Hope Virgo knew something was wrong. She also knew that if she didn’t get help, her condition would worsen. But when she went to the doctor to ask for help, she says she was refused treatment.

“I developed anorexia when I was about 12 years old,” says Virgo. “I really struggled with my emotions and I was sexually abused when I was 12 and I was left with all this guilt and shame around it and didn’t know what to do about it.”

After her heart almost stopped due to malnutrition and low potassium levels, she spent a year in a mental health hospital learning about food, exercise, and how to talk about her emotions. But, when she was 26, Virgo relapsed. “I got all those voices back in my head, the anorexia telling me that I should be exercising all the time,” she says. Virgo went to her doctor to ask for sessions of talking therapy to help get “back on track” with her eating. But, when she talked to her GP and local mental health authority, she was weighed and told that because her body mass index (BMI) wasn’t considered “low enough,” and she was refused all treatment, including therapy. Per the NHS, BMI is “a measure that uses your height and weight to work out if your weight is healthy.” The NHS considers an “ideal BMI” for most adults to be within a range of 18.5 to 24.9.

“The really frustrating thing was that I knew that something was the matter, and I knew there’d be a point that I’d completely lose that control and I’d have to do something to get back on top of it,” she says. “I just didn’t know how I was ever going to get back on track with my eating again.”

SEE ALSO: Doctor no: The women in their 20s being refused sterilisations

“What followed was this four-week period where I felt like this really fake anorexic person who was not good at having an eating disorder,” says Virgo. “I felt really unhappy all the time, I cried pretty much all the time when I wasn’t at work, and I came very close to ending my life on a number of occasions.” Eventually, Virgo — who’s now 28 — went to her GP and was prescribed antidepressants with the hope that it would stop her suicidal thoughts. 

For patients experiencing anorexia, hearing they’re not thin enough can be an additional blow, which can make them feel invalidated, and can lead to further weight loss. 

“I felt like this really fake anorexic person who was not good at having an eating disorder.”

Virgo later discovered she was not alone in her experience — many other people with eating disorders had also been denied medical care because their BMI was not low enough. So, she decided to do something about it. Virgo launched the #DumpTheScales campaign in an effort to lobby the government and health authorities to ensure that no one with an eating disorder is refused treatment because of their BMI or weight. 

Anorexia nervosa is defined by the NHS as both an “eating disorder and a serious mental health condition”. Physically, the condition can “lead to severe health problems” due to malnutrition, including, in severe cases, an irregular heartbeat, heart failure, kidney problems, fertility issues, and neurological issues including seizures. It is common for recovered anorexia patients to relapse — particularly within the first 18 months after treatment. 

The guidelines NHS doctors are encouraged to follow — created by the National Institute for Health and Care Excellence (NICE) — stipulate that “single measures such as BMI” or weight should not be used as for the sole criteria for deciding whether to offer treatment for an eating disorder. Some scientists have criticised BMI as it can be an inaccurate and misleading measurement, which can mistakenly identify athletes and muscular people as overweight. 

But, despite the guidelines in place, a leading eating disorder helpline says it “often” receives calls from people who’ve been refused care because of their weight. “Through our Helpline Beat often speaks to people who were not referred for treatment because were told their weight ‘wasn’t low enough,’ which only deals another blow to their self-esteem and makes the situation worse,” says Rebecca Willgress, head of communications at Beat, a charity supporting people with eating disorders. “You certainly do not have to be underweight to have an eating disorder and just because someone does not fall under a certain BMI measurement does not mean they do not need help,” Willgress adds. “Equally, reaching a particular BMI level is not necessarily evidence of recovery and should not be the only reason for taking patients out of care.”

Mashable spoke to two people with eating disorders who say they were refused various types of treatment because of their BMI. Amy, who prefers to use just her first name, has had an eating disorder since she was about 12 years old. She sought treatment when she was 19 and after several suicide attempts, she was hospitalised and spent nine weeks on a secure mental health ward. Amy was discharged, but one year later she relapsed. Her GP referred her to her local eating disorder service, but during an assessment appointment she was told she wouldn’t be offered outpatient care because her BMI wasn’t low enough. Amy has a sporting background and says she had a higher weight due to muscle, which made her BMI higher — an issue that has been flagged by scientists. 

