Title: #EDAW23: “What Does Your Tattoo Mean?” - Stripping Away the Shame, Secrets and Stigma from Eating Disorders

Bodywhys, the National Eating Disorder Association of Ireland, have selected ‘’Breaking the Stigma: Diverse Male Experiences with Eating Disorders and Body Image’ as the theme for their upcoming annual Eating Disorders Awareness Week. An extremely pertinent topic, as increases in this life-threatening illness continue to rise yet remains considerably misunderstood despite considerable progressions in mental health discourse.

“Always hold your head high and look a person in the eye with pride when you tell someone your secret.” The courageous words of a young man living with HIV broke through the screen, penetrating the seats at the back of the documentary film premier How to Tell a Secret at the Alliance Francaise in Dublin, as I watched in awe.

Approaching my second relapse-free Christmas, I had almost forgotten what my own ‘secret’ was. This ignorant bliss being disrupted however, as soon as I am often called upon to answer a somewhat dreaded five-worded question: “What does your tattoo mean?”. 

A heart, a flame, a woman’s body, a chilli pepper (this one is a personal favourite), a character in a foreign language, a sideways Egyptian eye. If feeling particularly brave or comfortable on a given day, I might just not scramble to employ one of these fake meanings and muster up the courage to murmur the NEDA (National Eating Disorders Association) acronym to explain the graphically small (though semantically hefty) symbol on my inner right wrist. This being said (or murmured) however, with optimistic hopes that most Irish/European company won't recognise this American organisations’ acronym.

“People who are affected by eating disorders can be impacted and worried a lot by what other people think and how they react. Speaking out or acknowledging that something isn't quite right about their relationship with food and their body is a really huge step for someone to take. On top of that, eating disorders thrive in secrecy,” Ellen Jennings, Bodywhys Ireland.

Unsurprisingly, I soon caught myself employing my go-to ‘flame’ cover-up (whatever that could even potentially signify) to a new friend. I didn’t even feel particularly uncomfortable in this friends’ company - quite the opposite, actually. Straight after, I was ashamed for not speaking my truth with pride. Why couldn’t I be like that brave young man in the documentary? What was I so afraid of? Then two former reactions received when I had responded honestly to this question in the past came to mind.

The first reaction encapsulated my apprehension around this question. I have little reason to believe that her reaction was (mal)-intentional, and can understand the constraint imposed on the respondent in spontaneously finding suitable words for such a sensitive subject.

Somehow that evening, (perhaps after my second glass of wine), or the fact that I was with familiar company, I found the courage to employ the film's advice and look her in the eye, head high and respond honestly about my ‘secret’ tattoo. As soon as the words left my mouth, I wanted to stuff them back in and ironically, purge away the shame I felt in that moment. I got nothing. Not even a rudimentary head-nod, nor the classic Irish I-don’t-know-how-to-deal-with-this-so-I’m-just-going-to-say “Oh fair enough” nor even a forced yet verbal nonetheless, “Wow that’s brilliant.” Just as I had found the courage to raise my head, she lowered hers. It felt as if the whole restaurant was staring at me; somehow aware of my secret. Was the silence symbolic of something bigger?

“We can't control how people will react. That’s part of recovery, (bearing in mind that there is no single definition of recovery), being able to tolerate and have coping mechanisms for difficult scenarios. It’s something that takes time. It’s about making sure you’re ready to speak out and also remembering that we don’t have to share our experience with everyone if we don’t feel comfortable.”

Thankfully, the latter reaction I received (with many others following thereafter), conversely, reconciled my apprehensions and re-fueled my courage to be honest. The risk of receiving negative reactions like that above is far outweighed in contrast with such positive, encouraging reactions in the mix; making it worthwhile to take that chance and assuredly look someone in the eye when I tell them my secret.

Funnily enough, I was on a first date, in a foreign country, when I received a reaction that was somewhat of a personal first and in fact, rather foreign to me. I wasn’t expecting to feel comfortable enough to share this personal detail nor was I expecting his response to be so impactful. “Wow, that's incredible. Are you good now?” Nothing verbose, over-sensationalised nor otherising; just a single, caring and genuine sentence. I finally felt heard, unjudged and understood. I was way more than just good in that moment. We moved on. The date was somewhat successful and although we never had a second date, his reaction always stuck with me.

“When someone is experiencing an eating disorder, there are certain ways of communication that are more helpful than others. There's really no one size fits all approach but it’s about talking about what feelings are going on underneath it all for that person suffering and learning how to support. There are many resources and help out there for those directly (and indirectly) affected- as the condition impacts not only the person struggling themselves, but also the people around that persons’ daily life.”

