healthscotland.com

Talking about eating disorders (reprinted 2010)

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 nervosa

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.

Bulimia 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.

Compulsive eating

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.