I want to talk about one of the more stigmatised and misunderstood mental health problems – anorexia nervous. I have been open about my struggles with anxiety and depression for the past couple of years, but not about life at the very start of my 20s, and the dark 18 months of struggling with physical health problems that led to a diagnosis of anorexia.
Why? The stigma and the shame I felt with the illness. The attention it drew from the physical changes and an inability to ‘be rational’ about not eating enough is something I found (and still find) difficult to come to terms with.
The main purpose of this post is to highlight the following:
- Early intervention and talking therapy helped me to recover. And I mean, recover – something I didn’t think would happen.
- My experience of being severely underweight came off the back of a physical illness (gallbladder disease). The interface between mental and physical illness must be taken into account when treating someone with an eating disorder.
- I had some fantastic physicians who looked after me, and treated me with understanding and compassion. I wasn’t told “just eat 2,000 calories and a few extra sandwiches”.
I’ll start with the positive: I now have a healthy BMI. I still struggle on some days, but I am in a good place in my life relative to previous years. I no longer fear wheat, dairy, chocolate, fat, carbs. I now enjoy eating out. I’m happy to be cooked for. I’m a vegetarian (and have been for over 20 years), and try to maintain a healthy diet, but I enjoy pudding and treats (possibly too much at times!) Following my recovery from anorexia, I battled periods of bulimia and binge eating, but I am relatively ‘stable’ these days.
With the anorexia, there were two turning points: firstly, having an operation to remove my gallbladder; and secondly, accepting that eating disorders are illnesses, and complex psychological problems that can be very serious and difficult to recover from.
Here is some context which shows the link between mental hand physical health problems: with the gallbladder disease, I started having symptoms at the age of 19 (much to the confusion of doctors, given my age and lifestyle). By 20, I was going to the hospital once every month – usually at midnight – due to the pain in my chest. It was usually triggered by a combination of caffeine and fatty food. For those who don’t know, the role of the gallbladder is to store and release bile when the body needs to break down fat. So, needless to say, eating a cake was fast becoming my least favourite activity, as the pain would build up slowly throughout the day and peak at night. The pain can be described as an intense, dull, stabbing pain just below the right ribcage. It was like someone pushed a metal pole into my side, and I would just writhe around on the floor as I couldn’t get comfortable in any position.
Given this context, it was often challenging to explain to specialists why I didn’t want to eat certain foods.
But this is the most interesting part:
The physical illness led to physiological changes in the body, which have been scientifically proven to occur after the body goes into starvation mode. I recommend a read of the Minnesota Study, a fascinating experiment conducted at the time of the Second World War which explains the behavioural changes behind a reduction in a person’s calorie intake.
After a few months of losing weight, psychologically I didn’t want to eat those foods – not just because of the physical pain, but the little (metaphorical) voice at the back of my mind which appeared, and began to instruct me to avoid other foods, because they’d make me put on weight.
So what started as a physical illness, became psychological. And as someone who struggled with being overweight as a child, and had to deal with the childhood taunts, these insecurities I didn’t realise still existed must have resurfaced.
What really saved me, however, is the quick treatment I received. I’ll never forget the conversation I had with my GP, when I said: “I don’t understand, this isn’t rational. I’m finishing a Law degree and have a few brain cells left in tact – why can’t I change how I’m behaving when I know it’s making me unwell?” Her response was just what I needed. “A lot of students struggle with food as a coping mechanism, and in your case, it’s linked to physical health problems too. You’re not the only one”. Just this reassurance was enough to make me realise that I wasn’t alone. In hindsight, I was struggling with depression at this point in my life, due to a variety of factors which all occurred at once. Isolation from my friends, physical pain, and coping with an intense Law degree probably meant I overlooked the fact I was also losing weight at a fairly rapid pace.
My GP (based at a university in London) referred me to Vincent Square, a specialist centre, where nutritionists could liaise with the psychologists, and help with my recovery. I had an initial assessment within 3 weeks of the referral, and therapy commenced within 8 weeks. Looking back, I can’t believe how quickly the whole process took, and I feel grateful for having lived in London. The services in the town in which I grew up are far more under-resourced and referral times (or even the option of an eating disorder service) are poor.
Acceptance in getting well is the main hurdle for many sufferers. Luckily for me (if that’s the right word), I realised early on that something wasn’t right. I got support within the first six months of being diagnosed. It took a while to really tackle this problem (and trust me, I didn’t think I’d get through it for so long), and the main thing was reminding myself that recovery is a collection of baby steps. And now, looking back, I can see it was a gradua process, with plenty of tears and setbacks, and I can’t believe it actually happened. A large turning point for me was the operation in 2012 that removed my gallbladder. It became much easier to recover once I knew that food wouldn’t send me into hospital.
Sadly there is still so much stigma around eating disorders.
I would hear whispers behind my back about the weight I’d lost, and during recovery, I would get awkward comments from relatives. Christmas was one of the worst times, as I didn’t like being cooked for, and was very rigid in my thinking.
What’s scary, is that I couldn’t see a problem when I looked in the mirror. Now, I see photographs and I can’t believe how unwell I began to look.
If I have one other tip, it’s to reach out to someone and seek their support. It can feel incredibly isolating, and as if no-one else can understand the thoughts going through your mind. But there’s a fantastic community online if you look in the right places. There are also several support groups that could be worth attending – but again, do what’s right for you, and at the right stage of your recovery.
Eating disorders are sadly taboo in a society that often revolves around food. I think the prevalence statistics are actually underestimating the problem, largely because a person doesn’t always match certain clinical conditions. What does this suggest? Listen to the patient. Listen to their story. Empathise and provide advice as early as possible.
To all those struggling with an eating disorder such as anorexia – you’re not alone. Recovery is possible. It is one of the most difficult things you might ever do and make sure you congratulate yourself on every positive step.
You’re a strong and beautiful person no matter what you’re size. Remember that.