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Interoception: the hidden sense that can help children understand their feelings before they react - CETC

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You're probably familiar with the five basic senses: taste, touch, smell, sight, and hearing. But did you know there are three additional 'hidden' senses that we use constantly to guide our bodies? These senses - proprioception, vestibular, and interoception - work together to organise how our body moves in space and interacts with our surroundings.

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It was day 29 of a gruelling 600-mile (966km) canoe journey across the Canadian subarctic when 17-year-old Alex Messenger was savagely attacked by a grizzly bear.

He'd left his camp alone that day in 2005 to climb a nearby peak. And on the way up, head down, his thoughts had meandered between everyday things -his high school reading book, The Liars' Club; the weight of the camera case he was carrying; the vivid little flowers beneath his feet. But while Messenger was daydreaming, the bear was lumbering unseen up the opposite side of the ridge.

When their paths finally converged, Messenger's body reacted before his mind. "I just saw this kind of brown blob come up over the rise," he says. "I wasn't sure what it was, but this tension ran through my body. My breath quickened, my eyes widened, my pulse doubled immediately, my airways opened."

Now, nearly 20 years on - and after writing about the experience in his memoir The Twenty-Ninth Day - Messenger can still recall how long it took for his conscious brain to catch up with the signals his body was bombarding him with. "There was this visceral or subconscious bodily reaction," he says. "And then, later, there was my intellectual and emotional reaction."

At first, he thought the "brown blob" was a musk ox. And it was only as the shape came into sharper focus that he realised his body had already prepared itself to deal with a far more ominous threat: a belligerent, 600lb (272kg) apex predator. The bear charged straight at him and swatted him to the ground with a blinding blow to the head. It locked its jaws around his thigh - causing Messenger to pass out - before leaving him for dead.

Messenger's experience isn't just a miraculous survival story. It also offers an insight into our often overlooked inner sense: interoception. While we're largely familiar with the five outward-facing or "exteroceptive" senses - sight, smell, hearing, taste and touch - interoception is our ability to perceive and interpret signals coming from within our own bodies. And it not only helps to keep our bodies in "homeostasis", or balanced working order (by invisibly regulating blood pressure and glucose levels or more overtly encouraging us to eat or drink, for example) but could also be having a profound impact on our thinking, emotions and mental health. It may even be behind our very sense of self.

(Credit: Serenity Strull/BBC/Getty Images)

Over a century before Messenger's terrifying encounter, American philosopher and psychologist William James was exploring the role bodily signals might play in shaping our emotions. He argued that running into a bear doesn't make our heart race because we are scared. Instead, as Messenger's experience seems to suggest, our body responds to the perceived threat by flooding itself with adrenaline, increasing our heart rate and breathing - and that we then interpret these bodily signals as fear. In other words, emotions are born of the body.

As James wrote in his 1884 essay What Is An Emotion?: "We feel sorry because we cry, angry because we strike, afraid because we tremble, and not that we cry, strike, or tremble, because we are sorry, angry, or fearful."

What became known as the James-Lange (Carl Lange was a physician working independently on similar ideas) theory of emotion has been vigorously debated and since evolved - not least to incorporate the idea, outlined in "appraisal theories", that context also plays a key role in determining how physiological signals shape our emotions. After all, if Messenger's heart had started racing on a rollercoaster or during a first date, rather than in a face-off with a bear in a remote wilderness, he may have "appraised" his bodily signals differently and felt excitement rather than terror.

Nevertheless, James laid the early groundwork for how we think about the closely intertwined relationship between brain and body. Indeed, according to Antonio Damasio, professor of psychology, philosophy and neurology at the University of Southern California: "Our thoughts and our feelings and emotions are not just influenced by our bodies but [are] actually inconceivable without them. All of our mental activity is a consequence of body/brain interactions."

For our recent book, Are You Thinking Clearly?, we explored many of the factors that influence and manipulate the way we think, from genetics, habits and heuristics to technology, time and the bacteria in our gut. And this mysterious inner sense, the subject of a fast-growing research field, proved to be one of the most intriguing.

"Interoception is the processing of bodily signals that come from the inside," says Jennifer Murphy, who researches interoception and how it impacts cognition and mental health at Royal Holloway University of London. "So this would be things like feeling your heart beating, your breathing and knowing when you need to go to the toilet or when you're sick." Hunger and fullness are other examples.

A watertight definition of interoception remains a topic of debate, but the emphasis is on internal signals. "We can gauge whether we're breathless by the sound of our breath," says Murphy. "But that's an exteroceptive, rather than an interoceptive route to perceiving that." Indeed, Sahib Khalsa, a leading interoception researcher at the Laureate Institute for Brain Research in Tulsa, Oklahoma, describes himself as an explorer of our "inner space".

Some of these bodily signals, which are transmitted from our organs and other body parts to our brains via an intricate "internet" of connections, including the spinal and cranial nerves and chemicals in the bloodstream, are too subtle for our conscious minds to perceive. Others, such as a speeding heart, nervous "butterflies" or hunger, aren't. We are all sensitive to these internal signals to varying degrees, and we can all interpret and respond to them differently, depending on who we are and what we're doing. In fact, disturbances in our sensitivity to and perception of bodily signals may be behind an array of conditions from anxiety and depression to anorexia nervosa.

This is pioneering science and many of the mechanisms behind interoception remain mysterious and hard to test. But researchers such as Murphy, Khalsa, Sarah Garfinkel, professor of cognitive neuroscience at University College London, Anil Seth, professor of cognitive and computational neuroscience at the University of Sussex, and Hugo Critchley, also at Sussex, are gradually drawing back the veil. And the results could have profound consequences for how we understand our minds.

"We know next to nothing about what's happening on the floor of the ocean," says Khalsa. "Yet we know that it's fundamentally important to determining our climate. It's the same thing with interoception. We know so little about what's happening inside of our bodies in relation to how we feel, yet we know that it's important. It cannot be ignored."

So how might interoception apply to our everyday lives?

Take your heartbeat - likely one of the bodily signals you're most often aware of. It's widely recognised that anxiety can cause the heart to quicken. But what if, as James and many others since have suggested, the process also happened in reverse and an increased heart rate could trigger anxiety and cause us to feel fear as well? If this were the case, the degree to which we are "interoceptive" and can perceive our heartbeat - and how we interpret and respond to those signals - might have major implications for our wellbeing and mental health.

Proving such a thing scientifically, however, is extremely difficult. "I've long worried that interoception research is hard because of the difficulty of precise measurement and manipulation of physiological variables and/or interoceptive signals," says Seth.

How interoceptive we are could have implications for our wellbeing and mental health (Credit: Serenity Strull/BBC/Getty Images)

Nevertheless, headway is being made. Garfinkel has already revealed that our response to fear stimuli can change across a single heartbeat. The study participants were shown fearful and neutral faces when their hearts were in systole (the muscles were contracting) and diastole (the muscles were relaxed). And the results showed that the participants more easily identified the fearful faces - and found them more intense - when their hearts were in systole. Their amygdalas - a primitive brain area related to fear response - were also more active. The brain, then, responds to the heart.

But a study published in 2023 by a team of researchers at Stanford University in California went further. They tested whether increased heart rate could induce anxiety and fear responses. The researchers used a non-invasive, optogenetic (a technique which uses light to manipulate cells) pacemaker to precisely increase the heartbeats in mice. They then monitored the rodents to see how willing they were to explore a maze and search for water.

The results were compelling. When their heart rates were elevated, the mice did become more anxious - they were less likely to explore the exposed sections of the maze, instead choosing to remain in the protected areas. Crucially, however, this effect only occurred in "risky contexts" (for example, when there was a threat of a mild shock). Full screens of the rodents' brains also enabled the researchers to accurately pinpoint several brain regions related to this behaviour, including the insular cortex, prefrontal cortex and brainstem.

"Of course, this is a study of mice not people, so the observation of anxiety-like behaviour doesn't necessarily mean that the mice were actually experiencing a mousey version of anxiety," warns Seth. "But the specific finding, that optogenetically enhanced heart rate produces anxiety-like behaviour only in risky environments, is exactly what would be predicted by classic appraisal theory, which extended James/Lange with the idea that perception of physiology in context matters for emotion."

In other words, the study suggests that our "appraisal" or interpretation of bodily signals may play a key role in how they impact our emotions.

Which brings us back to the significance of bodily signals - and how we perceive and respond to them - in our (human) wellbeing, mental health and decision-making. Accurately establishing how interoceptive people are is one of the field's biggest obstacles. "One of the first things you encounter with interoception is quite how complicated it is to test exactly what is happening," Murphy says.

These signals can come from all over our body, from our guts to our lungs. But interoceptive ability is typically measured by asking participants to count their heartbeat and then comparing their reported result with an objective measure. But there are several problems with this method, not least that around 40% of people are unable consciously to perceive their heartbeat.

Nevertheless, an intriguing study by Garfinkel and others found that City of London hedge fund traders who could more accurately perceive their own heartbeats were more likely to make profitable decisions and enjoy longer careers (although it's important to note that the study didn't show causation).

