Publication
Talking about eating disorders (reprinted 2010)
Introduction
Food is an essential part of our lives; we need it to survive. When we are under stress, our appetite and the way we view food are often affected. We may lose interest in eating, we may eat more than usual, or crave certain types of food. Very often this will pass when our lives return to normal and the difficulties are resolved.
However, for some of us food can become an overwhelming concern which comes to dominate our lives. It may get to the stage where food is all we think about - either so that we can control our intake of food to the extent of avoiding eating, or so that we can try to satisfy our need to eat and eat.
This leaflet is written for people who use food in these ways to cope with distressing feelings. It provides some basic information for those who themselves are experiencing an eating disorder, or for whom eating causes distress, as well as for their families and friends. The leaflet looks at the different ways people are affected, the possible causes and the various sources of help available.
At the end of the leaflet there are some references to other reading material and to organisations which can provide further information for those who wish it.
What are eating disorders?
It is very common for people - especially women - to be unhappy about their weight and shape. We are constantly being urged by advertising and by the media to believe that 'slim' means 'beautiful' and 'fat' equals 'unattractiveand undesirable'. Added to which, we are given more and more advice about thetypes of food which are good for us. Not surprisingly, many of us are becoming increasingly aware of our appearance and of what we eat. In an effort to loseweight and supposedly improve our looks we may adjust how much we eat, or what we eat. Although this may make us dissatisfied with ourselves, it does not usually stop us getting on with our everyday lives.
However, someone who has an eating disorder finds that their life comes to revolve around food - planning what to eat, how to avoid eating or how to rid themselves of what they have eaten.
This pre-occupation with food can conceal all sorts of confused and painful feelings. It may seem the only way we can cope with stress or uncertainty in our lives. It may seem the only way we can express the turmoil and confusion inside us.
'I had just left University, had no job and felt as if I was adrift on the ocean. I felt helpless, frightened. The only thing I could control was my own body and what it consumed. That became more and more important. It was the only thing that made me feel safe.'
But while this way of behaving may help us get by for a time, it only creates further distress. Not only can we do real harm to our bodies, we may also be plagued by feelings of anxiety or guilt about our eating.
'I really hate myself for what I'm doing. I binge and binge and then starve for days to compensate, but I don't know how to get out of it. It's become a way of life.'
Both men and women are affected by eating disorders, although women far outnumber men. Each person's experience will be unique, but all eating disorders can have serious effects on our bodies as our weight drops or fluctuates:
- we may find our usual sleep pattern is disturbed
- we may feel very depressed or lethargic
- our bodies may suffer internal damage because of excessive weight loss
- we may be very sensitive to extremes of temperature
- women may find their menstrual cycle is disturbed.
There are three main forms of eating disorder - annorexia nervosa, bulimia and compulsive eating.
Anorexia is most common among young women on the verge of adulthood,although young men seem increasingly prone to develop it, and it can also affect people in other age groups. We shouldn't be misled into viewing anorexia as an excessive form of slimming. It is much more than that. In our teenage years it can feel as if life is very challenging and very uncertain. It may feel as if we are going to be submerged by all sorts of new demands and expectations:
- intellectual, as we make decisions about our future, and face important exams
- emotional, as we establish our independence from our families
- sexual, as we explore our physical needs in close relationships.
Making sense of what is going on, and making choices for ourselves is not easy. Yet one area where we can assert control is over what we eat.
It can give us a great sense of satisfaction to push our bodies to the limit and survive on less and less nourishment. We may deeply resent other people'sconcern about how little we eat, and resist their efforts to get us to eat more.
'I became really deceitful - an expert liar: I'd say I'd just eaten, or had a bug. I'd stay at home rather than face going somewhere if I knew there'd be food'.
Gradually the way we see ourselves becomes distorted; others tell us we are painfully - even dangerously - thin, yet the slightest gain in weight throws us into a panic and makes us feel bloated and fat.
BulimiaBulimia is less obvious than anorexia, in that other people would not necessarily know someone was affected from their appearance alone. Indeed we may seem to be coping well with life, and look happy and confident when really we may feel very different. People who have bulimia are often very unsure of themselves, and frightened of not achieving what's expected of them. We may desperately want reassurance and acceptance.
Eating may seem the only way we can satisfy these needs and quell our uncertainties. We find ourselves eating huge amounts of food (generally in private) but then ridding ourselves of it by vomiting or with laxatives, out of guilt and disgust. It can feel as if we're trapped. We don't know how else to cope, yet feel ashamed and revolted at this chaotic way of life. We withdraw from other people and our increasing isolation only seems to confirm to us that we are unlikeable and unattractive.
Some of us may find it hard to regulate what we eat, particularly if we are upset or distressed. We resort to eating to block out our disturbing feelings, perhaps eating large amounts at a time whether we are hungry or not.
'After I split up with boyfriend - it was the evenings were the worst. I'd feel so empty and lonely. I'd just start off with one small snack, and then I'd keep on and on, eating anything at all.'
