Author: Nistha Bade Shrestha

I struggled with anxiety during my freshman and sophomore years of high school, which inspired me to take AP Psychology and Post AP Psychology during my junior and senior years. Additionally, I wrote an essay about the stigmatization of mental health ailments in the Asian American society (a topic I am very passionate about), which won the 2016 Asian American Youth Scholarship.
As a psychology major, I would like to focus on child development, because mental health-related issues are often rooted in our childhood. Additionally, I want to partake in the effort to destigmatize mental ailments, because I understand how difficult it is to live with a mental illness in a society that is very critical of it, and I want to do my best to make sure no one struggles in silence or feel ashamed.
I love 90’s rock and cartoons, I play the guitar, and I am interested in learning meditation

Categories
Eating Disorders

Pregorexia: Two Lives at Risk

Pregnancy is viewed as a sacred experience by many women across the globe. In fact, when discussing her pregnancy with Australia’s “Sunday Night,” the widely known and adored singer, Beyoncé Knowles-Carter said, “I’m very grateful that God has blessed me with the biggest gift any human being can have.” However, not every woman shares the same experience or perspective on pregnancy. For eating disorders specialist and trauma therapist, Maggie Baumann, pregnancy was a dangerous battle against weight gain, a condition known as pregorexia.

In recounting her struggle with pregorexia, Baumann said, “Getting on the scale at the doctor’s office was very triggering for me…I was just like, I am not doing that again, I am not getting that big. I am not getting that out of control,” (Wallace, 2013). As most women with pregorexia, Baumann tried to control her weight by engaging in “extreme” workouts and by tightly monitoring her caloric intake, which led to complications such as uterine bleeding and concerns about fetal growth restriction (“a condition in which a fetus is unable to achieve its genetically determined potential size”), during her pregnancy.

Baumann isn’t alone in her struggle with pregorexia. According to estimations by Dr. Ovidio Bermudez, the chief medical officer at the Eating Recovery Center in Denver, Colorado, approximately 30% of women in the United States fail to meet minimum weight requirements (Wallace, 2013). However, Bermudez also states that of the 30% of expecting mothers who struggle with weight gain, not everyone has pregorexia (Wallace, 2013).

As stated in the review, “Maternal Nutrition and Birth Outcomes,” by Kathleen Abu-Saad and Drora Fraser, nutrition is one of the most essential parts of an expecting mother’s life, because of its long-term effects on her baby. Additionally, Abu-Saad and Fraser connect poor  maternal nutrition and resulting low infant birth weight to neonatal death; “increased risks of disorders/disruptions of child growth and development (e.g., neurologic disorders, learning disabilities, childhood psychiatric disorders, mental retardation)”; and increased vulnerability to type 2 diabetes, coronary heart disease, and hypertension in later life (Abu-Saad & Fraser, 2010). In line with this review, Baumann revealed that in the initial months after her birth, her daughter experienced seizures (Wallace, 2013).

Pregorexia is attributed to two major factors in the article, “Pregorexia: Extreme dieting while pregnant,” by Kelly Wallace: a pre-existing eating disorder (it is important to note that not every expecting mother who has struggled with an eating disorder will develop pregorexia) and media coverage of celebrities’ post-baby bodies. Claire Mysko, the spokeswoman for the National Eating Disorders Association says, “it’s almost become an expectation now that if a celebrity is pregnant, there will be a mention of her body during pregnancy and then there’s the countdown to how fast she’s going to get the weight off,” (Wallace, 2013). This is demonstrated by People Magazine’s article, “Kim Kardashian Says She’s Lost Nearly 70 Lbs. Since Giving Birth and Khloé Is Her Body Idol,” by Stephanie Petit and Jeffrey Slonim, which discusses reality television personality Kim Kardashian’s seven-month journey to weight loss after giving birth.

Many moms (including my own) like to bring up the topic of post-pregnancy stretch marks when their children aren’t on their behavior. While this makes for a humorous (and sometimes, groan-worthy) mother-child interaction, the obsession with weight-gain experienced by women with pregorexia, is extremely deadly for the expecting mother and her baby. The prevalence of pregorexia in our society, as shown by Dr. Bermudez’s estimations, demonstrates the need for an increased awareness on the issue of eating disorders and maternal nutrition. An effective method of raising such awareness would be to push for a focus on maternal well-being in social media (as opposed to articles about ideal pregnancy bodies) and for the increased availability of resources for expecting mothers who express concerns regarding weight gain.

