Why don’t you just eat normally?
We have come a long way in understanding the processes behind mental health disorders, but the stigma of them is ever-present. Whilst slowly improving, the misconceptions we hold haven’t faded completely. In the case of eating disorders, like anorexia and bulimia, it is all about food, right? -Wrong.
An eating disorder is not about food. In fact, they stem from something we all have: anxiety. Now anxiety isn’t a bad thing. It is a natural feeling we are born with, helpful when there is cause for alarm; but our levels of anxiety vary from person to person as a result of genetics, early social environment and day-to-day experiences. This is our trait anxiety- we all have it.
Anxiety makes us feel unsafe and often it can fuel our low self-worth. In turn, our low self-worth reinforces anxiety. So how does this develop into an eating disorder? An individual’s low self-worth is projected onto their body. They might then believe that they need to restrict their diet. In bulimics, most restrict but then eat or binge when they are very hungry. They then feel the need to purge. The resulting weight loss gives them a sense of achievement and control. Surely, we would expect this as every day we are bombarded by the idea that losing weight is always a good thing. You are not good enough unless you are perfect. This is just wrong.
What’s even more worrying is that this method of losing weight in both anorexics and bulimics is spurred on by negative reinforcement. If they don’t continue to lose weight, they feel out of control and unsafe, increasing their anxiety. Their coping mechanism to purge or to restrict their diet further will give a brief sense of control. This is a cycle that leads to the compulsion driven by irrational beliefs.
But we can break it.
Methods of cognitive behavioural therapy, meal planning and care for physical health are all used. But it is not easy. Changing the way we think, the way perceive things, takes time, patience and hard work. This is not the only challenge. In a modern society where social media is prominent, we are flooded with images. The best way to look, the only way to look. Somehow, we have normalised this.
Scarier still is the easy access to pro-ana and pro-mia websites. People compete to see who is skinnier and give advice on how to purge as well as the best ways to keep weight off. Those with eating disorders are not ignorant, they feel they have to keep following their compulsion. In the extreme, this may mean even if they know they are dying.
However, people have and still continue to beat this horrific cycle. Living in recovery having survived and beaten an eating disorder. One example of this is a twenty-seven-year-old lady, wishing to stay anonymous, who beat anorexia. She had much to say about her own experiences in the following interview:
Tell me about yourself.
I'm 27, I work part time as a church community worker and part time running a chamber opera group. Outside of work, I volunteer with a charity that befriends death row inmates, have a begrudging love for Parkrun and like all kinds of crafts.
Tell me about your experience with an eating disorder
I was diagnosed with anorexia when I was 24 after a struggle with OCD and BPD that started at 15. I had early life experience in a very controlling youth group that I now recognise as a cult. Their influence had eroded all sense of control over my own life by controlling what I did and who I saw through fear, and I had desperately tried to regain that control using self-harm, compulsions and then dietary restriction. My anorexia got much worse after the death of my dad, another situation where I felt I lacked control. The youth group had also told me I was a fundamentally evil person so I had a lot of deep seated beliefs that I deserved punishment and suffering. I was an inpatient in a general psych hospital for five weeks age 24 to treat my self-harm, and in an eating disorder day unit for 8 weeks age 25 where I was able to very successfully tackle my anorexia.
Do you think you have recovered like you would a physical illness?
Yes, in the sense that some physical illnesses can be treated to a point where you suffer no symptoms on a day-to-day basis, but need to remain vigilant against relapse. For example, I don't think I'll ever be able to diet again or follow a fad food trend, just like a person in remission from asthma wouldn't be able to smoke again.
What steps do you take to not fall into old habits? Do you ever feel the need to?
I try to keep to a very loose meal plan now, making sure I eat three meals plus snacks a day. I try to keep an eye on whether I'm looking at nutritional info without realising and tackle that head on by eating foods that would be scary to my eating disorder. I try to keep on top of my stress levels and self-care to stave off anxiety which could trigger relapse. I'm lucky that I have a job I really like, an amazing family and a sense of purpose - quality of life is the biggest inoculation against relapse!
Do you ever wish you never developed an eating disorder in the first place?
Whilst I'd never wish an eating disorder on anyone else, I do think good things came out of my anorexia. I realised how loved I was by family and friends, really learnt about myself and how resilient I am and met incredible people. I try to have no regrets! I think, given my trauma, if I hadn't developed an eating disorder, I may well have developed another maladaptive coping mechanism.
How has your eating disorder affected your relationships?