Meanwhile, individuals who struggle to perceive their bodily feelings find it more difficult to articulate and regulate their emotions. "We have really good theories and we also have really good reason to expect that there might be disruption in interoception across a variety of both physical and mental health conditions," says Murphy - who conducted a recent review of the evidence. These conditions include depression, anxiety, obesity, anorexia nervosa and autism.

There are, of course, large variations in how interoceptive individuals are. In one wide-ranging review, for example, Murphy found there are differences in how cisgender men and women perceive bodily signals, finding women were much less accurate at perceiving their heartbeat in tasks than men. While the reasons for this are unclear - and could include genetic, hormonal and environmental factors - the findings could provide clues as to why women are more likely than men to suffer from depression and other common mental health issues. Indeed, Murphy will now be researching how interoception and mental health vary across the menstrual cycle.

Interoception research is also informing new potential treatments for a range of conditions. Khalsa, for example, has developed a vibrating capsule that can be swallowed, allowing researchers to determine people's sensitivity to gut sensations and how they interpret them. This could help scientists understand and treat those with anorexia nervosa, for example, who appear to experience disruptions in their perception of bodily signals and often report feeling bloated or prematurely full after eating just small amounts.

Garfinkel, Critchley and colleagues, meanwhile, have applied interoceptive techniques to the treatment of anxiety in autistic adults. Autistic people suffer more anxiety than the general population and may be less accurate at perceiving and interpreting bodily signals and less able to understand emotions. In a randomised controlled trial, autistic adults received either a control treatment or a novel "Aligning Dimensions of Interoceptive Experience (Adie)" therapy involving interoceptive heartbeat detection tasks, feedback on their performance and exercises to moderately increase their heartbeat. After the trial, those on the Adie therapy reported significantly lowered anxiety compared with the control group. It seems the therapy enabled the participants to more accurately predict and interpret their bodily signals, such as a quickening of heart rate, which in turn helped them to regulate their anxiety.

Remarkably, this intriguing internal sense may also be behind our very sense of self. After all, as Seth explains, our most basic sense of selfhood is "being a body". But what drives this? We often picture our "self" as the captain of a ship or, in Seth's words, "a mini-me within the skull that 'does' the perceiving, and then decides what to do next".

Seth, however, believes that this is the wrong way of looking at it. Instead, he argues that what we experience as the "self" is more of a process - an amalgam of the brain's predictions about and perceptions of signals coming from the exterior world and, perhaps even more importantly, our own bodies.

Ultimately, the brain's number one goal is to keep the body, and therefore itself, alive. But while it must do its best to map and manage its external surroundings (to avoid being eaten by a bear, for example) and maintain favourable conditions in the body (to avoid glucose levels becoming too high or blood pressure too low, for example) it can't directly access these two environments. It is effectively locked away, even though we don't experience it like that, and must rely on indirect signals it can't guarantee the cause of.

Instead, the brain creates a model of the body based on a whole range of parameters necessary for survival. It then constantly makes predictions, which it tests for errors and corrects against the sensory inputs it is receiving, allowing it to regulate the system. Seth believes that emotions - which are "variations on the theme of things feeling good or feeling bad" - emerge out of this process of "interoceptive inference" as a means to keep the body where it needs to be to stay alive.

So how does this pioneering theory play out in a scenario such as the one Messenger found himself in? As Seth explains in his book, Being You: "The experience of fear I feel as a bear approaches is a control-oriented perception of my body - more specifically 'my body in the presence of an approaching bear' - that sets in train the actions that are best predicted to keep my essential variables where they need to be. Importantly, these actions can be both external movements of the body - like running - and internal 'intero-actions' such as raising the heart rate and dilating blood vessels."

But whether we're on a quest to discover the elusive source of consciousness, better understand our emotions, ease our anxiety or tame our butterflies, we could all benefit from being more in tune with what our bodies are telling us. And for Seth, a good place to start is meditation. "One thing you're doing when you learn to meditate is to pay attention to your body, to what's happening in your body, and not just think, 'I feel this way, and then project your emotions back out into some narrative about what's happening in your life'."

Just don't focus on it too much. "You can potentially become overly sensitive to every little thing that's happening in your body and I imagine that could drive some kind of anxiety as well," Seth warns.

When it comes to understanding interoception, a great many mysteries remain. But as science delves ever deeper, watch this inner space.
* Miriam Frankel and Matt Warren are science journalists and authors of Are You Thinking Clearly? If you liked this story, Join one million Future fans by liking us on Facebook, or follow us on Twitter or Instagram. sign up for The Essential List newsletter - a handpicked selection of features, videos and can't-miss news delivered to your inbox every Friday.
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Interoception: The inner sense driving your thoughts

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Sometimes our bodies react to the world around us before we realise, shaping our emotions.

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Frontiers | A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma

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Polyvagal theory advocates for working with the body, becoming aware of the body and connecting with the senses. Similarly, paying attention to and influenci…

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Frontiers | A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma

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Polyvagal theory advocates for working with the body, becoming aware of the body and connecting with the senses. Similarly, paying attention to and influenci…

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Verifying you are human. This may take a few seconds.

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The Metabolic Perspective of Mental Health |Leah Benson Therapy

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The metabolic perspective of mental health, a discussion on the application of the theory of constructed emotion to bioenergetic analysis. Character structure

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What’s Wrong with Polyvagal Theory | Leah Benson Therapy

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The pseudoscience that therapists love to believe explains their “trauma-informed therapy.” Does polyvagal pseudoscience help or hinder clients?

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The backlash against mental health awareness has started. Media interest is swelling, but more research is badly needed
Something major is going wrong with how we talk about adolescent mental health - in schools and universities, at home, online. There are multiple layers to this problem, which started with a well-intended desire to destigmatise mental disorders and ends somewhere considerably more complex, problematic and surprising.

The first layer is the concern that talking so much about mental health has meant milder problems are now confounded with mental disorders, and young people are diagnosing themselves with problems they don't really have. Low mood is too readily being described as depression, mild anxiety as an anxiety disorder, and so on. I think this really can be a problem, and I stand by the arguments I've made about this before. I'm conducting research on this right now.

But the changing public conversation had led to a second, less acknowledged problem: that in some camps all young people who say they have mental health problems are now being treated with scepticism. In my research group, we are currently running a study analysing attitudes towards self-diagnosis of mental disorders, and some people believe that any young person who self-diagnoses has inevitably misunderstood and is mistaking their mild problems for more serious disorders.

When I am interviewed about this topic, the subtext is sometimes obvious: W hy are young people lying, and how can we get them to stop? If I could sum up how some adults feel today about adolescent mental health problems, it would be one big eye roll: one collective, disdainful urge to tell snowflakes to pull up their socks.

I think overpathologising is happening in some cases, as I say above, and that this needs careful examination. But the problem is that, obviously, some young people really do have significant levels of distress and dysfunction that absolutely cross the threshold for a psychiatric disorder, whether or not they have been officially diagnosed. Even the ones who don't meet all the criteria are simply fighting to have their distress heard, using the language that surrounds them. But now, ironically, none of them are being believed. They can't all be unwell, the attitude seems to be, so none of them are. The backlash against mental health awareness has begun before we are even close to understanding how to support anyone who needs help.

This is where things get really messy. It's all happening in parallel. We are in a situation where some adolescents are very legitimately experiencing mental health crises, without decent treatment, while others are inaccurately describing typical developmental stress with the language of disorder. Adults who support young people know there is a difference, but understandably struggle to make the distinction, partly through a lack of knowledge and partly because there is no clean distinction between the two groups anyway - everything exists on continua; lines are blurred. The upshot is that in some cases everyone is treated like a serious risk, which is unhelpful in itself, but in others everyone is dismissed. The whole thing is a mess, and a thousand miles away from the original goal of mental health awareness.

Whenever I am interviewed about all this, I try to convey that, whatever the impact of the changing conversation, there are still young people who are seriously unwell and need help. But I cannot guarantee this point will make the final cut and often it doesn't. I firmly believe we need to critique the recent transformation in the public mental health discourse, but I worry about the consequences of asking the questions. I'm deeply conflicted about how the things I've said and written might end up being misused.

What makes this harder is that there is almost no empirical research on any of this. The potential downsides of mental health awareness - overpathologising, scepticism - are widely discussed among anyone working with young people. Yet with a handful of exceptions, my research group is the only one in the world looking at this, and even we are still right at the beginning. Academic research into adolescent mental health is focusing on many other (important!) issues, but not this.

This is utterly at odds with the public interest in this topic. In the last few months alone, my theoretical article on this topic had been discussed on BBC2's Newsnight and BBC Radio 4's Analysis, and in articles for The Economist, , again, New Scientist, The New York Times and The Atlantic. I have turned down many other requests to be interviewed. When I don't have the capacity, and journalists ask me who else they can talk to, I don't know who to suggest.

I am writing this as a call to action. This is potentially a major, major public health problem, a damning tale of unintended consequences, and we need sensitive academic research to understand it better. We need to empirically test, somehow, whether the burgeoning mental health conversation has affected how adolescents understand, label and experience mental health problems. Somehow, we need to do this without dismissing or ignoring any of the young people who are clearly struggling so badly, whatever you call it.