References:

Abu-Saad, K., Fraser, D. (2010, April 1). Maternal Nutrition and Birth Outcomes. Epidemiologic Reviews. Volume 32, Issue 1, Pages 5–25, https://doi.org/10.1093/epirev/mxq001

Lopez, K. (n.d.) Beyonce’s baby due in February, singer talks pregnancy. ABC 7. Retrieved February 11, 2018, from http://abc7.com/archive/8385953/

Petit, S., Slonim, J. (2016, July 17). Kim Kardashian Says She’s Lost Nearly 70 Lbs. Since Giving Birth and Khloé Is Her ‘Body Idol.’ People. Retrieved February 11, 2018, from http://people.com/bodies/kim-kardashian-weight-loss-plan-how-she-dropped-70-lbs-after-baby/?obref=obinsite

Ross, M.G. (2015, November 10). Fetal Growth Restriction. Medscape. Retrieved February 11, 2018, from https://emedicine.medscape.com/article/261226-overview.

Wallace, K. (2013, November 20). ‘Pregorexia’: Extreme dieting while pregnant. CNN. Retrieved February 4, 2018, from https://www.cnn.com/2013/11/20/living/pregnant-dieting-pregorexia-moms/index.html

Categories
Eating Disorders

Traumatic Experiences and their Relationship with Eating Disorders

We often connect eating disorders to body dissatisfaction brought on by societal standards of beauty. However, the root of eating disorder are often more tangled and complicated. In addition to body image issues, victims of eating disorders often struggle to maintain control over their lives, bodies, and diets. As a result, there exists a connection between Post Traumatic Stress Disorder and eating disorders. In other words, traumatic experiences–most often prolonged–can lead to the development of an eating disorder.Trauma victims seek to gain control over their lives and eating disorders provides a channel, through associated behaviors such as calorie counting.

Dr. Judy Scheel, whose work focuses on the research and prevention of eating disorders, states that 30% of individuals with eating disorders have suffered sexual abuse. Scheel also summarizes the Psychiatric Times article, “The Links Between PTSD and Eating Disorders,” by Timothy D. Brewerton, in which Brewerton discusses data collected from multiple studies. In particular, Scheel cites Brewerton when he says, “74% of 293 women attending residential treatment indicated that they had experienced a significant trauma, and 52% reported symptoms consistent with a diagnosis of current PTSD based on their responses on a PTSD symptom scale.” These data points reveal the link between post-traumatic stress and eating disorders.

According to the National Eating Disorders Association (NEDA), traumatic experiences that most often lead to eating disorders are: sexual abuse at a young age, domestic abuse (victims and observers), and other experiences that cause PTSD. The article also states, “Bulimia, in particular, has been connected to trauma as a means of self-protection, because the binge/purge cycle of behaviors seem to reduce awareness of thoughts and emotions as a means of escape for several of the emotions that may accompany traumatic experiences.”

Furthermore, Scheel mentions that sexual abuse victims often project their feelings of shame attached to their experience onto their bodies. Scheel explains this by providing a hypothetical example, in which a woman associates the glance of a man with that of her abuser and projects the feelings of shame onto her body. This creates in her mind negative body image issues and causes her to binge and purge.

This occurrence is not strictly limited to victims of sexual abuse a survey of 642 male veterans revealed that there was a strong correlation between military trauma and the manifestation of eating disorder symptoms. This finding demonstrates the need for increased awareness about the demographics of individuals afflicted by eating disorders. In other words, we need to overlook common misconceptions about eating disorder patients being primarily female. This can be accomplished through further research and increased diversity in the media coverage of eating disorders.

References:

“Military-Related Trauma Associated With Eating Disorders,” (2017, October 2). Psychiatry Advisor. Retrieved November 19, 2017, from  http://www.psychiatryadvisor.com/ptsd-trauma-and-stressor-related/military-trauma-linked-to-eating-disorders/article/696877/

Scheel, J. (2016, March 29). PTSD and Its Relationship to Eating Disorders. Psychology Today. Retrieved November 14, 2017, from https://www.psychologytoday.com/blog/when-food-is-family/201603/ptsd-and-its-relationship-eating-disorders

“Trauma and Eating Disorders,” (2012). National Eating Disorders Association.  Retrieved November 14, 2017, from https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/TraumaandEatingDisorders.pdf