Without invalidating my own subjective experience with eating disorders, I nonetheless cannot begin to imagine the augmented stigma, prejudices and marginalisation faced by those stereotypically less ‘aligning with’ the restrictive clichés and essentialisms of eating disorders conjured up by the media and society. Poor knowledge on this issue, coupled with harmful, reductive misconceptions of eating disorders can also lead to a serious mental health illness being undermined, thus adding to an existing plethora of reasons as to why sufferers, especially those representative of minority groups, don't come forward for help. One “throwaway” comment I received on social media after attending a conference concisely and sadly, unsurprisingly demonstrates this harmful pattern - “Eating disorders?! 😂 God's sake eat a burger.” I hoped that someone who decided to tell this individual their ‘secret’ would never receive such a disparaging response. Clearly, despite positive progressions in mental health discussions, ongoing knowledge and awareness gaps around this particular issue require constant addressing. 

“Part of breaking down stigma is addressing misconceptions around eating disorders and illustrating how complex the issue really is. Historically, eating disorders had been seen as a female issue, and that's not the case hence why this year we're focusing male experiences and helping men to feel heard and more understood. We often hear from male sufferers feeling isolated in their experience because they didn't have any kind of a role model who spoke out about these issues. We're also raising awareness of the impacts of weight stigma on people with eating disorders. Eating disorders don't have a single look, shape or size. It's important to recognize that people in certain body shapes and sizes are still vulnerable to eating disorders.”

Recent post-pandemic statistics have reported a spike in the number of hospitalisations of eating disorder cases (Health Research Board, 2021). Scarily enough, these figures are largely said to be an underrepresentation of the realities for various reasons. It has also been estimated globally that just 5% to 15% of people with eating disorders seek help (Bodywhys) and most figures cited are “only those who have come to the stage in their eating disorder that it's no longer working for them, where the eating disorder has fully taken control, and the person may be very physically on well at that stage,” Ellen Jennings.

On top of the pandemic, eating disorders, already complex in nature are constantly facing new, aggravating challenges such as social media or even the impacts of an inflated cost of living: “Recent research has shown an association between food insecurity and certain eating disorders, particularly binge-eating disorder and bulimia nervosa”. (NHS Confederation, 2022).  Lower and more marginalised socioeconomic groups, including young university students, are said to be at a higher risk of being affected. These statistics, seeming perhaps insensate at times in their quantitative summary, are far from being abstract cases, but real instances of one of the most deadly of all mental health illnesses in Ireland and worldwide.

Social media remains a pertinent factor that has amplified biased, (largely consumerism driven) narratives and has normalised problematic behaviours when it comes to eating disorders. The emergence of the Body Positivity movement over the past decade was largely aimed at calling out these harmful narratives online such as ‘thinspiration’ propaganda. However such narratives constantly rebrand themselves and re-emerge back into pop culture. In the past year alone, content such as ‘What I Eat in a Day’, ‘That Girl/Guy Diet Plan’ (promoting unrealistic body and lifestyle ideals) and even articles proclaiming that ‘Heroin Chic’ is back have all gone viral.

“Everyone can have an opinion on social media. It’s important to be aware of the dangerous effects that influencers can have despite good intentions. Certain concepts and videos can be taken very literally by people vulnerable to eating disorders. People talk of nutrition like it's a matter of fact. It can be so oversimplified. However, there is so much more nuance to our relationship with food than portrayed. Blame and shame often falls on the person themselves and not the diet itself which has actually failed. Eating disorders are complex- there's no one driving cause behind the increase- but social media is definitely part of that picture.”

The theme of Bodywhys’ upcoming national annual eating disorder week is ‘Breaking the Stigma: Diverse Male Experiences with Eating Disorders and Body Image’, taking place from 28th February- 6 March, and will feature a diverse range of expert-lead events both nationwide and online. Through special speaker discussions, a special emphasis will be put on additional ‘hidden challenges’ such as social identity and stigma that can prevent individuals from seeking help. Bodywhys has also recently launched a new online third-level monthly student support group as well as a men’s support group for those wishing to avail of and provide mutual support through sharing personal experiences.

For support, resources and more information please contact the Bodywhys Eating Disorders Helpline (LoCall 1890 200 444) or visit their website, www.bodywhys.ie

For a full list of #EDAW23 events taking place please visit: https://www.bodywhys.ie/eating-disorders-awareness-week-2022-28th-february-6th-march/

With special thanks to contributions from Ellen Jennings, Communication Officer of Bodywhys Ireland.