Chapter 1
Introduction
Eating disorders are a growing problem in the western world, where thereâs a culture of individualism and considerable emphasis on the importance of appearance. In developing countries, where food shortages and famine are more common, eating disorders are very rare. So is it our culture thatâs to blame? Where people starve in a land of plenty?
Thatâs certainly part of the story, but eating disorders actually go much deeper than concerns about body image. Theyâre a sign of inner turmoil, emotional struggles, and itâs often said that by controlling their bodies, sufferers feel more in control of their lives. The illness may be an expression of repressed inner pain that has been bottling up for years.
So why is the problem growing and what can we do about it? This book sets out to explore different theories, scientific studies and real life experiences relating to eating disorders. The aim is to offer information, comfort and support to those affected by eating disorders and to assist sufferers on the road to recovery.
While eating disorders have been around for decades, in recent years they have become increasingly common, seeing a 15 per cent rise between the years 2000 and 2009. They affect people of all ages, and from all backgrounds.
A survey published in the International Journal of Eating Disorders in 2012, found symptoms of eating disorders in 13 per cent of women over the age of 50. So although the disorders are more common among young people, theyâre certainly not the only group affected. Indeed, young children are increasingly developing eating disorders as they feel the pressure to meet a Western ideal of beauty. Thereâs also been a surge in the number of men succumbing to eating disorders. The shame of the disease keeps it hidden from society and can make getting accurate data difficult. Itâs a secretive illness and often, sufferers are afraid of being judged, so theyâre reluctant to reveal the truth about their condition.
In 2015, the eating disorder charity, Beat, commissioned research by Pricewaterhouse Cooper, which concluded that 725,000 people in the UK are affected by eating disorders. In 2007, NHS researchers stated that up to 6.4 per cent of adults showed signs of having an eating disorder, and that up to 25 per cent of these people were male. Eating disorder related hospital admissions rose 8 per cent in 2014 compared to the previous year. Itâs clearly a big problem.
The causes of the eating disorder epidemic are many and varied, but underlying issues typically include severe self-esteem issues, depression, loneliness, and a longing to fit in and be accepted by our peers.
Our modern society can feel like a cold and uncaring place. People can be unduly critical, judgemental and unkind, offering ridicule rather than help, belittlement rather than direction. Being on the receiving end of endless criticism can erode your sense of self-worth; itâs not always easy to walk away.
Furthermore, having a vocation is important, so if you canât find work, fulfilling hobbies, or another meaningful occupation, the long empty days, possibly accompanied by countless rejection letters from employers, can erode your self-esteem. Some individuals just donât feel valued.
Itâs also common for people to feel stressed or overwhelmed by the pace of modern life. Everyoneâs so busy. You might get carried along, or left behind. Either way, some individuals feel that their life is out of control. They might have emotional problems and feel there is no-one they can turn to. Controlling their body gives them some semblance of control over their lives, and might provide an emotional lift â a sense of achievement.
Itâs common for young people to experience a longing to be socially accepted if theyâve been bullied, abused, or treated like an outcast for years. Body image is often the first line of defence if we feel under attack, are called nasty names and told we need to try harder to fit in.
A background of bullying, abuse or neglect is common among people with eating disorders. Everyone needs to feel valued, feel that they are worth something, accepted by society and appreciated occasionally. Sufferers might feel torn apart by unrequited love, crushed by bullies, or just feel empty, lonely, unfulfilled and unable to change their circumstances. The range of underlying emotions and difficulties can be diverse and wide-ranging.
In an ideal world, our happiness should not depend on the love or approval of other people. But the world is not ideal and, in reality, most people would agree that they need to feel valued by someone else. So when this need is unmet, some individuals are prepared to go to extreme lengths in pursuit of peer approval, self-worth, societyâs acceptance, or good old-fashioned love. In an environment where body image is valued so highly, this often plays out as an obsession with appearance. In reality, itâs often in pursuit of a higher goal: happiness.
Anorexia and bulimia are often triggered by attempts at slimming, to meet societyâs ideals. Individuals are then driven to continue by that glowing sense of achievement, pride and social acknowledgement that you get from success. Society loves people who take pride in their appearance and puts them on pedestals. Slimmers of the Year are looked up to as inspirational role models. Books on slimming are best sellers all year round. There are dozens of fad diets. Magazines are constantly promoting weight-loss. Itâs a billion dollar industry worldwide.
Itâs true that if youâre overweight then slimming can be good for your health, but only if it results in healthy lifestyle changes, permanently. Yoyo diets can actually cause an increase in weight and theyâre demoralising. Yoyo dieting is a destructive pattern that many slimmers get into, and it can lead to bulimia nervosa, an overwhelming compulsion to binge and purge, disposing of the food youâve eaten.