We then need to understand what we might be able to do about this. I am asked repeatedly what might be a better way of talking about adolescent mental health, if the current approach is wrong. My honest answer is I don't know. I have no idea. We are miles off even understanding whether and how the current approach is wrong. It's hard to say 'I don't know' to a journalist, in a public display of my apparent expertise, but right now it's all I have.

I am also asked, sometimes, whether attempts at a corrective might be too late. An interviewer asked me whether, if TikTok videos are indeed shown to warp young people's understanding of mental health, then what I am proposing to do about it. My answer, again, is that I don't know. Of course, I hope it's not too late. Societal approaches to mental health have changed in the past, so there's every chance they can change again. But an awful lot of work needs to be done to get there, and there are adolescents growing up, right now, while we try to figure it out.
If you or your group are working on the negative consequences of mental health awareness or are planning work in this area, and we haven't yet met, please get in touch - I'd love to hear about your research.

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The backlash against mental health awareness has started. Media interest is swelling, but more research is badly needed Something major is going wrong with how we talk about adolescent mental health...

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Abstract

In the past decade, there have been extensive efforts in the Western world to raise public awareness about mental health problems, with the goal of reducing or preventing these symptoms across the population. Despite these efforts, reported rates of mental health problems have increased in these countries over the same period. In this paper, we present the hypothesis that, paradoxically, awareness efforts are contributing to this reported increase in mental health problems. We term this the prevalence inflation hypothesis. First, we argue that mental health awareness efforts are leading to more accurate reporting of previously under-recognised symptoms, a beneficial outcome. Second, and more problematically, we propose that awareness efforts are leading some individuals to interpret and report milder forms of distress as mental health problems. We propose that this then leads some individuals to experience a genuine increase in symptoms, because labelling distress as a mental health problem can affect an individual's self-concept and behaviour in a way that is ultimately self-fulfilling. For example, interpreting low levels of anxiety as symptomatic of an anxiety disorder might lead to behavioural avoidance, which can further exacerbate anxiety symptoms. We propose that the increase in reported symptoms then drives further awareness efforts: the two processes influence each other in a cyclical, intensifying manner. We end by suggesting ways to test this hypothesis and argue that future awareness efforts need to mitigate the issues we present.

Data availability

No data was used for the research described in the article.

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Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis

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In the past decade, there have been extensive efforts in the Western world to raise public awareness about mental health problems, with the goal of re...

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When I was 13, two of my friends were arrested for shoplifting. Along with two boys in our year, they had decided to bunk off school - our suburban grammar school renowned for its academic excellence - and get the train to a shopping centre nearby. The day had been going well until they reached HMV, where a security guard asked them about the CDs they had hidden in their coats. Cue a call to the police, and some time in a cell at the local police station. By the end of the day, news had travelled to the rest of us via an SMS on our Nokia 3310 s and we gathered at one of our houses to discuss the situation. Most of us were crying.

It was but one dramatic moment in a lawless year. In year 7 we had been a fairly risk-taking group, but in the spring of year 8, a new girl joined our school and her arrival set things on fire. Beside the shoplifting habit, there was a lot of alcohol, stolen from parents' cupboards or bought for us by strangers on the high street or by older siblings. We drank where teenagers have always drunk: in parks at night or during unsupervised parties at home. Blacking out was not uncommon, and more than once someone ended up in A&E. There was a lot of smoking, too, cigarettes and weed, and a lot of arguing about boys and each other (more crying there, too).

I remember going through all of this with a sort of stunned horror: confused about why it was all happening, terrified that something would go wrong or I'd get into trouble, but desperate to fit in with my friends. In hindsight, our behaviour that year was so typically teenage as to be cliched, almost banal, but that didn't make it any easier to live through. Year 8, for its sheer volatility combined with our immense vulnerability, was one of the wildest years of my life.

Fast forward 23 years, and a new public narrative about adolescents has taken hold. The psychologist Jonathan Haidt's new book, Anxious Generation, focuses on a significant problem: rates of anxiety and other mental health problems are increasing in this generation of teenagers. He links this to the emergence of social media and a decline in exploratory play, and says that we can solve the problem by banning smartphones for under-14s and social media for under‑16s. There is a huge appetite for this narrative: political leaders and grassroots parent-led groups alike are calling for bans. Haidt's book has gone straight to the top of bestseller lists because, well, his argument just sort of feels right - look at all those teenagers glued to their phones, listen to the accounts of self-harm images, cyberbullying and sexting gone wrong. They're suffering, and of course it's their phones.

Except that psychological science (and life) is rarely this neat. Many other changes have coincided with the increase in teenagers reporting rising mental health problems: for example an increase in obesity, an increase in academic pressure and the Covid pandemic, all of which are associated with worse mental health. Haidt's theory about social media is relevant, but it's likely to be one piece of a large and complicated puzzle.

We need to ask more nuanced questions about who exactly is vulnerable to experiencing problems from social media

There is also the critical and often overlooked fact that public discourse around mental health has transformed. Adolescents today are taught about mental health in schools and universities and inundated with public awareness campaigns. This shift will itself have contributed to the increase in reported rates of mental health problems - because more teenagers are now accurately seeking help, but also because others will mislabel lower levels of distress as a mental health problem: both of these will bump up overall rates. I am certain that, had my friends and I been given anxiety questionnaires to fill out in year 8, our scores would have been off the scale. But teenage mental health wasn't measured much then, so it didn't make the headlines.

When trying to understand the cause of adolescent mental health problems, current conversations pursue what is new and different about this generation. This matters to an extent - we are trying to understand an apparent increase, after all - but focus on the new too much and we risk missing a vital point: being an adolescent is, and always has been, really, really hard.

I recently wrote a book about this period of life, and alongside descriptions of the latest research, I included plenty of interviews with adults looking back on their own teenage years. I was struck by how powerful and self-shaping their adolescent memories were even decades later. But I was also fascinated by how similar the struggles were across the generations, whatever age people were now. A 48-year-old interviewee, who went to an all-boys school he likened to Lord of the Flies, summed it up thus: "My adolescence was full of anxiety, just like everyone else's."

Whatever the historical context or technological era, adolescence is bewildering to live through because of the monumental transformation that must take place. At the start of adolescence, there is a child, small and vulnerable, reliant on their parents or carers. By the end, that child typically emerges as an independent adult, capable of having sex, reproducing and navigating complex social relationships and the world at large. That's a huge shift, and the changes that happen in our brains and bodies to help us get there are the same things that can make adolescence so difficult.

When puberty kicks off, it's as though a flashing red light turns on in the brain, telling adolescents to care about one thing above all else: their peers. It's a running joke that teenagers succumb to peer pressure and are obsessed with copying their friends, but this has a clear evolutionary purpose. To survive beyond the family unit, to integrate with a new social group and find a sexual partner, it's imperative that an adolescent spends a lot of time thinking about what their peers think about them and whether or not they fit in with their friends. In my own adolescence, as with everyone else's, no one was smoking or getting drunk on their own - they were doing these things with, and because of, their friends.

But to add fuel to the fire, at the exact moment that this light turns on, something huge happens in the outside world. Young people move to secondary school and their social context is transformed. In 1961, the sociologist James Coleman wrote that, with the move to secondary education, adolescents were "dumped into a society of peers",and that's still as true today. Adolescents spend most of their days with their peers, within and beyond the school gates, far less supervised than they were in primary school. Just as pubertal hormones are kicking in - driving teenagers to form deep friendships, fall in love, try sex, skip school to go shoplifting - adolescents are dropped into the very arena where all these urges can be enacted.

'Had my friends and I been given anxiety questionnaires to fill out in year 8, our scores would have been off the scale' ... Lucy Foulkes. Photograph: Chris McAndrew/Times Newspapers Ltd

Sometimes, this biological and social pressure cooker can produce wonderful experiences and memories. The people that I interviewed for my book told me about teenage friendships that saved them, about love affairs that made them better people, about exhilarating adventures that made them feel alive. But the same drives that make adolescence wonderful can also make it terrible, and people told me stories about that, too: about being relentlessly bullied, having a regretted first experience of sex, or being rejected by someone they loved.

When things like this happen in the teenage years, they have always caused enormous amounts of psychological pain. Being rejected, humiliated or ignored by other teenagers has always led to distress and misery, because the one thing the young person is longing for - to be accepted by others - has been crushed. At a time when self-development is in flux, adolescents internalise the messages they receive from peers, and a bad evaluation can be devastating. We have known for decades that, when things go badly wrong, a minority of teenagers will be at risk of mental health problems or mental illness. None of this is new.

That doesn't make the issue of phones irrelevant today. Social media has transformed social interactions for everyone: you have more people to compare yourself with, you can edit and curate how you present yourself to the world, and you can quantify how well liked you are - or not - by your peers. When embarrassing things happen, they happen in front of a bigger audience, and videos or images of the incident can be replicated and shared. It's reasonable to research whether these changes make life meaningfully worse for teenagers, who care so deeply about peer relationships, and how we might help them to navigate this.

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Yet it's an oversimplification to blame social media for the rise in adolescent mental health problems. First, there are many other factors at play. Second, social media affects individual teenagers differently. The majority of teenagers do not have mental health problems, and do have social media, so clearly it's possible to use social media without incurring notable harm. Some young people are merely unbothered by social media, but some will benefit from it. Teenagers use social media to enjoy all the aspects of friendship that exist offline: providing and receiving social support, being validated, having fun.