 

Categories
Eating Disorders

Addressing the Eclairs in the Room

Addressing the Eclairs in the Room

Eating disorders among children are becoming a rising issue on both sides of the weight spectrum. According to data collected by the Centers for Disease Control and Prevention, the rate of obesity in children in the 2-19 year age range was 18.5% in 2016. This is a 4.6% increase from 2000 when the CDC reported the obesity rate as 13.9%. On the other hand, the Agency for Healthcare Research and Quality reports that hospitalizations for eating disorders such as anorexia and bulimia rose by 119% between 1999 and 2006. One way in which this issue can be addressed is through improved parent-child communication about healthy eating and positive body image.

A 2012 study shows that while there is an insufficient amount of data to make direct conclusions about the parental influence on childhood weight gain, parents are a contributing factor to childhood weight gain. Parents provide the primary environment for their children and shape their eating habits and diet (Tzou and Chu 2012).

Given their influence on childhood eating habits, parents must actively promote healthy eating and exercise among their children. Additionally, they must be sensitive and positive when verbally addressing weight-related issues. Dr. Sandra Hassink, the director of the American Academy of Pediatrics Institute for Healthy Childhood Weight, breaks down childhood into three phases: elementary, middle school, and high school. Parents are taught specific reaction strategies to efficiently help children form healthy eating habits in each of these phases.

In the elementary age, Hassink discusses the importance of actions and observations. In other words, this is considered to be a time when children observe and copy their parents. Being such, parents are taught more to practice “eating a good variety, right-sized portions, eating healthy food and not junk food, all of that gets observed.”

Hassink identifies middle school-aged children as being highly sensitive due to the numerous changes brought about by puberty. As a result, she advises parents to establish a safe, judgment-free environment, where children are encouraged to be accepting of their body types, rather than feeling the need to be compared to others or obsess over their weight. “Body image: pre-teens and teenagers,” an article posted on the Australian parenting website, Raising Children, discusses the importance for parents to teach their children about positive self-image and it also states that children with negative body image may lead to anxiety, stress, and social withdrawal.

Hassink encourages parents of children who fall in the high-school phase to be informational, by discussing family history, proper diets, and exercise schedules. In any case, parents are encouraged to promote optimism and self-confidence in children, as opposed to excessively controlling their diets and having them obsess over calories.

As shown by behaviorist, Albert Bandura, children often imitate the behavior of those around them, which is why it is important for parents to be sensitive and model healthy eating behavior and positive body image. This can be achieved by emphasizing nutrition and exercise over calories, weight, and other numeric factors.

References:

Harb, C. (2012, August 22). Child eating disorders on the rise. Retrieved October 30, 2017, from http://www.cnn.com/2012/08/22/health/child-eating-disorders/index.html.

Raising Children, (2017, February 2). “Body image: pre-teens and teenagers.” Retrieved November 5, 2016, from http://raisingchildren.net.au/articles/body_image.html.

The State of Obesity. The State of Childhood Obesity, (n.d.). Retrieved October 30, 2017, from https://stateofobesity.org/childhood-obesity-trends/.

Tzou, I. and Chu, N. (2012) Parental influence on childhood obesity: A review. Health, 4, 1464-1470. doi: 10.4236/health.2012.412A211.

Wallace, C. (2016, September 12). How to Talk to Kids About their Weight. Retrieved October 30, 2017, from http://time.com/4488025/how-to-talk-to-kids-about-their-weight/.

Categories
Eating Disorders

Brawny, Burly, Bigorexia

Brawny, Burly, Bigorexia

How may a 300-pound bodybuilder compare with a 60-pound 15-year-old battling with anorexia? In addition to shared human genotypes and phenotypes, they may be connected by an eating disorder. Although we often associate the word “eating disorder” with women from the 15-25 year age group, the National Eating Disorders Association estimates that 10 million American men struggle with an eating disorder. In addition to the well-known anorexia and bulimia, muscle dysmorphia (“bigorexia”) is currently on the rise and affecting men as young as 19, according to psychologist Dr. Lauren Muhlheim.

Muscle dysmorphia is sometimes labeled “reverse anorexia,” because although both disorders revolve around a fixation with food, exercise, and weight control, individuals with muscle dysmorphia are plagued by the desire to gain weight and look muscular. This disorder particularly affects men and an estimated 10% of bodybuilders are said to have some form of the disorder, according to cognitive behavior therapist and chairman of the Body Dysmorphic Disorder Foundation, Rob Wilson.