Once slimming becomes an obsession, it takes on a whole new life of its own. It can be emotionally rewarding on many levels â not just the sense of achievement, but by reducing your internal conflicts about being âgood enoughâ, lovable and attractive. Fast and dramatic weight loss can numb inner pain and an obsessive focus on food can make the causes of angst and unhappiness seem less important. When youâre starving, you become anaesthetised to emotional pain. The strength of feelings fades quickly, making you less vulnerable to being hurt. Your sex drive fades away and your need for companionship lessens, so you start to feel better if your social needs are unmet. It doesnât matter any more. You feel more independent.
The more weight is lost, the more emotionally detached you become. It makes you feel less exposed and you canât be so hurt by what life throws at you. For someone whoâs been struggling with painful emotions, this can be a relief. You feel stronger and more able to cope. You just donât feel so bad. Some experts say that starvation actually creates a sense of euphoria, as brain chemicals combine to create sensations similar to those of being on morphine.
Physiologically, extreme weight loss can result in hormonal crashes that cause a cease in menstruation and numb your sex drive, radically reducing the loneliness and pain you feel from being so alone. Individuals become so obsessed with food and their weight, that they have little time for anything else. They withdraw from their interests, go into solitude and often lose interest in relationships. But eating disorders have health consequences too.
A psychological disorder with dangerous physical implications
While some people may hold the view that eating disorders are just expressions of vanity, it actually goes much deeper than that. An eating disorder is fundamentally a psychological disorder and this is what makes it so difficult to treat. Some people do reach weights which they can see are unattractive, yet they continue to restrict their food, because they feel better that way. Understanding the long-term consequences of eating disorders can help sufferers find the strength to break free.
Very low body weight causes a drop in female hormones and a cease in menstruation. This puts some women with eating disorders at a high risk of osteoporosis in later life. Disordered eating and nutrition can also adversely affect fertility and cause reproductive problems.
One study showed that eating disorders could cause serious eye damage, possibly leading to an increased risk of blindness, or compromised vision. Sufferers may experience problems with dehydration and very poor skin condition. Dehydration can lead to kidney failure, which can be fatal. Fungal infections are more likely to occur and these can be extremely upsetting and difficult to treat.
Bingeing can cause rupture of the stomach, which can be fatal. Constipation is a common problem and thereâs a risk of irritable bowel syndrome whereby abdominal pain continually recurs, accompanied by constipation and/or diarrhoea. Abdominal distention and bloating supports the suffererâs impression that theyâre fat. Vomiting may make tiny red spots appear around the eyes, caused by burst blood vessels. When stomach acid hits your teeth, it causes slow erosion of your tooth enamel. Serious tooth decay is not pretty and costs a fortune to fix.
Skin becomes dull, dry and unhealthy in appearance. Salivary glands swell up making the face puffy, which although painless, makes the sufferer think that they have a plump face. Fasting and prolonged dieting causes sensitivity to cold and hypothermia. Low blood pressure leads to dizziness, weakness, nausea, and blurred vision.
Many people with eating disorders are at risk of a lifetime of ill health, with permanent organ damage, because in the absence of food, the body will start using its own tissues for energy. The result is a risk of life-threatening health problems, including heart weakness, kidney failure and liver damage.
Then, on top of all that, the precise balance of minerals, vital for the body to function properly, becomes altered. Malnutrition in people with eating disorders causes muddled thinking, difficulty problem solving and it makes it more difficult to make the right choices for a brighter future.
The abuse of laxatives causes metabolic disturbances, stomach cramps, water retention on stopping use and damage to the muscles that line the bowels. Chronic diarrhoea causes malabsorption, so very little of the nutrition stays in the body, making the sufferer more susceptible to disease. Malnutrition also causes exhaustion and the severest cases can go into stupor, coma and, finally, death. Eating disorders result in more deaths than any other psychiatric disorder. Beat says that around 20 per cent of anorexics die from their illness.
Laxative abuse can lead to âlazy bowelâ, a potentially permanent condition, which, for those affected, presents a daily battle. The symptoms are severe constipation, abdominal pain and bloating. Toxins build up in the intestines, increasing the risk of bowel cancer and other diseases. So the sooner laxative use is stopped and healthy eating begun, the greater the chance of avoiding this condition.
Making you better again
For sufferers of eating disorders, losing some of the best years of your life to mental illness is just so sad. When you should be out in the world making your dreams come true, youâre worrying about food, weight, and living in an insular world of depression. You need to learn to love yourself, overcome the obsession with weight, look outwards and break free from this downward spiral. I hope this book will help you find the strength and willpower to do that.
Weâre going to look at the science, the facts, backgrounds, circumstances and influences that might lead to an eating disorder. But more importantly, weâll look at how to help you, or your loved one, break free.
Weâll look at treatments and the latest science. Thereâs a section on understanding nutrition, so that you can give yourself permission to eat and not worry about the impact on your weight or appearance. Understanding nutrition can be really helpful in aiding your recovery.
