Eating disorders – understanding them and getting help

Wendy Bramham was invited to BBC Wiltshire in 2013 to give advice about a range of mental health conditions, including eating disorders.  The following is information which may help sufferers or their families and friends.

EATING DISORDERS

An eating disorder is when an eating pattern starts to have a serious impact on your emotional or physical health, and on your day-to-day feelings. Typical categories include anorexia, bulimia and binge eating; many people will swing between all three, or not fit into any of these. Eating disorders are a form of addiction, and can be extremely difficult to relinquish. You can suffer from an eating disorder at any weight, i.e. you don’t have to be thin (only 10% of sufferers are anorexic; 40% suffer from bulimia; the remainder fall into binge-eating or non-specified categories).

Why does a person develop an eating disorder?
It is difficult to answer this question simply, and it is dangerous to generalise. Mental health issues involve a mixture of mind, body and emotions, and so are complex. Many psychological difficulties occur due to a mixture of genetics, early childhood experiences, personal and family history, and current life circumstances. Each individual will have their own different reasons and different avenues that lead to recovery.

• Often an eating disorder begins in adolescent or teenage years, but not always
• We are vulnerable if we are preoccupied with studies at school; are desperately trying to hold things together; are afraid of letting people down; feel that we must keep going; want to be high achievers; or feel deep down we must be perfect to be lovable
• Onset may follow a stressful life event, such as trauma, neglect, a difficult relationship or a bereavement
• Eating disorders are sometimes linked to anxiety about bodily changes during and after puberty and the onset of sexual maturity
• Conflicting fears and wishes for independence and autonomy can be a factor. For example teenagers and  young adults naturally  need their parents’ support and affection and yet equally need to be separate and have their own relationships
• Underlying issues may include low self-esteem, depression and anxiety, and these have a great impact on someone who is, for example, vulnerable to societal and media pressure to be thin. Such a person may not be able to find enough of an identity for themselves beyond such false/unrealistic comparisons
• People who do not develop eating problems may be concerned about their weight but there are other domains in life that influence their self-esteem; these act as a protective buffer

The National Centre for Eating Disorder lists the following typical personality traits in eating disorder sufferers (http://eating-disorders.org.uk):
• Feelings of powerlessness, or worthlessness
• Sensitivity to imagined rejection or abandonment
• Poor assertion skills and difficulty managing relationships healthfully
• Perfectionist attitudes, and applying high standards to themselves whcih they would not necessarily apply to other people
• Poor emotional problem-solvers, tending to avoid life’s difficult situations
• Difficulty saying “no” or asking for what they want in life; tendancy to be “people pleasers” or go out of their way to be nice, but may have moments of aggression when things get on top of them
• Lack of confidence in managing relationships in a way that serves their needs rather than those of other people

An eating disorder can seem like a logical way of coping with some of the issues listed above. It is an attempt to regain a sense of control and safety when life or our feelings are overwhelming and chaotic, and because weight can be controlled it becomes an important source of power for the sufferer. Controlling food intake is often an attempt to manage feelings of anxiety, fear, helplessness, hopelessness and sadness, and additionally the disorder can become a useful scapegoat for all that is wrong with a person or their life.

Hidden Benefits of an eating disorder
 offers something that the sufferer cannot achieve elsewhere (eg control)
 a way of communicating something that can’t be done in other ways
 a way out of commitments or pressure
 due to the pressure to be slim (endorsed by fashion media) we falsely believe that if we have the “perfect” body we will feel more confident and life will be good
 helps us to feel we can cope when life feels overwhelming
 a way to rebel against parents, and assert autonomy

Stages
 Most eating disorders start from dieting
 A person begins to set very strict rules about “good” and “bad” food, which must be followed
 Meals with family and friends will be avoided, leading to withdrawal/isolation
 Strange rituals with food may occur
 Weight loss happens, and this may also be due to over-exercising and/or making oneself sick and/or taking laxatives
 People make themselves sick (bulimia) because they can’t keep up the strict controls over eating, and then resort to binge eating on the so-called bad foods. This leads to guilt, self-hatred and shame. Due to these feelings the problem can remain hidden from others for years.

