because I wound him up. At one point I was even told by his step-dad to “get over it” because my refusal to speak to my abuser was “making the atmosphere in the house horrible”.
On one occasion, he was hanging off a multi-storey carpark, after running off with my bag, pushing me, throwing my bag into a wall with valuables inside, and tearing a necklace off of me, causing bright red scratches down my throat. I also wish to add that there were people walking past us who witnessed his assault, and did nothing about it. Another time, he accused me of being unfaithful when I did not rip out the male centrefolds in my Cosmpolitan magazine, which resulted in my being on the floor, him on top of me, with his hands around my neck, screaming that I was a bitch and a whore, and ended with him running out of the house threatening to ride his moped into the middle of the road without putting on the brakes. I previously attempted to stop him leaving, sobbing, and grabbing onto his clothes, begging him not to kill himself. He pushed me onto the floor, and later claimed that this was my fault because I would not let go of him (which may have been annoying, yes, but I’m sure in that situation it was perfectly understandable, as I naively believed he really would end his own life). Another argument concluded in the entire bedroom being destroyed: all my possessions had been swiped onto the floor, the speaker stand was through our coffee table, and there was paint all over the carpet. I had been physically thrown out of the room but had returned to continue the argument (and therefore, obviously, making it all my fault – please note the sarcasm there) and was forcefully carried to the bed and then briefly choked. My worst memory, though, took place in a hotel. I cannot remember it in detail, although I am not sure if that is because my mind blocked it out or whether there were just so many incidents that that particular one has faded from my memory. What I do recall though was my bag being flung into the pool, being forcefully carried to the elevator and then to our room, my phone being dangled above the toilet in one of his hands, and being held away with the other, and the grin on his face as he let it drop. I also remember being pinned down on the bed with him sat on my stomach; his knees pressing into my forearms so that I could not move, except for my uselessly flailing legs. I’m not sure what happened subsequently to that (not anything horrifically brutal though, I can assure you of that much), but after the whole ordeal was over, I was left with a severe burn-like mark on my arm and a couple of other bruises elsewhere. To this day if anyone, even in jest, tries to restrict me in that position, I panic.

Why did you stay with him? you might ask. The truth, which I am ashamed to admit, is because I did not think it was bad enough to leave. I rationally knew that what I was experiencing was domestic abuse, but I kept thinking that I was a perpetrator too; that I was partly to blame, and because I did not fear him, I believed that I was not a victim. The abuse was emotionally destructive, horribly distressing, and extremely hurtful, but apart from the first few times that the physical violence occurred, I was never really afraid of him, and that, to me, made my experiences invalid. This, obviously, is completely untrue. I know this, and still even now I sometimes downplay what happened to me for fear that someone may accuse me of making a big deal out of nothing. I can assure you, though, that it wasn’t nothing. In fact it was something that had a huge impact on me, and unfortunately I am sure still does, even when I am not really aware of it.
I also naively believed that he would stop. On most occasions, afterwards, he would cry and tell me to leave him, or promise that it would never happen again, but of course it did. It always does.

My abuse was a long time ago but it left scars. I flinch sometimes around people, I get tense in certain situations, I panic if someone has me in one particular position, and I jump at loud or sudden noises. I even find men who look like my abuser uncomfortable to look at.

The thing is, a huge amount of people seem to believe that abuse is just physical, when it is not. There also seems to be people that believe that if you have never had your partner’s fist in your face then it doesn’t count. “But he never actually hit you, did he?” was genuinely something that I have had said to me, after opening up about my abuse. I cannot stress enough that any kind of physical violence is domestic abuse. Verbal abuse, emotional/psychological abuse, and sexual abuse are all forms of domestic abuse, in addition to physical violence. The US Office on Violence Against Women (OVW) defines domestic violence as a “pattern of abusive behaviour in any relationship that is used by one partner to gain or maintain power and control over another intimate partner”. (Wikipedia, 2013). People need to be aware that this is about control, not about violence, and does not necessarily include getting physical. People also need to be aware that whilst 85% of domestic abuse victims are women, 15% are men.

Domestic abuse is never okay. Ever.

Do not allow yourself to be treated without the respect that you deserve.
Do not let anyone tell you that what you deserve is an abusive partner.
Do not let your partner convince you that this is the last time, because it is not.
Do not let domestic abuse make you live in fear, misery, or silence.
Do not let domestic abuse endanger your life.

Do get out of your abusive relationship. There is much, much more awaiting you in life.

Please read below if you think you may be in an abusive relationship.

You may be in an emotionally abusive relationship if your partner:

Calls you names, insults you or continually criticizes you.
Does not trust you and acts jealous or possessive.
Tries to isolate you from family or friends.
Monitors where you go, who you call and who you spend time with.
Does not want you to work.
Controls finances or refuses to share money.
Punishes you by withholding affection.
Expects you to ask permission.
Threatens to hurt you, the children, your family or your pets.
Humiliates you in any way.

You may be in a physically abusive relationship if your partner has ever:

Damaged property when angry (thrown objects, punched walls, kicked doors, etc.).
Pushed, slapped, bitten, kicked or choked you.
Abandoned you in a dangerous or unfamiliar place.
Scared you by driving recklessly.
Used a weapon to threaten or hurt you.
Forced you to leave your home.
Trapped you in your home or kept you from leaving.
Prevented you from calling police or seeking medical attention.
Hurt your children.
Used physical force in sexual situations.

You may be in a sexually abusive relationship if your partner:

Views women as objects and believes in rigid gender roles.
Accuses you of cheating or is often jealous of your outside relationships.
Wants you to dress in a sexual way.
Insults you in sexual ways or calls you sexual names.
Has ever forced or manipulated you into to having sex or performing sexual acts.
Held you down during sex (without your consent).
Demanded sex when you were sick, tired or after beating you.
Hurt you with weapons or objects during sex (without your consent).
Ignored your feelings regarding sex.
Involved other people in sexual activities with you (without your consent).

If you answered ‘yes’ to these questions you may be in an abusive relationship; please call the National Domestic Violence Hotline at 1-800-799-SAFE (7233), 1-800-787-3224 (TTY) or your local domestic violence center to talk with someone about it.