dieting without end
by Jenny Bryan
Everyone with anorexia has a slightly different story to tell. But you don't need to listen for very long to people like Anne, Claire and Sarah, who speak out in what happened to me, before you hear some familiar themes.
- Uneasiness with parents and siblings, troubled adolescence, closed-off emotions
- Then a trigger – an illness, a failure, a death, abuse or rape – followed by feelings of misery, guilt, inadequacy, worthlessness
- Time after time, a failure to get fast, effective help – often, a physical and emotional cover-up.
Few of the women who have shared their experiences with us intended to lose huge amounts of weight. Either they dieted because they were a little overweight and never came off the diet. Or they were afraid to eat normally in case they ballooned in size. Some never weighed themselves and were unaware of how thin they had become until it was too late. Others found calorie counting the only way they could take control of their lives.
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Today, some recognise they have a problem and want very much to get better. A few have succeeded. Others live within rigid boundaries, barely maintaining a weight that will keep them alive.
how does anorexia start?
Anorexia usually starts around puberty and mainly affects people in their mid to late teens. But it can affect young children and it can go on well into adult life. Those who continue to have anorexia in their 20s and 30s are at greatest risk of long-term health problems and even of dying.
Most people with anorexia are girls and young women. But about 10% of cases are male. In the past, there has been less cultural pressure on men than women to stay slim, but this is changing.
There's no single cause of anorexia. Usually, there's a complex mix of family, cultural and lifestyle triggers. Since anorexia so often starts at puberty, it is linked with a fear of growing up and a desire to avoid the physical and emotional changes of adolescence, explains eating disorders specialist, Professor Arthur Crisp:
'Puberty isn't invited and some people find it very threatening. They panic about the physical changes and they panic about the challenges they are facing within their family and within society. If they don't have the coping skills to deal with all these changes they may use dieting as a way of coping, but they need help to accept the process of growth and maturation.'
Puberty is also a time when young people want to conform to the images and stereotypes of the body beautiful that they see in the media. They want to fit into the fashionable clothes that require small breasts, flat stomachs and narrow hips. As younger children are being exposed to such pressures, they too want to diet, and some fall into the anorexia trap well before puberty.
But, again and again, people with anorexia explain that they do not think that super-model images alone are responsible for the rising numbers of people with eating disorders. After all, most of us don't respond to such pictures by embarking on dangerous dieting. Societal pressure to be thin is one of many triggers for anorexia.
what harm is there in being thin?
Anorexia is a very serious disease. One in five to one in seven people with anorexia die as a result of their illness or take their own lives – that's around 14-20%.
Anorexia can also do permanent damage to many parts of the body, and this can start long before there is significant weight loss. At the very least, people who do not eat enough feel dizzy and cold, become confused and get stomach pains and constipation. Muscle weakness not only affects their mobility, it can affect internal muscles, such as those which control bladder and bowel movements, and may lead to incontinence (see what happened to me.)
Young women with anorexia have hormonal changes which stop their periods and may make them infertile. These hormone changes may also make their bones brittle – a condition called osteoporosis. In healthy women, this doesn't normally occur until after the menopause, but it can affect women with anorexia much earlier and more severely, leading to broken bones and disability.
Anorexia damages the blood and immune systems. So people become anaemic and find it hard to fight infection. In time, anorexia can lead to kidney failure and heart problems which can be fatal. Others just become so weak that they are killed by a relatively minor infection.
A growing proportion of women with anorexia use vomiting, laxatives and slimming pills to help reduce their weight and these can cause additional health problems (see our features disorderly eating and binge and bust.
getting treatment
Anorexia doesn't have to be a life sentence. About half of people with the disease do recover. But the main barrier to effective treatment is getting someone to admit they have a problem. There are no instant cures and treatment is likely to be more effective in those who want to get better and agree they have a problem.
As a first step, someone who has been persuaded to seek medical help by family or friends may still need to be persuaded that they require treatment. A psychological technique called motivational enhancement examines the positive and negative aspects of maintaining the anorexia, with the aim of helping an individual realise the benefits of further therapy.
Most people with anorexia are treated as outpatients or as day patients in hospital. Dietary advice and psychological therapy may be combined to help them begin to gain weight and start to understand why they are using food in such a dangerous way. It's a slow process. No one who is as afraid of putting on weight as someone with anorexia will suddenly tuck into big bowls of food. Each extra pound on the scales will be seen as a step on the slippery slope to being fat. Demanding that someone put on a lot of weight straight away may well frighten them back into their dangerous eating patterns.
Various types of psychological therapy are used in anorexia. They address how people think and feel. Analytic therapy is one option. It explores links between current eating and behaviour problems and earlier life events and experiences. Plenty of people grow up with difficult relationships with family or at school, and don't develop eating disorders. But, for some, anorexia may be their very destructive way of dealing with unhappiness in another part of their life.