This is especially important for marginalised or minority groups of adolescents - such as those who are autistic, LGBTQ+ or have chronic health problems. For some teenagers, the internet has opened up a new social world, allowing them to understand themselves and foster relationships in a way that wasn't possible before. There are at least some young people who will be happier with social media than without it.

When understanding the overall impact of social media on mental health, this has to be taken into account. Instead of assuming that social media is bad for everyone, we need to ask more nuanced questions about who exactly is vulnerable to experiencing problems from this technology and what ancient adolescent drive is being activated in any specific scenario: this kind of work is starting to happen. When we do this, we can make use of the extensive existing research knowledge about adolescent suffering and how to manage it, rather than throwing our hands up in the face of something that seems entirely new.

Teenagers use social media for providing and receiving support, being validated, having fun

There is also a need to be pragmatic, because social media isn't going away. In my view, a social media ban would be impossible to enforce, and would not even reliably improve adolescent mental health. Some teens will still get their hands on a phone: handed down by a sibling, bought secondhand or given by a parent who is less concerned about all this. In fact, if you make smartphones or social media officially adult-disapproved, they will become more desirable. My prediction is that an attempted ban them would lead to a two‑tier society within schools and friendship groups: those with and those without smartphones and social media. The possible social exclusion of the have-nots could cause its own problems. And teenagers will still have access to tablets and computers, because that's how the world is run now, so they could access social media there. The internet is integrated into adolescence, and has been for many years.

So what should we do instead? Rates of mental health problems in young people are unacceptably high and seem to be increasing, and at least some individuals are negatively affected by social media. There are straightforward steps that tech companies could take to limit the most obvious dangers from their platforms, such as removing images of self-harm and other graphic content. In parallel, parents can help teens navigate what they find hard about social media: by being interested in what their teenager is doing, by teaching them the basics of online safety, and by supporting them to be open about what happens to them or what they see.

It might also help if adults reframed what they thought about phones. The sight of a teenager glued to their screen should be interpreted not as a sign of them being ensnared by a new digital "addiction", but rather a visible manifestation of them caring about what young people have always cared about: their peers. Adults should see phones not as a threat to their relationship with a young person, or a mysterious black box they will never understand, but instead as something more familiar: in what way is this situation tapping into an age-old adolescent phenomenon that I already understand, and probably experienced myself?

We should also care a lot about the messages we share about young people's mental health, and whether that's adding to the problem. It has become unfashionable to say this, but many teenagers are OK. Some are even happy. With the right help - which may involve mental health support - even those who are struggling enormously can find a way through their challenging years.

So many books and articles say that today's teenagers are a lost generation, uniquely doomed. Teenagers read this stuff, too, and will absorb the message. I don't think today's teenagers are the anxious generation. I think they are teenagers, navigating the enormous challenges of adolescence and expressing it with the language that adults have given them.

When I interviewed adults about their adolescent years for my book, I was left with a resounding feeling of hope, and that message needs to be promoted. Many people face exceptional hardship in their adolescence, whether or not they grew up with social media. Even my own relatively privileged teenage years were fraught with difficult feelings and situations. But with patience, compassion and support, young people can emerge as healthy, well-adjusted adults. They are more resourceful and resilient than we give them credit for. We should respect and acknowledge the complexity of their lives, including the elements now mediated via a screen. To dismiss them as an anxious generation lost to their phones is to flatten who they are and what it means to be an adolescent. As with every adult who has gone before them, they are so much more than that.

Coming of Age: How Adolescence Shapes Us by Lucy Foulkes is published by Bodley Head on 4 July (£22). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply

Lucy Foulkes is an academic psychologist at the University of Oxford

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I'm an expert on adolescence: here's why a smartphone ban isn't the answer, and what we should do instead

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Jonathan Haidt's bestselling book blames social media for a decline in teenage mental health. But is he right?

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The Anxious Generation wants to save teens. But the bestseller’s anti-tech logic is skewed

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There’s no doubt about the mental health crisis facing young people. Jonathan Haidt blames our devices – which oversimplifies the problem

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The principle that some products are available to adults and not children is uncontroversial. Access to weapons, alcohol and pornography is curtailed in this way because a level of maturity is the precondition for access (but not a guarantee of responsible use).

Until recently, few people put smartphones in that category. The idea of an age restriction on sales would be dismissed as luddism or state-control freakery. But ministers are reported to be considering just such a ban for under-16s. Opinion polls suggest that it could be popular with parents. Government guidance already calls for a de facto ban on mobile phone use in schools in England and Wales. Many headteachers had already imposed rules to that effect. If there is not yet a consensus that young people's use of smartphones needs stricter regulation, that is the trajectory.

The smartphone is a recent enough innovation (the first iPhone was launched in 2007) to limit firm conclusions about effects of its use. But there is evidence of sudden, steep rises in depression, anxiety and other mental health problems in the first generation to pass through adolescence in a state of digital saturation.

Correlation doesn't prove causation. There might be many reasons why young people are increasingly lonely and lacking in self-esteem. But there is plausible culpability in the simultaneous mass dissemination of platforms and devices that dissolve notions of privacy, are engineered to be addictive and turn social interaction into something akin to a competitive video game. There is no obvious other candidate to account for a pattern that is replicated in so many different countries. The connection is credible enough that societies might not want to wait for definitive confirmation before intervening.

One counterview is that phones are the wrong target. It is the apps and the content they channel that harm young people. The hardware is neutral. Another objection is that the phone is an essential tool of modern life, with benefits that outweigh disadvantages. The task is to teach safe use, or empower parents to enforce it. In that view, the state cannot hold back a social revolution, nor should it want to. The tortured evolution of the recent online safety bill shows the immense complexity of regulation in a rapidly evolving realm.

Defenders of a relaxed approach would note that every advance in communications technology, from the novel to the transistor radio, has been accompanied by panics about the impact on young mores. It is wise to be wary of over-romanticising memories of an analogue childhood. On many measures - the absence of routine corporal punishment, for example - young people in Britain are much safer today than their forebears. There is also a reasonable practicality hurdle. Now that phones are already so routinely found in young hands, it will be very hard to confiscate them.

Those are caveats to the case for regulation, and reasons why it must be carefully designed, not persuasive arguments for keeping the status quo. The balance of risk tends towards favouring political action to reinforce boundaries around childhood when it has been invaded and commodified by advances in digital technology.

It is easy to see why companies that profit by monopolising the attention span of young minds want unchecked access. It is far from obvious why that access should be granted.

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The Guardian view on smartphones and children: a compelling case for action | Editorial

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Editorial: Regulating new technology is never simple, but the status quo offers inadequate protection

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The mass migration of childhood into the virtual world has disrupted social and neurological development.

This disruption includes social anxiety, sleep deprivation, attention fragmentation, and addiction. Alarmed by the rates of anxiety and depression in adolescents, social psychologist Jonathan Haidt wrote The Anxious Generation. The book explores these growing phenomena and attributes them to the transition from a play-based childhood to a phone-based childhood.
Order the book to learn more About the movement
Together, we can reclaim childhood in the real world.

How can we free the anxious generation?

The Four New Norms

For solving collective action problems

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The Anxious Generation - Free the Anxious Generation

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From New York Times bestselling coauthor of The Coddling of the American Mind, an essential investigation into the collapse of youth mental health-and a plan for a healthier, freer childhood

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The Anxious Generation by Jonathan Haidt - Reading Guide: 9780593655030 - PenguinRandomHouse.com: Books

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THE INSTANT #1 NEW YORK TIMES BESTSELLER • A Wall Street Journal Top 10 Book of 2024 • A New York Times and Washington Post Notable Book • One of Barack Obama’s Favorite Books of 2024 •…

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Find the latest interdisciplinary research and essential information on digital media and child development via our #AskTheExperts webinars, video shorts. parent tip sheets, and more. Search all content.

Body Image

Digital media's impact on children and adolescent body image can be significant and multifaceted. The consistent and pervasive nature of unrealistic body ideals can contribute to negative body image perceptions and unhealthy behaviors. What influences should parents, educators, and caregivers be aware of to mitigate their impact?

Even when adult women with fully-developed brains and decades of experience...are aware that an image has been photoshopped...exposure to mass media images still leads to decreases in body image.

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Find the latest interdisciplinary research and essential information on digital media and child development via our #AskTheExperts webinars, video shorts. parent tip sheets, and more. Search all content. Digital media's impact on children and adolescent body image can be significant and multifaceted.

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Pew Research Center: Internet, Science & Tech

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TikTok has established itself as one of the top online platforms for U.S. teens, while the share of teens who use Facebook has fallen sharply

The landscape of social media is ever-changing, especially among teens who often are on the leading edge of this space. A new Pew Research Center survey of American teenagers ages 13 to 17 finds TikTok has rocketed in popularity since its North American debut several years ago and now is a top social media platform for teens among the platforms covered in this survey. Some 67% of teens say they ever use TikTok, with 16% of all teens saying they use it almost constantly. Meanwhile, the share of teens who say they use Facebook, a dominant social media platform among teens in the Center's 2014-15 survey, has plummeted from 71% then to 32% today.