As stated in The National Eating Disorders Collaboration article, “Eating Disorders in Males,” muscle dysmorphia is often rooted in a sufferer’s experiences with bullying and childhood obesity. Additional causes include genetic factors; sports and activities with a strong focus on weight (i.e. weight lifting, football, bodybuilding, wrestling); and media portrayals of the “perfect” V-shaped body with abs.

Consequences of muscle dysmorphia include: injuries caused by excessive exercising; muscle, joint, kidney, tendon, heart, and/or liver damage; and heart problems. In addition to health issues that stem directly from the eating disorder, people who struggle with muscle dysmorphia are known to take steroids; in fact, Dr. Muhlheim states that over 50% of men with muscle dysmorphia have reported steroid abuse. While steroid use promotes muscle growth, “Muscle dysmorphia: One in 10 men in gyms are believed to have ‘bigorexia,’” a September 21, 2015 BBC article by Athar Ahmad, Nicholas Rotherham and Divya Talwar, attributes its use to “hair loss, testicle shrinkage and increased risk of heart and liver problems.”

According to “Muscle dysmorphia: One in 10 men in gyms are believed to have ‘bigorexia,’” a September 21, 2015 BBC article by Athar Ahmad, Nicholas Rotherham and Divya Talwar, symptoms of muscle dysmorphia include: “working out compulsively; abuse of supplements and constant drinking of protein shakes; training while injured; and prioritising working out over family and social life,” (Ahmad, et al., 2015).

Treatment for body dysmorphia is similar to that for individuals with anorexia, as it is based on cognitive-behavioral therapy and seeks to moderate food and exercise and reduce obsessive thoughts. However, as with most eating disorders, complications to treating males with bigorexia arise from the misconception that eating disorders are feminine by nature and that it isn’t manly to seek for help. These misconceptions often result in affected men to either be diagnosed late or go undiagnosed, which in turn may cause depression or even suicide. Given the severity of the consequences of the disorder as well as the lack of acknowledgment of male body dissatisfaction, the need for awareness on male eating disorders has become increasingly important. As a society, we must teach individuals of all genders, from a very young age to be accepting of their body types.

References:

Ahmad, Rotherham, and Talwar, (September 21, 2015).  Muscle dysmorphia: One in 10 men in gyms believed to have ‘bigorexia.’ BBC. Retrieved October 18, 2017, from http://www.bbc.co.uk/newsbeat/article/34307044/muscle-dysmorphia-one-in-10-men-in-gyms-believed-to-have-bigorexia

Chatterjee, R. (October 7, 2013). For Boys With Eating Disorders, Finding Treatment Can Be Hard. NPR. Retrieved October 22, 2017, from http://www.npr.org/sections/health-shots/2013/10/07/229164585/for-boys-with-eating-disorders-finding-treatment-can-be-hard

“Eating Disorders in Males,” (n.d.). The National Eating Disorders Collaboration. Retrieved October 18, 2017 from http://www.nedc.com.au/eating-disorders-in-males

Muhlheim, L. (2014). Muscle Dysmorphia. Mirror Mirror. Retrieved October 18, 2017, from https://www.mirror-mirror.org/muscle-dysmorphia.htm

Categories
Eating Disorders

Diabulimia, Anything but Sweet

Diabulimia, Anything but Sweet

What would you sacrifice for a perfect body? A cheesy slice of pizza? Or perhaps a vanilla yogurt with generous quantities of Oreo and rainbow sprinkles? 29-year-old Becky, from Aberdeen, England sacrificed her legs, in her arduous battle with diabulimia (“Diabulimia: The World’s Most Dangerous Eating Disorder,” 2017).

Diabulimia is an eating disorder that affects individuals with Type 1 diabetes, which is a form of diabetes that manifests in an individual’s childhood and requires the life-long intake of insulin. While some individuals with diabulimia may show signs of bulimia (binge eating and purging), diabulimia is distinctly characterized by the affected individual’s refusal to take insulin. Symptoms often include: high blood sugar levels, dehydration, frequent urination, and unexplained weight loss (“Diabulimia,” n.d.).