After a 'binge' like this, we may determine to eat more carefully, and may go through periods of cutting down our food intake to compensate for past excesses.
Understanding eating disorders
There are various possible explanations of what causes eating disorders, and the reasons will be different for each individual.
Sometimes we may find ourselves uncertain of how to cope with major changes. We may face important decisions about what to do next as one chapter of our lives comes to an end. We may then turn to food to console ourselves, or to deny ourselves so that we feel safe and in control at last. The pre-occupationin our society with looking slim and the assumption that we should all aim to look like the willowy models in the fashion pages can create pressure on us to conform. Otherwise we won't feel acceptable or accepted.
There are other sorts of expectations which may make us very uneasy. Perhaps we feel pushed into achieving, into living up to other people's standards. Sometimes achievement can appear all-important. We may push ourselves harder and harder since we don't know how else to define ourselves as individuals.
Women may feel obliged to fit in with the roles society expects of them, yet not be clear about what exactly is expected - sex object or mother, career woman or housewife? It can be difficult to acknowledge we have needs of our own and to recognise what we really want.
Relationships which are important to us can sometimes cause us distress. In some families, young people may find it hard to assert their own individuality as they grow up, and may use food as a weapon in their struggle to resist overprotective parents. When young people have been badly treated or abused, they may see themselves as worthless. The consolations of eating, the satisfactions of not eating, may seem the only options available.
Whatever the reason for it, the fear of not being able to cope and of being overwhelmed is something experienced by many people who develop an eating disorder. We feel so unsure of ourselves, so powerless and so unable to express what we want in other ways that we become totally pre-occupied with food and eating. This is more than just seeking comfort, it is an attempt to escape or to control our deepest insecurities. Yet is it not a true solution, since we become more entrapped than ever.
What you can do
We gradually become more and more fixed in our attitudes to food and more rigid about following the eating routines we have started. It grows increasingly difficult to break out of these patterns. Indeed for much of the time, we may not even want to, as living our lives in any other way seems unimaginable.
'It's like you're holding two conflicting things in your head at once. You want to get better, put on weight. You know you have to and at the same time you'd do anything to avoid the next meal, the next bit of food you put in your mouth.'
Help of different types is available, but we can do a lot ourselves to escape from our situation. Even if we feel very uncertain about wanting to change things, we can take some very small first steps. It's likely to be a long slow process, so it's important not to expect too much of ourselves. What works will be different for each individual, but here are some of the things other people have said helped them:
- find ways of 'spoiling' yourself (apart from with food). Do things you enjoy - or used to enjoy but perhaps haven't done for a while
- put your energy into different channels. Find things you're good at, which give you satisfaction
- try to make sure you get a chance to do what you want, not just what other people want, at least some of the time
- don't become overly concerned with reaching a target weight. If you can get to the point of liking yourself and being more at ease with yourself, that's progress indeed!
Inevitably there will be ups and downs. In times of crises, we may find we go back to the 'old ways' but this is usually just a phase which will pass.
'Some people use drink or cigarettes when things get rough. With me, it's my eating which goes haywire. I find it really hard to eat for days on end if I'm stressed, but I now know that won't last.'
As our lives become less and less focused on ourselves and what we eat, it can be surprising to find how much scope there is to do other, more fulfilling things with our lives.
Getting help | Medical treatment | Self help | Counselling and therapy
Getting help'I felt terrible, life was dreadful. The pain and hunger were overwhelming. I felt very frightened. I realised I could die ...I knew I needed help. Someone to trust, someone who could understand what I was feeling.'
'It was a huge relief in the end, when someone else stepped in and helped me. I knew I couldn't go on as I was.'
Accepting there is something wrong and that we need help to deal with it can be extremely difficult. We may have struggled so hard for a long time to cope by ourselves that offers of help can be very threatening. The more concerned those close to us are, the more they may pressurise us into accepting help. It can feel like we're being backed into a corner. There are situations where an eating disorder becomes life-threatening, and action may have to be taken to preserve someone's life even without their consent. However, it is important that we find help which suits our own particular needs, when we are ready.
There are different sources of support available to people with experience of eating disorders, each offering different kinds of help. It is worth contacting one of the organisations listed later to find out what's available in your area.
Because of the possibility of physical harm, it is important to be seen by adoctor. People may well go to their family doctor when they first decide to seek help. Your doctor may refer you to a psychiatrist for specialist advice or to a counsellor or therapist (see below). Sometimes, medication will be suggested - usually tranquillisers or anti-depressants - to relieve some of the symptoms. This can be helpful in the short term, to get through a particularly distressing time for example. But drugs will only help with the symptoms not the cause. These types of medication can have unpleasant side-effects and some tranquillisers should not be taken for a prolonged period. You are entitled to ask your doctor to explain the pros and cons of any medication you are given.