Amy says she wasn’t seeking hospitalisation, she wanted regular outpatient appointments to get help and advice for her eating and purging “I felt really embarrassed when they refused because it was like my illness wasn’t real and I didn’t deserve help,” says Amy. 

“I felt abandoned, like I was failing at anorexia — the one thing I was meant to be good at.”

“I felt abandoned, like I was failing at anorexia — the one thing I was meant to be good at — and like I was just really fat,” adds Amy. “I remember my parents asking me how the appointment went and my reply was that ‘I’m not thin enough yet.’” Later that year, she was re-referred by her GP, but by this point Amy says her weight and symptoms were severe, and she was offered treatment at a residential eating disorder clinic, where she spent 15 months. 

Amy says her weight continued to drop thereafter until the point where she was at risk of heart failure. “I was told by the outpatient team that, despite my BMI being about 13.8, my weight would still not normally be low enough yet for them to push for inpatient treatment.” She’s now at home, receiving private therapy and being monitored by her GP. 

Adam Fare was 12 when he developed an eating disorder and sought help when he was 17 years old. He says he was refused hospitalisation, therapy, and nutritional guidance. He was, however, offered cognitive behavioural therapy (CBT) by the NHS — but he says he didn’t find this therapy helpful. “I was refused treatment because my BMI was not low enough, because my bloods did not show anything serious,” says Fare. 

“I feel I was never trusted until I had to make myself ‘unwell’ enough for treatment.”

Fare says he became very physically unwell and experienced complications like a low heart rate, and kidney and heart failure. “When I turned up to A&E with a BMI of 14.5, and my parents and me begging them [doctors] to admit me, they were going to give me an ‘urgent’ appointment until they realised my heart and kidneys were failing.”

Fare says his experience has made him feel “lost” and he no longer trusts doctors or mental health professionals. “It has severely impacted my life and I feel I was never trusted until I had to make myself ‘unwell’ enough for treatment,” says Fare. “It angers me that it takes something this severe to get help for what is a mental health illness, it should not have to become a critical physical health illness before treatment is offered.”

A Department of Health and Social Care spokesperson said in a statement that decisions about treatment should be “based on best evidence and national guidance” and that they want “mental illness to be treated the same as physical illness”. The Department also acknowledged they’re aware of the issue of weight being used as a criterion for deciding treatment. In 2017, NHS England’s Children and Young People Community Eating Disorders Programme administered training to all teams emphasising the importance of not using BMI or weight as the sole deciding factor for treatment. Professor Gillian Leng, deputy chief executive at NICE, told Mashable clinical guidelines do “not advocate the use of single measures” like BMI or duration of illness.  

Through the #DumpTheScales campaign, Virgo wants to get across the message that “you don’t have to be stick-thin to have an eating disorder.” “You can be any size, any shape, and still mentally not be in a good place,” says Virgo. She is calling on the government to review the eating disorder guidance given to doctors and medical professionals. She now has cross-party support and has been working with MPs in parliament, including Wera Hobhouse MP, to work on drafting a piece of legislation. 

Virgo also wants better training for junior doctors. “I do a huge amount of work with junior doctors at the moment running workshops for them, all of them are so keen to know what they can do to prevent people with eating disorders ending up in hospital.”

When she first launched her Change.org petition, Virgo didn’t expect it to pick up much steam. “If I’m honest, I didn’t think it would do as well. I thought it would get 100 signatures, and just fizzle into nothing,” says Virgo. But within a few weeks of launching, it had gained 30K signatures and it’s now on 68K. 

“At the moment, there’s this whole misunderstanding across the whole of society that to have an eating disorder, you have to be really skinny,” say Virgo. “The way it’s currently being run through services, it’s just fuelling that whole misunderstanding about it.”

If you’re living with an eating disorder and want to speak to someone, call the Beat Adult Helpline (UK) on 0808 801 0677. If you’re under 18, call Beat’s Youthline on 0808 801 0711. 

