‘I can’t fight anorexia any more. I’ve tried so hard’

Pip McManus died three years after becoming ill with an eating disorder. Her parents explain how medical care failed their daughter

Marie McManus wants to show me the final photograph taken of her daughter Pip. It was 9 December 2015, and the 15-year-old is standing on the platform of a railway station five minutes’ walk from the family home. In the CCTV image, Pip is wearing a red hoodie and looking up the track to see if her train is coming. But she’s not going to get on it.

Related: Mother of anorexic girl killed by train criticises care failings after inquest

I thought, they’ll put a drip in, they’ll give her fluids. They’ll make her better

Related: Mental health services turn away 23% of under-18s referred to them

Related: Anorexia: you don’t just grow out of it | Carrie Arnold

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Female mannequins aren’t just skinny, they’re emaciated

A new study has found that female mannequins, but not male ones, represent extremely underweight women

There have have been several observations in the press and on social media in the past few years that some of the mannequins used to sell women’s fashion represent unrealistic and unhealthy body sizes. But until we started to look into it, the issue had not been researched properly, and the evidence was mostly anecdotal.

Back in 1992, researchers surveyed a handful of mannequins from the 1930s-1960s housed in museums. They concluded that real women of a similar body size would be so thin that they would be unable to menstruate. More than 80 years on, and with women in a very different societal position than previously, you might expect things to have changed.

Is it even humanly possible to be as skinny as this Topshop mannequin? pic.twitter.com/fDJSO88v2L

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Fashion models in France need doctor’s note before taking to catwalk

New law to counter promotion of unhealthily thin bodies will require media to state when photos have been manipulated

Fashion models in France will need to provide medical certificates proving they are healthy in order to work, after a new law was introduced banning those considered to be excessively thin.

Related: Fashion industry told to end its quest for ‘unattainable thinness’

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Mother of anorexic girl killed by train criticises care failings after inquest

Marie McManus, whose daughter Pip took her own life, according to a jury verdict, says shortfalls were ‘from beginning to end’

The mother of a severely anorexic 15-year-old girl who died after stepping in front of a train has said that failings in her daughter’s care “from beginning to end” resulted in her death.

Pippa “Pip” McManus was granted home leave from the Priory hospital in Altrincham, Greater Manchester, ahead of completion of the formal discharge process, in December 2015.

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It’s a deadly fallacy that eating disorders are a teenage illness

Most patients with an eating disorder are adults. The lack of specialist services could prove fatal

Sophie* developed an eating disorder when she was 11 years old. With the help of child eating disorder services, she got better and by the age of 16 had achieved a stable weight. But her A-levels proved tough and she relapsed. This time, she had to face the challenge of navigating adult eating disorder services as a vulnerable teenager. When she was finally referred to me nearly eight months after her relapse, she was 19 years old with a BMI of nine.

I worked as a consultant psychiatrist in child eating disorders before moving to adult services in Oxford. When the government announced in the Five Year Forward View a £30m investment for eating disorders in child and adolescent mental health services (Camhs) each year until 2021, I was delighted. We know early intervention offers the best chance of recovery and it’s great to see that 66 new specialist services have been set up across the country.

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Young people and mental health: ‘Since diagnosis, I have taken massive strides’

As part of the MQ Speak your Mind series, younger readers who have experienced mental health problems share their stories in the hope they will raise awareness and change attitudes

Holly, 22, Sydney, Australia
I have suffered from depression and suicidal ideation since I was about 12. If my parents did not have private healthcare, I would probably be dead.

Vulnerable young people shouldn’t have to wait for months to see a psychiatrist, or to compensate for the lack of communication between specialists. Help-seeking behaviour should be supported and encouraged.

Related: Experiences of eating disorders: ‘I’ve been to many dark places’

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Experiences of eating disorders: ‘I’ve been to many dark places’

As part of MQ’s Speak your Mind campaign, readers describe the issues they’ve faced brought on by eating disorders, their therapy and recovery as well as the strains NHS cuts are placing on services in this field

Anonymous, 22
The first time I was depressed, I was 12 and I didn’t know I was ill. I didn’t even know what depression was. After a family feud and several years of being a victim of bullying, I didn’t want to live any more. I remember standing on my balcony, hands on the railing, and thinking: “Should I jump?” I thought that I was a coward, because I was afraid of dying more than I hated living. I began to self-harm, and my mental illness had the sting of a pair of scissors cutting into my skin.