YouTube tops the 2022 teen online landscape among the platforms covered in the Center's new survey, as it is used by 95% of teens. TikTok is next on the list of platforms that were asked about in this survey (67%), followed by Instagram and Snapchat, which are both used by about six-in-ten teens. After those platforms come Facebook with 32% and smaller shares who use Twitter, Twitch, WhatsApp, Reddit and Tumblr.

Changes in the social media landscape since 2014-15 extend beyond TikTok's rise and Facebook's fall. Growing shares of teens say they are using Instagram and Snapchat since then. Conversely, Twitter and Tumblr saw declining shares of teens who report using their platforms. And two of the platforms the Center tracked in the earlier survey - Vine and Google+ - no longer exist.

There are some notable demographic differences in teens' social media choices. For example, teen boys are more likely than teen girls to say they use YouTube, Twitch and Reddit, whereas teen girls are more likely than teen boys to use TikTok, Instagram and Snapchat. In addition, higher shares of Black and Hispanic teens report using TikTok, Instagram, Twitter and WhatsApp compared with White teens.

This study also explores the frequency with which teens are on each of the top five online platforms: YouTube, TikTok, Instagram, Snapchat and Facebook. Fully 35% of teens say they are using at least one of them "almost constantly." Teen TikTok and Snapchat users are particularly engaged with these platforms, followed by teen YouTube users in close pursuit. A quarter of teens who use Snapchat or TikTok say they use these apps almost constantly, and a fifth of teen YouTube users say the same. When looking at teens overall, 19% say they use YouTube almost constantly, 16% say this about TikTok, and 15% about Snapchat.

When reflecting on the amount of time they spend on social media generally, a majority of U.S. teens (55%) say they spend about the right amount of time on these apps and sites, while about a third of teens (36%) say they spend too much time on social media. Just 8% of teens think they spend too little time on these platforms.

Asked about the idea of giving up social media, 54% of teens say it would be at least somewhat hard to give it up, while 46% say it would be at least somewhat easy. Teen girls are more likely than teen boys to express it would be difficult to give up social media (58% vs. 49%). Conversely, a quarter of teen boys say giving up social media would be very easy, while 15% of teen girls say the same. Older teens also say they would have difficulty giving up social media. About six-in-ten teens ages 15 to 17 (58%) say giving up social media would be at least somewhat difficult to do. A smaller share of 13- to 14-year-olds (48%) think this would be difficult.

Beyond just online platforms, the new survey finds that the vast majority of teens have access to digital devices, such as smartphones (95%), desktop or laptop computers (90%) and gaming consoles (80%). And the study shows there has been an uptick in daily teen internet users, from 92% in 2014-15 to 97% today. In addition, the share of teens who say they are online almost constantly has roughly doubled since 2014-15 (46% now and 24% then).

These are some of the findings from an online survey of 1,316 teens conducted by the Pew Research Center from April 14 to May 4, 2022. More details about the findings on adoption and use of digital technologies by teens are covered below.

Smartphones, desktop and laptop computers, and gaming consoles remain widely accessible to teens

Since 2014-15, there has been a 22 percentage point rise in the share of teens who report having access to a smartphone (95% now and 73% then). While teens' access to smartphones has increased over roughly the past eight years, their access to other digital technologies, such as desktop or laptop computers or gaming consoles, has remained statistically unchanged.

The survey shows there are differences in access to these digital devices for certain groups. For instance, teens ages 15 to 17 (98%) are more likely to have access to a smartphone than their 13- to 14-year-old counterparts (91%). In addition, teen boys are 21 points more likely to say they have access to gaming consoles than teen girls - a pattern that has been reported in prior Center research.

Access to computers and gaming consoles also differs by teens' household income. U.S. teens living in households that make $75,000 or more annually are 12 points more likely to have access to gaming consoles and 15 points more likely to have access to a desktop or laptop computer than teens from households with incomes under $30,000. These gaps in teen computer and gaming console access are consistent with digital divides by household income the Center has observed in previous teen surveys.

While 72% of U.S. teens say they have access to a smartphone, a computer and a gaming console at home, more affluent teens are particularly likely to have access to all three devices. Fully 76% of teens that live in households that make at least $75,000 a year say they have or have access to a smartphone, a gaming console and a desktop or laptop computer, compared with smaller shares of teens from households that make less than $30,000 or teens from households making $30,000 to $74,999 a year who say they have access to all three (60% and 69% of teens, respectively).

Almost all U.S. teens report using the internet daily

The share of teens who say they use the internet about once a day or more has grown slightly since 2014-15. Today, 97% of teens say they use the internet daily, compared with 92% of teens in 2014-15 who said the same.

In addition, the share of teens who say they use the internet almost constantly has gone up: 46% of teens say they use the internet almost constantly, up from only about a quarter (24%) of teenagers who said the same in 2014-15.

Black and Hispanic teens stand out for being on the internet more frequently than White teens. Some 56% of Black teens and 55% of Hispanic teens say they are online almost constantly, compared with 37% of White teens. The difference between Hispanic and White teens on this measure is consistent with previous findings when it comes to frequent internet use.

In addition, older teens are more likely to be online almost constantly. Some 52% of 15- to 17-year-olds say they use the internet almost constantly, while 36% of 13- to 14-year-olds say the same. Another demographic pattern in "almost constant" internet use: 53% of urban teens report being online almost constantly, while somewhat smaller shares of suburban and rural teens say the same (44% and 43%, respectively).

Slight differences are seen among those who say they engage in "almost constant" internet use based on household income. A slightly larger share of teens from households making $30,000 to $74,999 annually report using the internet almost constantly, compared with teens from homes making at least $75,000 (51% and 43%, respectively). Teens who live in households making under $30,000 do not significantly differ from either group.

This survey asked whether U.S. teens use 10 specific online platforms: YouTube, TikTok, Instagram, Snapchat, Facebook, Twitter, Twitch, WhatsApp, Reddit and Tumblr.

YouTube stands out as the most common online platform teens use out of the platforms measured, with 95% saying they ever use this site or app. Majorities also say they use TikTok (67%), Instagram (62%) and Snapchat (59%). Instagram and Snapchat use has grown since asked about in 2014-15, when roughly half of teens said they used Instagram (52%) and about four-in-ten said they used Snapchat (41%).

The share of teens using Facebook has declined sharply in the past decade. Today, 32% of teens report ever using Facebook, down 39 points since 2014-15, when 71% said they ever used the platform. Although today's teens do not use Facebook as extensively as teens in previous years, the platform still enjoys widespread usage among adults, as seen in other recent Center studies.

Other social media platforms have also seen decreases in usage among teens since 2014-15. Some 23% of teens now say they ever use Twitter, compared with 33% in 2014-15. Tumblr has seen a similar decline. While 14% of teens in 2014-15 reported using Tumblr, just 5% of teens today say they use this platform.

The online platforms teens flock to differ slightly based on gender. Teen girls are more likely than teen boys to say they ever use TikTok, Instagram and Snapchat, while boys are more likely to use Twitch and Reddit. Boys also report using YouTube at higher rates than girls, although the vast majority of teens use this platform regardless of gender.

Teens' use of certain online platforms also differs by race and ethnicity. Black and Hispanic teens are more likely than White teens to say they ever use TikTok, Instagram, Twitter or WhatsApp. Black teens also stand out for being more likely to use TikTok compared with Hispanic teens, while Hispanic teens are more likely than their peers to use WhatsApp.

Older teens are more likely than younger teens to say they use each of the online platforms asked about except for YouTube and WhatsApp. Instagram is an especially notable example, with a majority of teens ages 15 to 17 (73%) saying they ever use Instagram, compared with 45% of teens ages 13 to 14 who say the same (a 28-point gap).

Despite Facebook losing its dominance in the social media world with this new cohort of teens, higher shares of those living in lower- and middle-income households gravitate toward Facebook than their peers who live in more affluent households: 44% of teens living in households earning less than $30,000 a year and 39% of teens from households earning $30,000 to less than $75,000 a year say they ever use Facebook, while 27% of those from households earning $75,000 or more a year say the same. Differences in Facebook use by household income were found in previous Center surveys as well (however the differences by household income were more pronounced in the past).

When it comes to the frequency that teens use the top five platforms the survey looked at, YouTube and TikTok stand out as the platforms teens use most frequently. About three-quarters of teens visit YouTube at least daily, including 19% who report using the site or app almost constantly. A majority of teens (58%) visit TikTok daily, while about half say the same for Snapchat (51%) and Instagram (50%).

Looking within teens who use a given platform, TikTok and Snapchat stand out for having larger shares of teenage users who visit these platforms regularly. Fully 86% of teen TikTok or Snapchat users say they are on that platform daily and a quarter of teen users for both of these platforms say they are on the site or app almost constantly. Somewhat smaller shares of teen YouTube users (20%) and teen Instagram users (16%) say they are on those respective platforms almost constantly (about eight-in-ten teen users are on these platforms daily).

Not only is there a smaller share of teenage Facebook users than there was in 2014-15, teens who do use Facebook are also relatively less frequent users of the platform compared with the other platforms covered in this survey. Just 7% of teen Facebook users say they are on the site or app almost constantly (representing 2% of all teens). Still, about six-in-ten teen Facebook users (57%) visit the platform daily.