There are now a number of specialist centres which provide inpatient treatment. Where you live may decide whether you have access to one. They offer a range of treatment. Some require patients to follow a strict regime laid down for them in order that they achieve reasonable weight levels and patterns of eating. Others encourage patients through counselling and group therapy to take more responsibility for their own recovery.
Meeting other people who have been through similar difficulties can be very valuable. It is all too easy to become isolated and to feel you are the only one who feels and behaves as you do. Being part of a group provides an opportunity to share experiences, to be understood and accepted without blame or guilt.
Counselling and therapy are sometimes called 'talking treatments' because they give people a chance to talk through their difficulties. Therapy - of which there are many types - tends to be longer-term and to be concerned more with explaining and coming to terms with past events.
Counselling is more practical and focuses on present day feelings and difficulties. In either, it is important to find a counsellor or therapist you can relate to and trust.
For many people with an eating disorder, their pre-occupation with food is away of dealing with emotions they cannot otherwise show or express. If we are able to find a counsellor or therapist we trust enough to confide in, this can provide a great release. It can enable us to begin to resolve some of our concerns.
'Without one-to-one counselling, I would not have got through it. It may not be right for everyone, but for me it was invaluable.'
'Some other people at the hospital had little time for me and they had no sympathy, as they saw my problems as self-inflicted. My counsellor was not at all like that.'
Friends and relatives
As a friend or a relative you can do a lot to help someone who is experiencing an eating disorder, although it can be difficult at first to see how, or to feel the person you care about will ever get through this. Your concern for their health may make you want to urge them to seek help and to change their eating. Often, however, this may only make matters worse, and worries about their eating can end up taking over your life as well.
Endless confrontations are exhausting, and will leave your friend or relative with an even lower opinion of themselves and possibly an even greater determination to resist your efforts to help. Try to accept their behaviour -although it may seem senseless and deeply distressing, it has come about for a reason and is their way of coping with life. As far as possible, try to let your friend or relative make their own decisions, painful as this may be for you.
Your role may be to encourage the person to talk more freely about what it is that distresses them to the extent that they react in this way. If they do not wish to confide in you, it is important you let them know you are standing by them. They may be feeling guilty about the pain and distress they are causing you, and not know how to deal with that. Try to be open and honest about your own feelings without getting angry. Encouraging your friend or relative to take up new interests and doing things together with them can help shift the focus away from food. Help them to see what they are good at.
When someone acknowledges they need help, you may be able to assist practically, by finding out about local support groups or other resources in your area. The person may be feeling very vulnerable and threatened at this stage, and need reassurance from you.
In all of this process, try to stand back and allow your friend or relative some breathing space, to make their own choices.
Watching someone close to you act in ways which harm them and disrupt the lives of all concerned is a terrible ordeal. You may feel:
- powerless, as your efforts to help are constantly rebuffed
- angry at the pain and worry caused
- guilty, that in some way you have failed the person and contributed to their current difficulties.
Try not to let your life be dominated entirely by the needs of your friend or relative. It is important to take care of yourself too. Keep up with your own friends and interests. Make sure you find time to do the things you enjoy. You may want to contact a local support group to learn how others cope, and to find an outlet for your own feelings.
Looking ahead
Getting over an eating disorder can take a long time. Many people worry they will never be free of it. It is a daunting prospect - as if you need to take your life to pieces and put it together in a different way. But it can be done.
Food and eating are part of our existence and cannot be avoided if we are to survive and to share parts of our lives with other people. We have to find some way of dealing with the distress which we previously disguised in the use we made of food.
We may need to assert our independence to find out what we really want. We may opt to make a fresh start doing something we choose to do.
Whatever route we take, we are unlikely to come out of the experience unchanged. We may even look back on it as an important landmark in our lives which helped us find out who we are and who we want to be.
Useful addresses
Useful Addresses
The national organisations listed below will provide information about the help available in your area and put you in touch with local groups:
Scottish Association for Mental Health
Cumbrae House
15 Carlton House
Glasgow G5 9JP
0141 568 7000
Health Promotion Library Scotland
Health Education Board for Scotland
The Priory
Canaan Lane
Edinburgh EH10 4SG
Tel 0845 912 5442
Fax 0131 536 5502
email: library.enquiries@hebs.scot.nhs.uk
Suggestions for reading
Bulimia nervosa: A guide to recovery,
by Peter Cooper.
Published by Robinson Publishing, 1993.
Anorexia and bulimia: How to help,
by Marilyn Ducker and Roger Slade.
Published by Open University Press, 1988.
Coping with bulimia,
by Barbara French.
Published by Thorsons, 1994.
Anorexia nervosa: A guide for sufferers and their families,
by Dr R. L. Palmer.
Surviving an eating disorder: Strategies for family and friends,
by Michele Siegel, Judith Brisman and Margot Weinshel.
Published by Harper and Row,1989.
Many different publications about the subject are available, we list only a few. For further suggestions and advice contact the organisations listed earlier, or your GP or local librarian.