Analytic therapy is designed to help them understand why starving themselves is not the answer and to find healthier coping strategies. Therapy sessions which involve all the family may be particularly helpful for people whose anorexia started under the age of 17, while one-to-one treatment tends to work better for those whose illness started later. Group analytic therapy is also widely used.
Some people whose weight is very low do need a stay in hospital and, if they are too ill and weak even to eat, the first priority may be tube feeding. Hopefully they will agree to treatment voluntarily. But sometimes people with anorexia cannot recognise that their life is in danger and it may be necessary for doctors to start treatment, with or without tube feeding, under the provisions of the Mental Health Act 1983.
Treating anorexia takes time, effort and commitment from everyone. It doesn't go away with a few sessions with a therapist. People with anorexia are likely to need long term support to help them develop the coping skills and the self-esteem they need to get on with the rest of their lives. But, as thousands of women and a smaller number of men have shown, there is life after anorexia.
help and info
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organisations
Careline
Cardinal Heenan Centre
326 High Road
Ilford IG1 1QP
Tel: 0845 122 8622 (Mon-Fri 10am-1pm and 7-10pm)
E-mail: info@carelineuk.org
Website: www.carelineuk.org
Provides confidential telephone counselling for children, young people and adults on any issue including eating disorders, depression, loneliness, anxieties and phobias. The website has a forum and an online counselling portal.
beat (formerly Eating Disorders Association)
103 Prince of Wales Road
Norwich NR1 1DW
Adult Helpline: 0845 634 1414 (Mon-Fri 10.30am-8.30pm and Sat 1-4.30pm)
E-mail: help@b-eat.co.uk
Youthline: 0845 634 7650 (Mon-Fri 4.30-8.30pm and Sat 1-4.30pm)
E-mail: fyp@b-eat.co.uk
Website: www.b-eat.co.uk
Campaigning organisation that provides information, advice and publications on all aspects of eating disorders. Operates a UK-wide telephone helpline and a youthline for information, help and support if you're aged 18 years and under. There is also a webzine, message board and chat room on the website.
First Steps to Freedom
PO Box 476
Newquay TR7 1WQ
Helpline: 0845 120 2916 (Mon-Thurs 10am-10pm; Fri-Sun 10am-midnight)
E-mail: first.steps@btconnect.com
Website: www.first-steps.org
Offers a confidential helpline, counselling and befriending, telephone self-help groups plus leaflets and audio tapes.
Centre for Eating Disorders (Scotland)
10 Carment Drive
Glasgow G41 3PP
Tel: 0141 632 6663
Website: www.eatingdisordersscotland.co.uk
Independent private practice set up by Mary Hart, Edinburgh and Grace Coia, Glasgow, which offers a counselling service to those who suffer from eating disorders.
Mental Health Foundation
9th Floor, Sea Containers House
20 Upper Ground
London SE1 9QB
Tel: 020 7803 1101 (Mon-Fri 8.30am-5.30pm)
E-mail: mhf@mhf.org.uk
Website: www.mentalhealth.org.uk
Working to improve the support available for people with mental health problems offering information and literature on all aspects of mental health. Unable to offer advice on an individual basis.
websites
All About Anorexia Nervosa
A booklet for those wanting to know more about Anorexia Nervosa.
Available to download here.
Anorexia and Bulimia Care
www.anorexiabulimiacare.co.uk
An organisation run by Christians for sufferers of anorexia, bulimia and compulsive eating disorders, their families and carers. Can point people towards support groups or put them in touch with ex-sufferers. Website has useful resources, plus a guide for parents.
Anorexia Nervosa and Related Eating Disorders, Inc
www.anred.com
American-based website containing information about anorexia nervosa, bulimia nervosa, binge eating disorder, compulsive exercising, and other less well-known food and weight disorders, and includes statistics, warning signs, personal stories and links.
The National Centre for Eating Disorders
www.eating-disorders.org.uk/info.htm
Contains information available to download, for those eating disorders such as compulsive or binge eating, anorexia, bulimia and dieting.
Something Fishy Website on Eating Disorders
www.something-fishy.org
Pro-recovery website dedicated to raising awareness about eating disorders, providing support and information for those with eating disorders, and their family and friends.
Youth Information.com
www.youthinformation.com
Information on healthy living including, healthy eating, different kinds of diet, and eating disorders. Contains details of organisations for further help.
reading
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Breaking Free from Anorexia Nervosa by Janet Treasure (Psychology Press, 1997) |
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Anorexia Nervosa: The wish to change by A H Crisp and others (Psychology Press, 1996) |
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Conquering Anorexia by Clare Lindsay (Summersdale Publishers, 2000) |
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Anorexics on Anorexia edited by Rosemary Shelley (Jessica Kingsley Publishers, 1997) |
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Skinny by Ibi Kaslik (Walker and Co, 2006) |
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(July 2001, resources updated October 2005)