I was 16 when I decided to lose weight, so the boys and the girls wouldn’t laugh any more, and perhaps, just perhaps, someone, one day, would even desire to touch me. Three years later, I was sitting on the toilet bleeding because I had taken too many laxatives, and my mental illness was as red as blood.

Related: How mental health problems affect relationships: ‘They’re scared that this time you might die’

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Stimulating the brain with electricity may reduce bulimia symptoms

Key symptoms of bulimia nervosa, including the urge to binge eat and restrict food intake, are reduced by delivering electricity to parts of the brain using non-invasive brain stimulation, according to new research by King’s College London.

Bulimia is an eating disorder characterised by a vicious cycle of repeated bouts of distressing binge eating and inappropriate attempts to compensate for overeating through vomiting, extreme dieting, or the misuse of different medicines. These symptoms are typically driven by an intense preoccupation with body weight, shape or appearance. Over time these features become compulsive and resemble those of an addiction.

Bulimia typically emerges in adolescence and is much more likely to develop in women. It is thought that 1-2 per cent of women have bulimia at some stage in their life. The disorder is associated with multiple medical complications and up to 4 per cent of people with bulimia die prematurely from the disorder.

Whilst existing treatments such as cognitive behavioural therapy (CBT) are effective for many people with bulimia, a substantial proportion do not get better with talking therapies. There is a pressing need for new techniques and researchers are increasingly looking towards neuroscience-based technologies that could target the underlying neural basis of eating disorders, such as problems with reward processing or self-control.

Previous studies published by the Eating Disorders Research Group at King’s found that repetitive transcranial magnetic stimulation (rTMS), already an approved treatment for depression in the US, was effective in reducing food craving in people with bulimia.

This new study, published today in PLOS ONE, examined the use of transcranial direct current stimulation (tDCS), a less expensive and more portable form of brain stimulation. tDCS uses electrodes placed on the head to stimulate specific parts of the brain, which could improve cognitive function in areas related to reward processing and self-control. The treatment is painless and the most common side effect is a slight itching or tingling on the scalp.

In the study, 39 people received real tDCS and placebo tDCS, with a period of at least 48 hours between both sessions. The researchers used questionnaires before and after each session to measure their urge to binge eat and a range of other bulimia symptoms, including concerns about weight and shape, restriction of food intake, levels of self-control and self-esteem.

They found that these bulimia symptoms were significantly reduced by the tDCS treatment but not the placebo session. For example, baseline scores on the urge to binge eat scale decreased by 31 per cent following tDCS.

The researchers also used a decision-making task where participants had to choose between a smaller amount of money available immediately and a larger amount available in three months.

They found that people showed a greater tendency to delay gratification following the tDCS session compared to the placebo session. This means they showed more prudent decision-making by waiting for larger, later rewards, rather than choosing the smaller, sooner option.

Maria Kekic, first author of the study, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, said: ‘Our study suggests that a non-invasive brain stimulation technique suppresses the urge to binge eat and reduces the severity of other common symptoms in people with bulimia nervosa, at least temporarily. We think it does this by improving cognitive control over compulsive features of the disorder.

‘Although these are modest, early findings, there is a clear improvement in symptoms and decision-making abilities following just one session of tDCS. With a larger sample and multiple sessions of treatment over a longer period of time, it is likely that the effects would be even stronger. This is something we’re now looking to explore in future studies.’

Professor Ulrike Schmidt, senior author of the study, from the IoPPN at King’s College London, said: ‘The advantage of tDCS is that it’s much less expensive and more portable than other brain stimulation techniques, which raises the prospect of one day offering treatment that could be self-delivered at home by patients with bulimia. This could either be as an addition to talking therapies such as CBT to improve outcomes, or as a stand-alone alternative approach.’