Weâll break down the experiences of anorexics, bulimics and those who feel out of control, so you donât feel so alone and weâll identify areas of muddled thinking and aim to address the root causes of your condition. There are many different scientific, nutritional and psychological theories around the causes of eating disorders and weâll discuss some of these and the treatments available.
You may want to seek talking therapies, or other therapies to help you, or your loved one, recover. Weâll look at different therapies. Indeed, a supportive environment can be key to recovery.
If youâre part of the pro-ana culture weâll look at that too, identify and discuss unhealthy perspectives and discuss how to break away from this so that you can find healthy alternative interests and start to feel better. Importantly, weâll look at how you can start engaging with society again in a positive way. Youâll need other things to focus on when you start to let go of your obsession with weight, so weâll find positive alternatives to help you build confidence and good health, at your own pace.
When I talk about âyouâ, I mean the sufferer. If youâre actually a carer, parent, partner, or a concerned citizen, thatâs fine too. This book is for anyone whoâs interested in learning more about eating disorders. But for me, itâs just helpful to sometimes address the sufferer directly, as âyouâ.
My background
In the mid-1990s, at the age of 20, I was recovering from anorexia and bulimia, contemplating the values of a culture in which Iâd developed an eating disorder that might have killed me. Long periods of anorexia and bulimia had engulfed my life for almost five painful years. And while my peers found partners, cosied up in romantic twosomes, moved away to study, or worked in well-paid jobs they enjoyed, Iâd been on a killer diet, couldnât find employment and felt exploited on a training scheme, which made things seem even worse. Iâd been throwing up down the loo regularly. Iâd been terrified of food, worried sick about my weight and convinced no-one would ever love me. Iâd been a total mess.
For decades, Iâd felt that the culture I lived in was cold, selfish and exploitative. I grew up in the 1980s, where yuppies, big hair, shoulder pads and excesses were the name of the game, but my life reflected none of that. It was an era of great hope and aspiration for many, but I grew up bullied, penniless and desperately unhappy. Most of my dreams and aspirations had been crushed before I even left school; the rest were crushed within months of leaving. Eating disorders were in the news â Princess Diana had one, and so did everyone else, it seemed. The Daily Mail was filled with information on the topic. The kids at school made throwing up seem normal.
My first boyfriend, who dumped me on Christmas Eve, a few weeks after my sixteenth birthday, told me I was fat â repeatedly. I was size 14 in UK sizes. Not huge. But I thought that losing some weight might solve some of my problems, making me more acceptable to my peers and more attractive to eligible young men. For years Iâd longed for a boyfriend, so the fact that the only lad whoâd ever paid me any attention said I was fat, was quite a big deal.
I started on a strict diet and felt good when I lost some weight. People were nice to me. Complimentary. I became addicted to it. This was, after all, the only thing in my life that was going well. So I focused on my weight and became obsessed with it.
After leaving school, Iâd tried to get a job and make something of myself, but the 1990 recession had set in that April and by June, everyone was making redundancies, not hiring. I couldnât find work. I was prepared to do anything and only expected to get a job in a shop, but I couldnât even manage that. I was exhausted, broken and desperate to be loved. I was lonely. I felt lost, unwanted, undervalued. Over many months, strict dieting turned to anorexia. Ten months later, I binged. I was starving.
I panicked. I felt like Iâd eaten a horse. Everything was ruined! That was the start of my bulimia. I recalled the girls at middle school, many years earlier, who practically issued instructions on how to be sick for weight control. I was only going to do it once. I mean, you wouldnât do it more than once would you? Itâs revolting!
But years of eating disorder obsession ensued. My body started to give up when I came close to six stone. I experienced temporary blindness. Towards the end, I realised it was causing more problems than it solved. Giving up was one of the hardest things Iâve ever done. But I went on to study psychology at Brunel University and I later went on to study nutrition.
Fast forward to the present day and the numbers of people with eating disorders are spiralling. So are rates of depression. We have unprecedented levels of people with mental health needs and a health service unable to cope with demand. Thereâs a stigma around mental health and I wonder whether, in twenty years, weâve actually made any progress at all.
So whatâs the root cause? What can be done about it? How can you rise above peer pressure? And ignore companies spending millions on exploiting your insecurities to shift products? Itâs become crazier in recent years, because while back in the 1980s, cosmetic surgery was the domain of the rich and famous (Cher had it routinely, not the girl next door), now itâs normal among everyday folk â all because of that pressure to be perfect.
This book will help you to understand what drives people to develop an eating disorder, to understand the nature of the different conditions and Iâll be suggesting approaches for recovery. Iâd like to think readers will experience hope for a better future and Iâll try to provide strength and encouragement to help those who feel trapped in the grip of an eating disorder, to break free and conquer the disease.
Weâll be looking at anorexia, bulimia, combinations of both, and compulsive overeating. Case studies are included to help you know that you ...