Across these five platforms, 35% of all U.S. teens say they are on at least one of them almost constantly. While this is not a comprehensive rundown of all teens who use any kind of online platform almost constantly, this 35% of teens represent a group of relatively heavy platform users and they clearly have different views about their use of social media compared with those who say they use at least one of these platforms, though less often than "almost constantly." Those findings are covered in a later section.

Larger shares of Black and Hispanic teens say they are on TikTok, YouTube and Instagram almost constantly than White teens. For example, Black and Hispanic teens are roughly five times more likely than White teens to say they are on Instagram almost constantly.

Hispanic teens are more likely to be frequent users of Snapchat than White or Black teens: 23% of Hispanic teens say they use this social media platform almost constantly, while 12% of White teens and 11% of Black teens say the same. There are no racial and ethnic differences in teens' frequency of Facebook usage.

Overall, Hispanic (47%) and Black teens (45%) are more likely than White teens (26%) to say they use at least one of these five online platforms almost constantly.

As social media use has become a common part of many teens' daily routine, the Center asked U.S. teens how they feel about the amount of time they are spending on social media. A slight majority (55%) say the amount of time they spend of social media is about right, and smaller shares say they spend too much time or too little time on these platforms.

While a majority of teen boys and half of teen girls say they spend about the right amount of time on social media, this sentiment is more common among boys. Teen girls are more likely than their male counterparts to say they spend too much time on social media. In addition, White teens are more likely to see their time using social media as about right compared with Hispanic teens. Black teens do not differ from either group.

This analysis also explored how teens who frequently use these platforms may feel about their time on them and how those feelings may differ from teens who use these sites and apps less frequently. To do this, two groups were constructed. The first group is the 35% of teens who say they use at least one of the five platforms this survey covered - YouTube, TikTok, Instagram, Snapchat or Facebook - almost constantly. The other group consists of teens who say they use these platforms but not as frequently - that is, they use at least one of these five platforms but use them less often than "almost constantly."

When asked how they feel about the time they spend on social media, 53% of teens who almost constantly use at least one of the platforms say they are on social media too much, while about three-in-ten teens (28%) who use at least one of these platforms but less often say the same.

Teens who are almost constantly online - not just on social media - also stand out for saying they spend too much time on social media: 51% say they are on social media too much. By comparison, 26% of teens who are online several times a day say they are on social media too much.

When reflecting on what it would be like to try to quit social media, teens are somewhat divided whether this would be easy or difficult. Some 54% of U.S. teens say it would be very (18%) or somewhat hard (35%) for them to give up social media. Conversely, 46% of teens say it would be at least somewhat easy for them to give up social media, with a fifth saying it would be very easy.

Teenage girls are slightly more likely to say it would be hard to give up social media than teen boys (58% vs. 49%). A similar gap is seen between older and younger teens, with teens 15 to 17 years old being more likely than 13- and 14-year-olds to say it would be at least somewhat hard to give up social media.

A majority of teens who use at least one of the platforms asked about in the survey "almost constantly" say it would be hard to give up social media, with 32% saying it would be very hard. Smaller shares of teens who use at least one of these online platforms but use them less often say the same.

The teens who think they spend too much time on social media also report they would struggle to step back completely from it. Teens who say they spend too much time on social media are 36 percentage points more likely than teens who see their usage as about right to say giving up social media would be hard (78% vs. 42%). In fact, about three-in-ten teens who say they use social media too much (29%) say it would be very hard for them to give up social media. Conversely, a majority of teens who see their social media usage as about right (58%) say that it would be at least somewhat easy for them to give it up.

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Emily A. Vogels, Risa Gelles-Watnick and Navid Massarat

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The landscape of social media is ever-changing, especially among teens who often are on the leading edge of this space. A new survey of American teenagers ages 13 to 17 finds that TikTok has established itself as one of the top online platforms for U.S.

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This is a PDF of the Book

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The British Association Of Art Therapists

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In this video, we hear from a young person who participated in art therapy. She reflects on how art therapy helped her express how having an eating disorder affected life and how it made her feel. She also gives insight into how creating art makes it easier to have open discussions about difficult topics and memories.

Please change your cookie settings to enable embedded content or see this video off-site:

Audio Transcription:

And then everybody else's plates - there's an eye where their food would be, sort of looking at where I'd be. And the knife and the fork have faces and arms and legs, like ready to run away.

Therapist: It seems like it was a very scary place.

Therapist: So, going back, looking in the picture again. So now the possibility of eating, the knives and forks would run away. So, you couldn't eat, and the food was monstrous. I'm just thinking about the eyes of the other three people's food. Can you say a bit about that?

YP: When we used to eat all together, all their plates always have more food on than mine and look different and they'd just look at me. Like I don't know, just sit there. I hated it, being there. I'd rather just be on my own or at least just with mum. But when there's too many people, it was just horrible.

Therapist: How do you think doing that picture helped in the process?

Therapist: How has, I mean as a general thing, how has art therapy been different from talking?

More service users' experiences

Claire reflects on her experience of art therapy, adolescent trauma and emotional dysregulation

At the age of 17, Claire accessed art therapy for approximately nine months.

An adult's perspective on art therapy and eating disorders

In this short film, C shares her experience of group and individual art therapy for adults.

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A young person's perspective on art therapy and eating disorders - The British Association Of Art Therapists

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In this video, we hear from a young person who participated in art therapy. She reflects on how art therapy helped her express how having an eating disorder affected life and how it made her feel. She also gives insight into how creating art makes it easier to have open discussions about difficult topics and memories.

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How many people have an eating disorder in the UK? - Beat

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The studies reviewed to create this estimate calculated prevalence using the diagnostic definitions of DSM-IV. There is still relatively little evidence about the prevalence of eating disorders in the community based on the new DSM-5 diagnostic categories, which no longer include the umbrella of EDNOS, but instead include Binge Eating Disorder as a separate diagnosis, and OSFED (Other Specified Feeding or Eating Disorder) where a patient's symptoms do not exactly match the expected criteria for Anorexia, Bulimia, or Binge Eating Disorder.

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Many people think anorexia only affects girls, but that’s not true. Roughly 25% of people who experience eating disorders like anorexia are male. The truth is that eating disorders can affect anyone of any age, gender, ethnicity or background.

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What To Do If You’re Experiencing Eating Problems

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Whether you have a diagnosed eating disorder like anorexia, bulimia or ARFID, or you have just begun to struggle with food and eating, help is available.

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When those of us in the field say "eating disorders don't discriminate," we're trying to express that eating disorders affect everyone. The intention is to challenge the stereotype of the thin, white woman and recognize a diversity of experiences and identities.

And while it's true that eating disorders affect all social groups, this statement is inadequate. Much like "eating disorders see no color," it lacks nuance and complexity. Taken alone, it doesn't advance meaningful conversation about race-related body, food, and illness experiences.

The conversation about eating disorders in the Black community cannot stop here.

As our field commits to racial diversity and inclusion, we must do more than name as myth the idea that only white women have eating disorders. It is not enough to nod to the few statistics and studies about these disorders in marginalized communities, suggesting representation is inclusivity. Doing so in the context of our white-oriented field implies that the prototypical eating disorder experience is the Black experience as well. It applies our understanding of eating disorders in white women to Black people and other people of color and upholds the dominant white framework.

We must truly see and center eating disorders in communities of color to challenge the systemic inequality perpetuated by and within our field. We must understand how race is tied to experiences of body and food, and how unique cultural forces contribute to the development of eating disorders in Black communities. Only then will our research and care be culturally informed and responsive.

Eating disorders can affect anyone, yes. But eating disorders affect people differently based on race, and understanding and accounting for the unique experiences of people of color is our field's necessary, overdue work.

The History of the Eating Disorder Stereotype

The eating disorder field is rooted in white-dominated medical, psychological, and psychiatric systems. Our knowledge is based largely on the experiences of a small, homogenous population: thin, white, privileged women. It is these women who had access to care when eating disorders were first identified and diagnosed in the late 1800s. It is these stories that were told, albeit from the perspective of the white men who treated them.

Psychiatrist Hilde Bruch advanced the field's knowledge with the 1978 publication of The Golden Cage. The book allowed for illness descriptions from patients themselves, but still the patients were exclusively thin, white women. Media further centered this demographic in the public's mind when singer Karen Carpenter died from anorexia in 1983, and when Princess Diana spoke out about her bulimia in the 1990s. In research, in clinics, and in popular culture, it seemed all who suffered from eating disorders were white women.

Eating Disorders in the Black Community

Though our understanding is based on the experiences of white women, eating disorders and disordered eating do affect people of color at significant rates. The limited research involving Black participants offers the following statistics:

Recurrent binge eating is more common among Black women than among white women (Striegel-Moore, Wilfley, Pike, Dohm, & Fairburn, 2000).

Black girls are 50 percent more likely than white girls to engage in bulimic behavior (Goeree, Ham, & Iorio, 2011).

Though anorexia is less common in Black Americans than in white Americans, Black Americans with anorexia develop the disorder at a younger age and struggle with it for longer periods (Taylor, Caldwell, Baser, Faison, & Jackson, 2007).