I know my husband and the rest of my family have been so frustrated with me when I was in the midst of my disorder but in general it's bought us closer because I've needed their support. They were a huge motivation for recovery and they never showed me how awful they were feeling, they have always cheered me on from the side-lines! It has negatively affected friendships with people who also have an eating disorder because anorexia is so competitive. Mostly, those relationships have been mended now but I was definitely hurt by them and am sure I hurt others as well with comparison behaviours.
What are your best and worst experiences with doctors and the NHS?
Absolutely the worst was my psychiatrist on inpatient who was wholly lacking in compassion and also basic psych knowledge. She told me “you don't look like you have an eating disorder” and advised me on how to keep my weight down. I don't really know why she was a psychiatrist because she clearly hated her job and her patients! I've had a similar one-off experience with a GP who clearly did not like dealing with psych patients. Conversely, most of my experiences have been really positive; in inpatient, day patient and A&E staff have treated me with compassion and respect- I've felt like a human! I always say that no one chooses to have an eating disorder, and most staff have seen that and I've felt they were on my side fighting the anorexia.
Why do you think eating disorders are stigmatised?
Women's bodies are still a commodity in our society, and the media and our peers reflect this. Being skinny is seen as “a good thing” and initially many anorexics are congratulated for weight loss, this really compounds the illness and makes seeking help very difficult. In addition, many people think all psychological illnesses are a sign of weakness, not realising the magnitude of the feelings and thought people who suffer experience. There's a school of thought that can't understand why anorexics don't “just eat.” and subsequently believe that people who persist in not eating are doing so for attention. They haven't really understood that choice is extremely skewed for people with an eating disorder and that the illness has a powerful hold over sufferers.
Have you ever felt the effect of this stigma?
I think I've been luckier than many, people have always taken me seriously. I think I've benefitted from being older, people are more inclined to think it's a “phase” if you're diagnosed younger. A lot of my friends from admissions have certainly suffered though. I do worry how people, particularly employers, perceive me as a person with a psych diagnosis and I think I do get treated differently by line managers who have seen my occupational health report- they can err on the side of patronising and an unwillingness to trust me with responsibility but in general it's fairly benign rather than malicious.
What would you say to other people with an eating disorder, worried about this stigma?
I would say that you will find people who you can trust and who don't judge you; try and focus on those people and let the opinions of people who feed the stigma go. As Dr Seuss says, “those that matter don't mind and those that mind don't matter!” If you are unfortunate enough to find medical professionals with stereotypes remember you have a right to see someone else, for the most part people know when their colleagues aren't equipped to deal with psychological illness and will help you find someone more appropriate.
What is the worst misconception people have about eating disorders?
Probably that it's all about food. In eating disorders, food is just a symbol for areas in an individual’s life where they feel out of control and vulnerable. I think if more people understood this then they wouldn't be prone to telling people to “just eat!” Therapy for eating disorders focuses on solving the underlying issues rather than just eating (although restoring normal eating is important).
More people seem to be presenting with an eating disorder every year, why do you think this is?
Partly, I think it's because people are more aware that disordered eating is a problem and where it might have been left untreated before it is now flagged up and treated properly, which is a positive thing. Our generation has a lot of stress; a focus on money, poor economic outlook, the inability to get on the housing ladder etc. and any stress makes people vulnerable to mental illness.
Does social media have an impact?
I don't like to demonise technology (smart phones, the internet) because I think it's overwhelmingly a positive thing that enables the dissemination of information to people who wouldn't have it otherwise and encourages communication. It would be foolish, however, to not address things like pro ana websites that we have yet to find an adequate response to and that we aren't equipping young people to deal with. I'd like to see school age children better taught to be confident at challenging things they're uncomfortable with online (thinspiration pictures etc.) and to foster self-esteem and good body image as a priority.
Does media in general affect this?
Of course, the media perpetuates stereotypes about body image but we can't blame the media for eating disorders. The main culprits are risk factors and predisposing circumstances (such as, but not limited to, childhood abuse, bullying and trauma- anything that erodes self-worth or a sense of agency). Our time would be most effectively spent working on resources to combat these and to help people deal with trauma and pain. Campaigns to stop size 0 models and ban Photoshop are great, and should be encouraged, but it's so so important we don't stop there!
Whether you know the effect of an eating disorder personally or not, it is clear to see it is not just a case of not eating normally.
NHS Website:
https://www.nhs.uk/Livewell/eatingdisorders/Pages/eatingdisordershomepage.aspx
BEAT Support Services:
https://www.beateatingdisorders.org.uk/support-services
Details for Edgbaston Support Group for those with eating disorders
https://www.nhs.uk/ServiceDirectories/Pages/GenericServiceDetails.aspx?id=8342044