If you want to talk to someone or are experiencing suicidal thoughts, call Samaritans (UK and ROI) on 116 123. If you’re based in the U.S., text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. For international resources, this list is a good place to start. 

If you have experienced sexual abuse, call Rape Crisis (UK) 0808 802 9999 (12-2:30 and 7-9:30). If you’re in the U.S., call the free, confidential National Sexual Assault hotline at 1-800-656-HOPE (4673), or access the 24-7 help online by visiting online.rainn.org. 

A big upgrade for decentralized app platform Ethereum has gone as planned on Thursday. 

After a failed try in January, which was postponed just one day before the scheduled upgrade date due to a security issue, Ethereum has now been upgraded to a new version called Constantinople. Another, smaller upgrade called St. Petersburg, was rolled out as well to mitigate the security issue found in the original Constantinople code. 

SEE ALSO: Ethereum upgrade delayed over security vulnerability

Constantinople brings a number of improvements to Ethereum’s efficiency and speed (read a detailed overview here). But, most importantly, it paves the way for a major future upgrade called Casper. That upgrade, sometimes also called Ethereum 2.0, is scheduled to go live later this year and bring an immensely important switch from proof-of-work to proof-of-stake consensus mechanism, among other changes. 

St. Petersburg, which went live immediately after Constantinople, essentially undoes one of Constantinople’s upgrades, which was found to be a security risk. 

Major upgrades (also called hard forks) of blockchain-based systems such as Ethereum can be tricky as they require participants on the network to switch to new software. If they don’t, the fork becomes contentious — the blockchain splits in two with some users switching to the new version and some staying on the old one. 

Constantinople and St. Petersburg were activated at block height 7,280,000 or roughly at 8pm UTC on Thursday. More than 3,700 blocks were mined on Ethereum since then, and everything points to the fork going as planned. 

The price of Ethereum is slightly down in the last 24 hours according to CoinMarketCap, having fallen roughly 1% to $136.81. 

Disclosure: The author of this text owns, or has recently owned, a number of cryptocurrencies, including BTC and ETH.

The most used platform for groomers is Instagram, according to an NSPCC report based on police data. 

Grooming is defined by the NSPCC (National Society for the Prevention of Cruelty to Children) as the act of building an emotional connection with a child to gain their trust for the purpose of sexual abuse or exploitation. The NSPCC report found that grooming cases involves one major social media platform or another in 70 percent of cases where the method is revealed by police, with Instagram being the most popular. 

SEE ALSO: TikTok fined $5.7 million for collecting children’s data

The NSPCC found that Instagram was used in 32 percent of those instances, Facebook in 23 percent, and Snapchat in 14 percent, citing data obtained from police under Freedom of Information laws. The data shows that the use of Instagram as a tool for grooming has seen a 200 percent increase from 2017 to 2018 (over a period of approximately 18 months). 

Sexual communication with a child has been a criminal offence since 2017, in the period since then more than 5000 instances have been recorded, the NSPCC found. The data also shows that girls aged 12 to 15 were most likely to be targeted by groomers. 

“These figures are overwhelming evidence that keeping children safe cannot be left to social networks.”

“Keeping young people safe on our platforms is our top priority and child exploitation of any kind is not allowed,” a spokesperson for Facebook and Instagram said in a statement emailed to Mashable. “We use advanced technology and work closely with the police and CEOP (The Child Exploitation and Online Protection Command) to aggressively fight this type of content and protect young people.” 

Facebook and Instagram also said that it removes 99.2 percent of content relating to child exploitation or nudity before it’s reported, and that it works hard to block users searching for known child exploitative terms. 

NSPCC chief executive Peter Wanless said in a statement that politicians must step in to help combat grooming, since platforms are still failing to protect its youngest users, after “10 years of failed self-regulation.” 

“These figures are overwhelming evidence that keeping children safe cannot be left to social networks,” Wanless said. 

March Mindfulness is our new series that examines the explosive growth in mindfulness and meditation technology — culminating in Mashable’s groundbreaking meditation bracket contest. Because March shouldn’t be all madness.

In a culture obsessed with self-care, feeling like you’ve failed at the practice of mindfulness can breed unique feelings of frustration, resentment, and even shame. 