It is important to note that even this research is based on frameworks and diagnostic tools developed with white women in mind. Accurate estimation of prevalence is difficult, and it is believed that a large percentage of eating disorders in Black Americans are unreported and untreated.

Cultural Context

We understand eating disorders as complex biopsychosocial disorders impacted by a range of biological, psychological, and sociocultural factors. There is no single cause. Instead, a genetic predisposition or particular temperament, for example, interacts with cultural factors to increase one's susceptibility to developing the illness.

The Thin Ideal

In discussions of cultural causes of eating disorders, we often mention society's obsession with weight. We name the obsession as it's reflected in body and diet commentary, weight-based bullying and bias, and idealized media imagery. Linking eating disorders to the internalization of the thin ideal, we promote positive body image as a protective measure.

While a cultural value of thinness may indeed contribute to body dissatisfaction and eating disorder development, emphasizing body ideals as the only cultural factor has likely impeded the detection of eating disorders in Black populations. As Becky Thompson writes in A Hunger So Wide and So Deep, "The culture-of-thinness model has been used, erroneously, to dismiss eating problems among women of color based on the notion that they are not interested in or affected by a culture that demands thinness" (1994, p. 9). Extrapolating from a cultural appreciation for size diversity, the assumption has been that Black women are immune to eating disorders. Such race-based stereotypes have impacted clinicians' ability to detect the illnesses in African-Americans ( Gordon, Brattole, Wingate, & Joiner, 2006).

Contrary to these stereotypes, research shows that Black women are not protected from cultural standards of thinness and beauty. In studies on body dissatisfaction, Black participants experienced similar ( Pumariega, Gustavson, Gustavson, Motes, & Ayers, 1994) or higher ( Fernandes, Crow, Thures, & Peterson, 2010) rates of dissatisfaction than white participants. The internalization of a thin ideal seems to be more common in Black women who are highly acculturated to white culture. However, we still cannot assume that a drive for thinness is the primary factor underlying eating disorders in Black women.

Racism and Other Contextual Factors

Often focused on the thin ideal and body dissatisfaction, our field largely overlooks the impact of other contextual factors on eating disorders in Black and other people of color. Experiences of racism, acculturative stress, and other race-related trauma influence how people of color exist in their bodies. These experiences negatively impact both physical and psychological health, but little research explores the effect of these stressors on the development of eating disorders specifically. As a means to cope with stress, eating disorders likely function as a response to these significant stressors. Our field must examine the link between eating disorders and racial discrimination, acculturation, and associated feelings of anxiety, lack of control, and lack of safety.

Prioritizing Diverse Voices

Because our field still centers the stereotypical eating disorder experience in research, treatment, and popular culture, marginalized voices are the only experts of their experiences. As we push for inclusivity, we must make space for this expertise and these voices to be heard.

The following list includes books and articles about Black women's lived experiences with eating disorders:
If you are concerned about you, a loved one, or a patient, please reach out to The Emily Program at 1-888-364-5977 or take our online quiz.

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Beyond "Eating Disorders Don't Discriminate" - The Emily Program

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We must consider how race is tied to experiences of food and body, and how contextual factors uniquely impact eating disorders in Black communities.

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There is a sense in which Hadley Freeman's Good Girls has been written by two authors: the anorexic teenager she once was and the recovered 44-year-old journalist with three children she now is (she was, until recently, a staff writer on the Guardian and, for almost a decade, its fashion correspondent). Anorexics tend to be unreliable witnesses when in the grip of the illness and, at times, there is an oddity about this book, a curious sense of separation between the suffering younger self and the aloof older self, but Freeman is a brave, illuminating and meticulous reporter and uses her experience wisely. According to the Royal College of Psychiatrists, hospital admissions for eating disorders have increased by 84% over the past five years, a fact that in itself should make this revelatory book required reading.

Freeman explores the anorexic's warped thinking and brings us as close as is possible to understanding the incomprehensible - the consuming obsession with not consuming. It was a casual comment that ignited her illness. It often is, apparently. A skinny girl said to her: "I wish I was normal like you." "Normal" triggered what would become her abnormal struggle (a "trigger", she points out, is not the same as a "cause"). She grew up in a Jewish-American family - loving, comfortably off - and came to England from New York, aged 11. At home, she believes she absorbed the subtext that "food was the medium through which women express unhappiness". She debunks the oversimplification that anorexia is caused by the fashion industry's insistence on skeletal models, but emphasises that "the association between female self-denial and perfect femininity is entrenched in our culture. This doesn't cause anorexia, but it gives it a fertile ground in which to breed." She investigates new theories about the illness, including its possible connections with autism, OCD and metabolic rate. The book is garnished with expert opinion from doctors, psychiatrists and co-anorexics encountered in hospital, with whom she has been back in touch. Her tendency is to challenge reflex opinion and never to make the mistake of claiming to know more than is known. For whatever you thought you knew, the truth about anorexia is always more complicated. One of her most unnerving assertions is that anorexia is "not a desire to be thin - it is a desire to look ill".

She watched a patient throw a tantrum, having been given more butter on her bread than the other anorexics on the ward

Freeman maintains that the "wan" and "wasted" look kicked off in the 1990s. Yet I was at school in the 70s and waifs were already chic. There existed an ideal image of girl-as-vanishing-act, wrapped in clothes as afterthoughts, thin enough to be beyond fashion, yet paradoxically to be embodying - disembodying - it. Anorexia appeared to be about perfectionism, about a control that would ultimately lead to a lack of it, to mortal helplessness. Anorexia was a form of overachievement requiring the sacrificial zeal of a nun. I used to feel a repelled awe for anorexic girls at school: how did they manage to stay gossamer thin, how did they sustain the superhuman willpower involved in starvation? This rivalry to be the thinnest between young women is one of the more depressing aspects of the illness and Freeman illuminatingly explores the issues of control, sacrifice and competition. But what her book most brutally brings home is the way that anorexia insidiously slides into mental illness. Inevitably, a handful of girls from my school ended up in hospital. In her generation, Freeman was one of those - she spent the years between 14 and 17 on psychiatric wards.

The chapters about her time in hospital are not for the faint-hearted. The ongoing competition between anorexics was toxic: "Do you know what makes you cool on an eating disorders ward? I'll let you in on that secret - it's if you've been fed intravenously." Some of the anorexics Freeman knew did not survive. But it was the extremity of hospital experience that led to her own turning point. She was watching a 32-year-old patient throw a tantrum, having been given more butter on her bread than the other anorexics on the ward, and realised she did not want to grow up to become that woman: "Look at them crying over mashed potatoes, hiding bags of vomit under their beds, sneaking in star jumps in the shower. Look at them, because unless you finally do something, this will be you." Freeman was saved, too, because she had been allowed to continue with her schoolwork and had done well in her exams. And once she - remarkably - had got into Oxford, although her eating there continued to be clandestine and disordered, she was happier.

Freeman lists the "impossible standards" set for women. We are told: "Look perfect, but don't be vain; don't age but don't get plastic surgery; be slim but don't be obsessed with diets; be smart but not smarter than the men around you; be pleasing, and have no needs of your own." And she makes a powerful case for a link between the wave of 13- and 14-year-old girls who want to become boys and those who become anorexic. At the same time, she is mindful not to confuse the two, acknowledging that gender dysphoria, unlike anorexia, is not a mental illness, but she is persuasive about the shared longing for transformation and the reasons why becoming a woman might seem uninviting.

Freeman is keenly aware, too, of the suffering faced by the families of anorexics, saying she has yet to meet a mother who does not blame herself for her daughter's illness. She writes lovingly about her mother and tends to advise the mothers of anorexics: "Get professional help as soon as you can and don't become her caregiver." Her book ends with an emotional rallying cry - to give girls an easier time of it. And she implies that, at the heart of the anorexic story, there is a delusion that is dangerous because it can be true in the wrong way: "If we change our bodies, we change ourselves."

Good Girls: A Story and Study of Anorexia by Hadley Freeman is published by Fourth Estate (£16.99). To support the Guardian order your copy at guardianbookshop.com. Delivery charges may apply

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Good Girls: A Story and Study of Anorexia by Hadley Freeman - review

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This searing memoir from a recovered anorexic, which explores the warped thinking around the illness, should be required reading

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Quotes Daring Classrooms Be Here. Be You. Belong. No Vulnerability No Learning She Has her own Website! Check it out! Building Brave Spaces for Students Dare to Lead Brené Brown Monica Lagares-Tovar EDUC 2110 Brené Brown is a researcher, and storyteller. she has spent the past two

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Brene Brown had an amazing discovery: The people who have love and belonging believe they are worthy of love and belonging. These people, dubbed the "wholehearted" were able to overcome the shame issues that limit people's lives. This post is based on Brown's video The Power of Vulnerability and in her book The Gifts of Imperfection.

The wholehearted have a set of common traits shown in the infographic below.

Vulnerability

The definition of the word vulnerable is "susceptible to physical or emotional attack or harm". How can this be a good thing?

At her TED Talk Listening to Shame, Brown surveys the audience to show that people see vulnerability as pure courage - as long as it's someone else!

