Part IV emphasises the significance of psychological and nutritional characteristics of orthorexia nervosa to gain better insight into the construct of orthorexia nervosa. It focuses on the relationship of orthorexia nervosa with self-esteem, personality traits, eating behaviours (disordered eating behaviours, food addiction, mindful eating), health-related beliefs and behaviours (physical activity), body image, emotion regulation and dietary patterns. It also presents a potential social risk factor of orthorexia nervosa - social media use. A summation of the highlights is included at the end of this chapter. The commentary of the invited international expert (Professor Marle Alvarenga, University of Sao Paulo) provides valuable insights on orthorexia nervosa.

Families have the potential for causing harm and can play a part in the onset of mental health problems. Women’s behaviour is judged by a different set of standards to that of men. Parents still socialise girls differently from boys. The pressures of family life chip away at our confidence and self-esteem and powerfully influencing our ability to make successful adult relationships. Girls and women may be told that they are ‘hysterical’ or ‘out of their mind’ when their emotional response is quite justified by what is happening to them. However, life pressures can also trigger mental illness, and family stress such as living in poverty and with domestic violence can make this worse. Girls and young women experience much more sexual abuse during childhood than boys – the sheer extent of which was not acknowledged in the past. Improving material and psychological support to families is a mammoth task, but what is within our power, among our own friends, families and communities, is to do something when we suspect that young women are experiencing trauma and abuse – believing, helping and supporting them to find someone to share their stories with who is trustworthy and skilled.

Half of all mental health problems start by the age of 15 and the teenage and young adult years are particularly difficult for girls with high and increasing rates of anxiety, depression and self-harm. Many different factors contribute, including social media, peer pressures, focus on appearance, friends, relationships, schoolwork and, as Everyone’s Invited has recently highlighted, personal safety. There is tremendous pressure to conform with the expectations of others. Attitudes to women and girls seem to have gone into reverse during the author’s lifetime. It is too simplistic to view the problems of young women as a simply a ‘lack of self-esteem’. The difficulties they face in society are consistently underestimated and not taken seriously. Fast access to therapy is crucial. Bullying must be addressed effectively. Sexist and mysogynistic attitudes in school must be challenged and, given the easy access now to pornography, the issues of consent should addressed head on by both parents and schools. Using the example of Everyone’s Invited, women and girls need to reach out and support each other. The personal is still political.

This chapter reviews the role of evidence-based practice (EBP) when providing clinical services to LGBTQ+ youth and adults. Evidence-based practice integrates three domains: the best available research evidence, clinical judgment, and patient characteristics, values, and contexts. Each of these domains is discussed in detail in the chapter. The chapter proceeds to review the adaptation of EBPs to be LGBTQ+ affirmative and cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based cognitive therapy as effective evidence-based interventions for mental and behavioral health concerns with LGBTQ+ individuals. Additionally, the chapter provides evidence-informed considerations for addressing self-acceptance, self-esteem, and career-related concerns in counseling for LGBTQ+ individuals. Evidence for group modalities with LGBTQ+ individuals is also provided. Lastly, the chapter provides a resource table outlining how to best integrate affirmative care and EBP when working with LGBTQ+ individuals, along with a clinical case study.

Antisocial personality disorder (ASPD) and violence result from a loss of mentalizing. Mentalization-based treatment for antisocial personality disorder (MBT-ASPD) is delivered primarily as a group intervention. Individuals with ASPD are more likely to learn from those whom they consider to be similar to themselves, so the task of the MBT clinician is to generate constructive group interactions during which learning can take place. Common mentalizing profiles of people with ASPD are outlined and examples of the formulation that can be used are given. The chapter discusses how to engage patients in treatment using the formulation, and it provides examples of how to prevent dropout by creating an atmosphere of equality within the group. A range of clinical problems that are commonly encountered when running groups for people with ASPD are outlined, and suggestions on how to intervene in these scenarios are given.

Sociocultural theories of body image propose that different societies have different conceptions of the ideal body shape. Within contemporary Westernized cultures, advertisements, the Internet, and social media networks promote particular assumptions about what constitutes the ‘ideal’ body, and thus exert a strong social pressure to achieve such a body shape. Individuals go to great lengths to achieve and maintain a body image that corresponds to these archetypes of ‘beauty’, which are reinforced as having a superior social value. Such social ideals of beauty are often entirely unrealistic, and can result in body dissatisfaction, appearance anxiety, body image disorder, low self-esteem, and depressive symptoms. Attempts to attain the ideal body can lead to excessive behaviours, such as compulsive exercising, the use of image- and performance-enhancing drugs (IPEDs), and eating disorders. This chapter focuses on excessive exercising and the use of IPEDs, and how these behaviours relate to distress about body image.

This chapter provides a thoughtful insight into the sometimes cruel world of elite sports, as seen through the eyes of Oluyinka Idowu, a former British Olympic athlete and Commonwealth Games silver medallist. As a medical doctor, parent, and educator, Dr Idowu reflects on her own experiences of how the perceptions and behaviours of others can have a profound effect on our body image and self-esteem, leading to long-lasting and significant psychological and mental health problems. Her account depicts a reality that many of us experience in everyday life, although we often do not appreciate its impact. Dr Idowu uses the world of athletics to describe how certain words and expressions can shape our thinking about our inner self. This positive personal story is intended to help the reader to recognize the power that they have over the inner critical self which has been created by their environment.

Chapter 12 considers why Homo sapiens needs a new name.

In this chapter we examine the historical background to poverty research, the definition and concepts of poverty, and how is it experienced by individuals, families, and communities. The focus is mainly on the UK and on qualitative studies. Poverty is a cause of human suffering and the experiences of people living in poverty are mediated by social divisions such as gender, ethnicity, and disability. It can be understood in terms of the need of material resources, but also in terms of its psychosocial effects. It has clear effects on mental and physical health. Many aspects of the lives of people in poverty parallel the position of people with mental health conditions: lack of agency, opportunity, and voice; living compromised lives with stigma and discrimination; and struggling with day-to-day functioning, employment, and housing. Poverty impacts negatively on self-esteem and produces feelings of shame and guilt in response to inadequate material and social situations. It is possible that some of the mechanisms for understanding mental ill-health may also be shared with those related to poverty.