Celebrating 100 years of life-changing medical research
Preventing eating disorders and self-harm
Adolescence through to early adulthood is a time of rapid physical, emotional and social change – all of which can make young people more vulnerable to mental health problems. Three quarters of mental health problems emerge before the age of 24, and these issues continue to rise in young people.
Despite advances in technology and new insights drawn from large sets of biological, social and environmental data, the burden of mental ill health has not gone away - nor has it been matched by investment in new research, which remains low compared to many physical conditions.
That’s why child, adolescent and early adulthood mental health remains one of our longest-standing research priorities.
In 2017 we identified eating disorders and self-harm as an area where we could make a real difference. These are devastating conditions which blight the lives of increasing numbers of young people and their families.
Around 1.2 million people in the UK have an eating disorder. Anorexia has the highest mortality rate of any psychiatric disorder, and other eating disorders such as bulimia can lead to severe medical complications.
The UK’s rates of self-harm are among the highest in Europe and have increased steadily over the past decade. Repeated self-harm results in around 150,000 attendances at accident and emergency departments each year and is one of the top five causes of acute medical admission.
Despite the devastating impact of these life-threatening disorders, our understanding of what drives them to develop is still limited.
In partnership with the Medical Research Council (MRC) we have invested £3.9 million into 13 ground-breaking projects, as well as a further investment of £1.1 million into four solely Foundation-funded studies.
These projects are improving understanding of what causes eating disorders and self-harm, and ultimately, these insights are helping to inform larger-scale prevention and treatment studies – all of which are aimed at improving the lives of affected young people.
These insights could help with predicting which children will go on to develop eating disorders, so that we can intervene as early as possible.
Exploring why eating disorders develop
We awarded a research grant to Dr Nadia Micali, from University College London, for a project exploring how changes in our genetic and physical make-up – particularly related to metabolism, appetite and growth - could lead to the onset of eating disorders.
“We still have very few treatment options for eating disorders,” Nadia explains.
“Certain treatments work well in some people, but it’s often difficult to predict those who will not respond to treatment. We need to get better at detecting young people at risk, in order to improve prevention and develop new approaches to treatment.”
Until recently, researchers have focused mainly on the psychology of eating disorders, and how they might be driven by the cultural and societal pressures faced by young people. But Nadia and her colleagues are starting to explore the biological roots of eating disorders, including factors related to genetics, metabolism, appetite and growth.
Nadia’s Foundation-funded research has shown that certain patterns of eating behaviours during the first ten years of life are associated with higher risk of eating disorders. More specifically, children who tend to consistently overeat are more likely to develop a binge eating disorder, whereas persistent fussy eating or undereating is linked to increased risk of anorexia nervosa.
Nadia also found evidence that persistent high body mass index (BMI) in children may be a risk factor for the development of binge eating, eating-disorder related thoughts, and that genes associated with BMI may also predict how eating behaviour develops throughout childhood.
“By untangling all of these factors, we can build a much better picture of how genetic and environmental influences shape eating behaviour. These insights could help with predicting which children will go on to develop eating disorders, so that we can intervene as early as possible,” says Nadia.
The evidence we’ve gathered so far shows the importance of addressing childhood adversity as early as possible.
Examining links between childhood trauma and self-harm
To tackle the growing problem of self-harm among young people, we funded Dr Becky Mars from the University of Bristol to investigate whether negative experiences in early life – such as abuse, witnessing domestic violence or having separated parents – are associated with specific biological processes linked with self-harm in adolescents.
We know the social environment can have an impact on the body’s internal working, including inflammation, alterations to DNA, and puberty. And previous research has shown a link between adverse childhood experiences and teenage self-harm, however it was unclear whether biological inflammation, sparked by the ‘fight or flight’ response to stress, could help to explain this association.
One of Becky’s studies was the first ever to look at childhood trauma, inflammation and self-harm, to help identify potential markers of future self-harm risk, as well as possible targets for treatment for young people who self-harm.
Becky analysed data from 4,300 young people in Bristol’s ‘Children of the 90s’ study to see if adverse childhood experiences such as experiencing abuse, witnessing domestic violence or having separated parents are linked to self-harm at the age of 16.
She found that for each extra type of adverse experience, a young person is 11 per cent more likely to self-harm at the age of 16, and 22 per cent more likely to have self-harmed with suicidal intent. There was no evidence that levels of inflammation or age of puberty linked childhood trauma and self-harm, so more research is needed to investigate other biological and psychological pathways linking adversity and self-harm.
“The evidence we’ve gathered so far shows the importance of addressing childhood adversity as early as possible, identifying potential markers of self-harm risk, and developing new ways of treating young people who self-harm,” says Becky.