Browns research shows that practicing vulnerability is essential for building the social connections required for living a life of joy and belonging. We have to risk being hurt in order to build strong connections with people. Yes, you do have to talk about that difficult issue if you want a strong relationship. Yes, you do have to ask that person out and risk rejection to make progress.

Many organizations are concerned about how to bring creativity and innovation to the workplace. Brown argues that vulnerability is the birthplace of creativity, innovation and change. How people inter-relate and function as a social network is at the core of this.

The following three elements are all necessary aspects of vulnerability: Courage, Compassion, Authenticity.

Courage

Courage is not about heroics and it's not about a character trait. It is about regular practice in daily life. Each day we have many opportunities to practice our courage: to do the right thing, to be vulnerable, to be authentic. It can be as simple as telling someone that you don't want a meeting that you don't think is valuable - even though you know it may lead to conflict. It may be in some areas of your life you are very courageous while others could use work.

We are imperfect. We all want to be seen as good, fair, reasonable. And yet the reality is that we are human, not perfect, and we make mistakes. We forget. We ignore our inside voices telling us what is right. The wholehearted not only recognize their imperfections, but see them as part of who they are and embrace them lovingly.

Compassion

Compassion is a deep form of empathy where we co-suffer with the other person. Pema Chödrön writes "When we practice generating compassion, we can expect to experience the fear of our pain. Compassion practice is daring. It involves learning to relax and allow ourselves to move gently towards what scares us." Wholehearted living requires that we be compassionate to ourselves as well as others.

I have noticed over the last few days as I have written about empathy and shame, I have room for improvement in practicing compassion towards myself. After a troubling event, I immediately went into the trap of "looking on the bright side". When I noticed this, I slowed down and gave myself the grace to experience a flood of emotions around the issue. To allow myself to be heard and acknowledged. It was difficult in the moment but allowed me to discharge the feelings so they did not impact the rest of my day.

A critical piece of this is kindness to ourselves. Brown states: " We can only be kind to others to the extent that we can be kind to ourselves. " I have kids and this struck me through my soul like a sharp burning knife. At the time I was aware I had low levels of self-kindness, so the implication that I could not be fully kind to my children really hurt. This truth, has led to a year+ long quest for self-kindness. (But that's another post).

Authenticity

Authenticity is about being true to who we really are 24 hours a day. It means that we know who we are (imperfections and all) and let ourselves be seen that way. It means that we say and do what our true identity requires. And yes, this means taking on risk. But that is what we need to do to fully reclaim our lives.

I would like to add Brown's Caution: "If you trade in your authenticity for safety, you may experience the following: anxiety, depression, eating disorders, addiction, rage, blame, resentment and inexplicable grief."

Closing

The good news is that there is a path forward for fully living our lives. The bad news is that there is a world of difference between knowing what you need to do and knowing how to do it. There are some guideposts (starting places) for learning how to make changes in your life in The Gifts of Imperfection. If you are interested in making changes in your life, it is best to start with Brown's first book I Thought it was Just me since this is much more helpful in understanding what challenges you are up against.

I would like to close with the following quote from Brene Brown: "Yes, I am imperfect and vulnerable and sometimes afraid, but that doesn't change the truth that I am also brave and worthy of love and belonging". (p.1)

Acknowledgements

I thank Brene Brown for her excellent job modeling the power of vulnerability and for helping me in my life. I would also like thank everyone who participated in the "Gifts of Imperfection" meetup group for a safe space to practice vulnerability.

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Brene Brown had an amazing discovery: The people who have love and belonging believe they are worthy of love and belonging.

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STATS

•Around 1% of the population might identify as trans, including people who identify as non-binary. That would mean there are about 600,000 trans and non-binary people in Britain, out of a population of over 60 million

•In the previous year, one-third of transgender people reported a negative healthcare experience, such as verbal harassment, refusal of treatment or the need to teach their doctors about transgender care

•Twenty-nine percent of trans respondents felt that their gender identity was not validated as genuine, instead being treated as a symptom of mental ill health

•Some 40% of trans people have attempted suicide, almost nine times the rate for the general population

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Gender Diversity training slides June 2023

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Gender diversity reading and resources 2023 (1)

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https://www.bbc.co.uk/programmes/b09202jz

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BBC Two - No More Boys and Girls: Can Our Kids Go Gender Free?

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Is the way we treat boys and girls the real reason we haven't achieved gender equality?

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Unlocking the Adolescent Mind: Insights from Dr. Siegel

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https://www.youtube.com/watch?v=BJfmfkDQb14

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What is trauma? The author of “The Body Keeps the Score” explains | Bessel van der Kolk | Big Think

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https://www.youtube.com/watch?v=QSCXyYuT2rE

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Treasure Box of Trauma Informed Organisations

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Treasure Box of Trauma Informed Organisations

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https://library.jkp.com/viewer/?id=007011269

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https://www.oxfordshire.gov.uk/sites/default/files/file/children-and-families/PACEforteachers.pdf

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What-We-Say-Comic - trauma informed language

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According to the ELS website the following design principles serve as a moral and cultural foundation for each Expeditionary Learning School.

The Primacy of Self-Discovery states that learning happens best with emotion, challenge and the requisite support. People discover their abilities, values, passions, and responsibilities in situations that offer adventure and the unexpected. The primary task of the teacher is to help students overcome their fears and discover they can do more than they thought they could.

The Having of Wonderful Ideas places emphasis on fostering curiosity about the world by creating learning situations that provide something important to think about, time to experiment, and time to make sense of what is observed.

The Responsibility for Learning argues that learning is both a personal process of discovery and a social activity. Therefore, every aspect of an Expeditionary Learning school encourages both children and adults to become increasingly responsible for directing their own personal and collective learning.

Empathy and Caring believes that learning is fostered best in communities where students' and teachers' ideas are respected and where there is mutual trust. Older students often mentor younger ones, and students feel physically and emotionally safe.

Success and Failure states the fact that all students need to be successful if they are to build the confidence and capacity to take risks and meet increasingly difficult challenges. But it is also important for students to learn from their failures, to persevere when things are hard, and to learn to turn disabilities into opportunities.

Collaboration and Competition positions Expeditionary Learning schools as integrating individual development and group development, so that the value of friendship, trust, and group action is clear. Students are encouraged to compete not against each other, but with their own personal best and with rigorous standards of excellence.

Diversity and Inclusion believes that both diversity and inclusion increase the richness of ideas, creative power, problem-solving ability, and respect for others. Schools and learning groups are heterogeneous.

The Natural World helps create a direct and respectful relationship with the natural world, which refreshes the human spirit and teaches the important ideas of recurring cycles and cause and effect. Students learn to become stewards of the earth and of future generations.

Solitude and Reflection argues that students and teachers need time alone to explore their own thoughts, make their own connections, and create their own ideas. They also need time to exchange their reflections with other students and with adults.

Service and Compassion places emphasis on strengthening students and teachers through acts of consequential service to others. One of an Expeditionary Learning school's primary functions is to prepare students with the attitudes and skills to learn from and be of service

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https://xptrust.org/our-vision/

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To do this best, we believe that schools should be tightly integrated into the community, and be focused on creating academically rigorous, authentic experiences that bring our children closer to this goal.

In the USA, High Tech High and Expeditionary Learning schools have been practicing this for over two decades to astounding success. Their children are articulate and confident, and possess not only deep subject knowledge, but the wider skills and competencies needed to be successful in the 21st century.

Design Principles

Our school is based on the following Design Principles:
Personalisation

we express who we are through our work

we forge our own pathways to career, University and life readiness

we have ownership of our own progress and learning

Connect with the world

we learn naturally across subjects from enquiry through to presentation to authentic audiences

we create meaningful relationships beyond the classroom

we engage in relevant work that matters

A common mission

we form genuine communities with shared goals

we have collaborative accountability

we take real risks to achieve more

we are 'crew' not passengers

Teachers are learners

we learn through the design process

we have ownership of the curriculum

we are accountable to our stakeholders

Language is our culture

we actively refer to our character values each day, using them as a framework for our conduct, they are not just words on walls.

we realise our values through our Habits of Work and Learning

we use sign language and common phrases when appropriate to express our thoughts, feelings and sense of community

These design principles act as a guide and big picture for our teaching and learning practices, and are adapted from HTH, which in turn came from the New Urban High School Project, facilitated by Big Picture Learning

What does this look like in reality?

We use the EL Education Core Practices to guide our own practice and have adapted this to our UK context.

Our prospectus for XP presents our schools in terms of key messages for prospective parents.

How do we embed our strategic vision through our schools?

Our strategic vision is secured through our Trust members being custodians of our Design Principles. Our Board of Directors support and challenge our school by monitoring and reviewing Key Performance Indicators that emerge from our Design Principles. These KPIs are reported on through our Local Governing Committees forming working groups made up of stakeholders, including students when appropriate.

This distributed leadership enables all our stakeholders to use their voice to support and challenge the development of our schools.

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Preparing our children to be successful in the modern world. To do this best, we believe that schools should be tightly integrated into the community, and be focused on creating academically rigorous, authentic experiences that bring our children closer to this goal. In the USA, High Tech High and Expeditionary Learning schools have been practicing [...]

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'It's hard to feel safe, so I have to watch for danger and stay in control'

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'I worry that you will forget me so I have to keep you involved' 