It seems so simple: Quietly observing your thoughts, you remain open to and curious about the present moment without judging the ideas that ping back and forth in your consciousness. You expect to experience the benefits that research says mindfulness can offer, including reduced stress, increased attentional focus, less emotional volatility, and improved relationship satisfaction. 

Except, for some people, that’s not what happens. They might find it hard to stay in the present moment, feel anxious after attempting mindfulness, and abandon their practice. Such frustration is often rooted in a misunderstanding of how mindfulness works, and what it’s meant to do, say experts. People’s expectations of mindfulness are sometimes far higher than what the tool could ever deliver. 

“There’s a lot of hype and buzz around mindfulness,” says Alex Haley, assistant professor and mindfulness program lead at the University of Minnesota’s Earl E. Bakken Center for Spirituality & Healing. “[People think] everywhere I turn it’s mindfulness-based something. I’m going to have all these expectations that mindfulness is a cure-all, that it’s a panacea. It’s not. There are limits to what it’s able to do.” 

Those misconceptions can be cleared up with just a little research. Yet there’s another, more complex reason why some people feel mindfulness isn’t effective. An emerging field of research is exploring how people who’ve experienced trauma may feel significantly worse during or after mindfulness practice. Researchers working to understand that dynamic believe it’s still possible to use mindfulness approaches, just with important modifications. 

So before giving up on mindfulness, or feeling ashamed that mindfulness isn’t producing the results you wanted, make sure you’ve considered the following things: 

What does mindfulness even mean? 

Mindfulness has multiple definitions and those can look different depending on your teacher, or whether you’re getting mindfulness tips or instruction from an app, best-selling book, YouTube channel, Instagram influencer, yoga class, or news stories like this one. 

“Mindful awareness is paying attention to present moment experiences with openness, curiosity, and a willingness to be.” 

Perhaps the most widely-known definition of the secular practice of mindfulness comes from researcher and meditation teacher Jon Kabat-Zinn, who said: “Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.”

Though Haley uses Kabat-Zinn’s definition, he frequently invokes another one from Diana Winston, director of mindfulness education at UCLA Semel Institute’s Mindful Awareness Research Center: “Mindful awareness is paying attention to present moment experiences with openness, curiosity, and a willingness to be with what is.” 

J. David Creswell, an associate professor of psychology at Carnegie Mellon University who studies mindfulness, thinks of it as an “open or present attention to your present situation.” 

SEE ALSO: One woman’s quest to find the right meditation app in a messed-up world

While different from each other, these definitions share a core element: attention to the present. If you embrace one definition over another, just remember that it’s meant to help you understand how to practice mindfulness, and it’s fine to consider what it might leave out. This approach will help guide your practice and refine your expectations.   

“It’s not unicorns and rainbows”

Creswell says popular misconceptions of mindfulness portray it as a tool for relaxation or “blissing out.”  

“It’s not unicorns and rainbows,” he says. “I liken mindfulness meditation practices to aerobic practices for the brain. [Exercising] hurts, it’s a little unpleasant, but at the same time it’s building muscle. With mindfulness, you’re building a brain that’s more resilient.” 

That mental strength develops over time as you focus the brain’s attention on the present moment and learn how to observe positive, negative, and neutral feelings without being carried away by any of them. This is no easy task for human beings, whose powerful thoughts and feelings can rip them from the present moment and thrust them into a stream of consciousness that’s confusing, exhilarating, fulfilling, or exhausting. 

Some people mistake mindfulness as a surefire way to avoid that overwhelming experience, but Creswell says that’s not the case. Developing mindfulness skills can mean, for example, staying observant and curious about what’s happening when you’re having a panic attack. From Creswell’s perspective, the goal is to cultivate “equanimity” in the face of uncomfortable experiences. That objective is why mindfulness is so frequently associated with formal, seated meditation, which can prompt physical discomfort and mental fatigue. 

Why should this make me feel better? 

Haley believes that mindfulness works because it puts people in a different state of mind, one where they’re actively aware of and paying attention to events happening in the present moment. As they take in that information, they better understand the situation and can make a choice about how to respond. With regular practice, this can create a “positive feedback loop” that leads to more moments of mindfulness, and our resulting choices become wiser and more compassionate, says Haley. 