What makes diabulimia so dangerous is the sensitivity of individuals with Type 1 diabetes to insulin dosage. According to Professor Khalida Ismail, the lead psychiatrist for diabetes at King’s Health Partners—a London-based academic health science center—when individuals with Type 1 diabetes decrease or stop their insulin intake, their blood sugar levels increase, making them vulnerable to damages to their eyes, kidney, and nerve endings, as well as heart failure, loss of limbs, and in severe cases, death (2017). Additional consequences include severe dehydration and coma (Karidis, 2015).

The BBC Three documentary, Diabulimia: The World’s Most Dangerous Eating Disorder follows the stories of women with diabulimia, including Becky and 21-year old Nabeelah, from Leicester, England. Becky’s struggles with diabulimia have resulted in the disintegration of her leg bones, requiring her to walk with crutches, and led to her 16 month-stay as an inpatient at an eating disorder unit. Similarly, the disorder has caused Nabeelah multiple health complications, including the worsening of her eyesight; nerve pains in her feet, hands, and fingers; migraines; and kidney pains.

Despite the perils of diabulimia, sufferers continue to skip their insulin, because as with any other eating disorder, the fear of weight gain outweighs the medical consequences. In the words of Professor Ismail, “People with Type 1 diabetes have a fear that insulin causes weight gain…this fear is so strong that it leads them to omit the amount of insulin they take, in order to have weight loss,” (2017).

Nabeelah’s hands tremble when her EpiPen is in close proximity and she says, “Me being completely recovered would be me being able to inject on a daily basis without the big cloud of depression or the big cloud of weight gain standing over my head,” (2017).

Like many other comorbid disorders, treating diabulimia is challenging, with relapse rates at a whopping 53% (2015). A major challenge to treatment plans is the extreme consequences of skipping insulin, as Professor Ismail states, “If the person with Type 1 diabetes does not take insulin, they will die very quickly.”

The mental and physiological characteristics of diabulimia also contribute to the difficulties in treatment. “With diabetes, there is a focus on numbers: What is your blood sugar? …How many carbohydrates have you consumed?..with eating disorders, people need to learn to let go of the obsession with numbers. So there is a conflict in treatment approaches,” says Marcia Meier, a diabetes nurse educator at the Melrose Center in Minneapolis (2015).

Treatment often includes cognitive and behavioral therapy, as well as group therapy, counseling, therapeutical activities (“Best Diabulimia Treatment Center & Rehab,” n.d.), and in severe cases, surveillance by professionals in treatment facilities (2017).

Approximately 40% of women between 15 and 30 with Type 1 diabetes suffer with either Diabulimia or another form of eating disorder. Additionally, it is estimated that 60% of women with Type 1 diabetes will have encountered an eating disorder by 25 years of age (Colton et al., 2015). However, diabulimia has yet to be recognized on the Diagnostic and Statistical Manual of Mental Disorders (DSM), and awareness is still low.

In England alone, the number of individuals with diabulimia is estimated to be 400,000 (Ollerenshaw, 2016). Despite the sheer magnitude and severity of this disorder, awareness on it runs low. This is further exacerbated by the stigma surrounding mental health and the ever-increasing standards on body image. As this is a childhood disorder, perhaps a possible solution can be incorporating lessons on body image and self-love into elementary/middle school curriculums.

References:

Best Diabulimia Treatment Center & Rehab. (n.d.). Retrieved October 7, 2017, from http://www.sierratucson.com/eating-disorders/diabulimia/

Colton, Olmsted, et al. “Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence.” Diabetes Care, vol 38, no. 7, Jul. 2015, pp. 1212-1217.

Diabulimia. (n.d.). National Eating Disorders Association. Retrieved October 1, 2017, from  https://www.nationaleatingdisorders.org/diabulimia-5.

“Diabulimia: The World’s Most Dangerous Eating Disorder.” Youtube. Uploaded by BBC Three, 24 September, 2017,  https://www.youtube.com/watch?v=tSLjM6cZaTo.

Karidis, A. (2015, October 28). When Diabetes Leads to an Eating Disorder. Retrieved October 7, 2017, from https://www.theatlantic.com/health/archive/2015/10/when-diabetes-leads-to-an-eating-disorder/412849/

Ollerenshaw, T. (2016, September 8). Diabulimia: Diabetes and eating disorder service launching in UK. Retrieved October 7, 2017, from http://www.bbc.co.uk/newsbeat/article/37155459/diabulimia-diabetes-and-eating-disorder-service-launching-in-uk

Categories
Eating Disorders

Eating Disorders Are Taking a Bite Out of Children

Eating Disorders Are Taking a Bite Out of Children

December 9, 2015. While many of us were counting the days until winter vacation, British teenager,  Pippa ‘Pip’ McManus was counting her last breaths, before jumping in front of a train, ending her three-year battle with anorexia (Scapens & Abbit, 2017). She was 15 years old.