“It allows us to understand our experiences, and most importantly, is the choice to how we respond to the things we’re feeling,” says Haley. “If we notice things that are really challenging, we can say, ‘I want to make a different choice.’” 

“If we notice things that are really challenging, we can say, ‘I want to make a different choice.’” 

That sense of agency is empowering, but it’s important to know that mindfulness is a state of mind that comes and goes.  Feeling calm and observant one day and at the mercy of your thoughts and emotions the next doesn’t mean you’ve failed at mindfulness. It just presents another opportunity to strengthen your skills, or to try again the following day. 

Haley says frustration and difficulty with mindfulness can come from overly strict ideas about how to practice it. People commonly believe that mindfulness means you must practice formal, seated meditation, but Haley says that’s just one option. He sometimes recommends people start with movement by observing how their body feels when its been moving for long periods of time. Haley also relies on a slight variation of the “STOP” technique in which you slow down, take a breath and extend the exhale, observe what’s happening in the body, and consider the possibilities before proceeding. That approach can shift people into a state of mindfulness and away from being reactive. 

Creswell’s own research has found that there are three types of evidence-based mindfulness programs: an 8-week mindfulness-based stress reduction course founded by Kabat-Zinn and offered by credentialed instructors around the world; apps like Headspace and Calm that use teachers trained in mindfulness; and mindfulness meditation retreats. Creswell recommends exploring various options to find research-backed programming and resources, or a qualified teacher.

What if mindfulness still isn’t working for me? 

Despite the clear benefits of mindfulness, science still can’t say who might benefit most or least from the practice. Creswell says it’ll be five or 10 years before researchers can confidently answer that question. In the meantime, some scientists and meditation practitioners who study mindfulness are focusing on the possibility that mindfulness might actually create the possibility of harm for some people who try it, particularly those with a history of trauma. 

David Treleaven, author of Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing, says that for some people struggling with trauma the basic tenets of mindful meditation practice, including focusing on the breath and remaining still for periods of time, can actually exacerbate trauma symptoms. Paying close attention to anxious or threatening feelings may heighten the body’s fight-or-flight stress response, elicit intrusive thoughts of harm or danger, and prompt flashbacks to traumatic events. 

For some, focusing on trauma symptoms because they’re happening in the present moment can lead to physical immobilization akin to freezing in place. Treleaven describes that response as a “deeply wired survival response in humans.”  

A meditation teacher unaware of these dynamics might insist that remaining curious and nonjudgmental about these sensations is a necessary part of mindfulness meditation. 

“People feel isolated and ashamed that a practice that seems to be working for so many people isn’t working for them.”

While Treleaven believes that mindfulness can be very beneficial for people who’ve lived through trauma, he disagrees with an approach that diminishes or minimizes their unique experiences. 

“People feel isolated and ashamed that a practice that seems to be working for so many people isn’t working for them,” he says. “They end up feeling like, ‘I’m broken beyond a point that even meditation can’t work for me.’” 

Treleaven instead advocates for adjustments to mindfulness meditation. He urges people to take breaks as needed in favor of pursuing lengthy sessions or weeks-long meditation streaks. He advises teachers against touching students without their explicit permission. If focusing on the breath is anxiety-provoking, Treleaven recommends finding an “object or anchor of attention,” like sounds or the feeling of your bottom touching a cushion or the floor. When sitting for long periods of time is uncomfortable for those who’ve experienced trauma-related freezing, Treleaven suggests mindfulness that incorporates movement. 

The goal, he says, is to create a consistent practice that builds mindfulness skills while reducing the risk of harm. He recommends people who’ve experienced trauma look for mindfulness resources, classes, and instructors with a trauma-informed approach. 

“It doesn’t need to be a one-size-fits-all practice,” Treleaven says. “We can modify it for people so that it enables them to have a sense of success.” 

No matter why you’re struggling to feel the benefits of mindfulness, that flexibility is key to starting, continuing, or pausing a practice. Mindfulness, after all, is never about perfection.