Pip’s struggles with anorexia began when she was just 12. According to her mother, Pip was initially obsessed with looking at herself in the mirror and asking if she looked fat. While her parents initially overlooked this behavior, Pip’s preoccupation with her diet and exercise, followed by her drastic weight loss eventually pushed them to admit her to the Priory Hospital Altrincham, which specializes in the treatment of mental disorders. Despite receiving professional help, Pip’s condition only worsened over time and she eventually succumbed to her disorder. Around the time of her death, Pippa weighed 55 pounds (“Priory’s care plan for anorexic teen Pippa McManus “inadequate,’” 2017).

Although we often associate eating disorders with women in their late teens and twenties, a study conducted by the Agency for Healthcare Research and Quality revealed that “hospitalizations for eating disorders in children under 12 increased by 119% between 1999 and 2006” (Harb, 2012). In a 2012 CNN article by Cindy Harb, psychologist Dina Zeckhausen links the rise in childhood eating disorders to the increased focus on obesity and diets.

Additionally, Zeckhausen states that children who are vulnerable to eating disorders often display a shared set of traits including: “high anxiety, perfectionism and obsessive-compulsive tendencies” (2012). Zeckhausen also states that children with troubled home and/or school lives are most likely to develop an eating disorder because they see food as one of the only aspects of life under their control. Zeckhausen’s statement is further explained by a University of Rochester Medical Center article on anorexia, which notes that individuals with eating disorders view calorie-control as a way of reducing stress, anxiety and helps in attaining a sense of control and accomplishment through visible weight loss (University of Rochester Medical Center [URMC], n.d.).

In response to childhood eating disorders, numerous incentives have emerged across the globe. For instance, Australian Federal Health Minister, Greg Hunt, recently enforced a policy requiring teachers, school counselors, and coaches to receive training in detecting signs of eating disorders. Additionally, he increased funding for the Ed Hope national helpline and the Butterfly Foundation, both of which are dedicated to helping individuals overcome their eating disorders (Brennan, 2017).

Similarly, many schools throughout the United States have sought to help students through in-school counseling as well as awareness and prevention programs (Olivero, 2015). Additionally, in a 2015 U.S. News article, Magaly Olivero provides suggestions for possible in-school initiatives, including: educating school staff on signs of eating disorders and broadening health curriculums and anti-bullying campaigns to address body-image issues and eating disorders.

The increase in childhood eating disorders depicts the importance of raising awareness on body-image issues among not only adults, but also children, as the future of the world’s youth is dependent upon it.

References:

Anorexia Nervosa. (n.d.). Retrieved September 25, 2017, from https://www.urmc.rochester.edu/childrens-hospital/adolescent/eating-disorders/teens/anorexia-nervosa.aspx

Brennan, R. (2017, September 18). First National Policy for Treatment of Eating Disorders Announced. Retrieved September 19, 2017, from http://www.dailytelegraph.com.au/news/nsw/first-national-policy-for-treatment-of-eating-disorders-announced/news-story/ef8f025b9fd376774d79f94962cf884f

Harb, C. (2012, August 22). Child eating disorders on the rise. Retrieved September 18, 2017, from http://www.cnn.com/2012/08/22/health/child-eating-disorders/index.html

Olivero, M. (2015, February 23). Tackling Eating Disorders With School-Based Initiatives. Retrieved September 25, 2017, from https://health.usnews.com/health-news/health-wellness/articles/2015/02/23/tackling-eating-disorders-with-school-based-initiativeshttp://www.bbc.com/news/uk-england-manchester-39781995

Priory’s care plan for anorexic teen Pippa McManus ‘inadequate’. (2017, May 2). Retrieved September 24, 2017, from http://www.bbc.com/news/uk-england-manchester-39781995

Scapens, A., & Abbit, B. (2017, May 3). The devastating last words of a teenager whose discharge from the Priory ‘was not done well enough’. Retrieved September 18, 2017, from http://www.manchestereveningnews.co.uk/news/greater-manchester-news/pip-mcmanus-anorexia-inquest-stockport-12975723