How can you tell if you have an eating disorder? (see www.b-eat.co.uk)
 Do you ever make yourself sick because you feel uncomfortably full?
 Do you worry you have lost control over how much you eat?
 Have you recently lost more than one stone in a three month period?
 Do you believe yourself to be fat when others say you are too thin?
 Would you say that food dominates your life?

Serious health side-effects
Due to loss of muscle and electrolytes (important chemicals in our bodily fluids), the vital organs can be seriously damaged, including the heart which can become weak. This can lead to cardio-vascular disease and heart attack. Other problems include loss of periods in females, lanugo hair on face and upper back, hypothermia, infertility and osteoporosis. Tragically, whether intentional or not, people can and do die from eating disorders.

First Steps to Recovery
Shame, guilt and fear can stop someone from getting the help that is so vital to recovery. Admitting things have gone wrong is not at all easy but is the crucial first step to getting better.
Don’t try to manage this on your own. It takes determination, motivation and insight – as well as time and patience – to begin to recover. Get support from family, friends and professionals. See your GP and join a local support group or contact a charity such as B-eat – 0845 6341414 or ABC – 01934 710679. Alongside daily practical support, try to find a therapist who will meet with you for as long as you think you need.

How to find a therapist
Ask your GP for what is available in your area on the NHS. Alternatively look for a private therapist. It’s always good to get a personal recommendation if you can. Otherwise I recommend searching for a local therapist by going onto the British Association for Counselling & Psychotherapy (BACP) website – Its Good To Talk – www.itsgoodtotalk.org.uk/‎ – look for “accredited” therapists. Or try the UK Council for Psychotherapy (UKCP) www.psychotherapy.org.uk/‎ Then look for someone with whom you feel comfortable and understood, where your strengths as well as difficulties can be validated. It is common practice for the first session to be utilised to work out whether it is right for you. Try to gauge if you feel safe enough with this particular therapist to be open, honest and vulnerable. Trust your instincts.

Self-Help
Don’t just measure eating and weight as a sign of getting better. It is crucial to try to address the emotional turmoil beneath the eating disorder.

 Take a realistic look at how your eating disorder affects you in a negative way. Also be honest about the hidden benefits (as mentioned above) you might be subconsciously gaining from your attitude to food and eating. What is your eating disorder giving you? What need is it meeting in you? Then learn more positive ways to meet that need. This endeavour should probably be undertaken in regular therapy sessions with a therapist who is supportive and who also can see you as a whole person beyond your eating disorder, i.e. so that you can discuss your passions, abilities and begin to address your future hopes and ambitions.
 Get support from friends and family
 Join a local support group see B-eat or ABC as mentioned above
 Consider family therapy
 Read up on it and learn – become an expert
 Be honest with yourself and others; don’t put on a false façade and pretend that all is OK

Words from a recoverer: “Developing a sense of self after years of being detached from life was very exciting!”.

How does Therapy help?
 Provides a safe container for the dialogue that can begin to explore the underlying and sometimes hidden feelings, thoughts and circumstances behind the disorder
 Such an exploration is done in the context of a trusting, reliable, boundaried, non-judgemental working partnership over time
 Can increase a person’s ability to tolerate difficult feelings and also uncertainty
 Can increase a person’s capacity for self-awareness, self-acceptance and self-compassion
 Negative thinking is often rooted in disordered relationships. Therapy can offer a different experience of relating
 Can illuminate self-destructive thinking and core beliefs such as “I am not good enough”. Such thinking patterns can form a person’s identity and gives reasons for bodily attack

Parents/Carers
It is extremely hard to have to watch your child suffer and to be confronted with strong emotions such as anger and despair. Parents have a tough job because they are trying to be both supportive but are also expected to “supervise” mealtimes etc.

 Try to see the person beyond the eating disorder. Try to view the eating disorder as separate from your child.
 Because your child feels safest with you, it is likely they will vent their anger and other scary feelings onto you. Remember that intense feelings are triggered by the eating disorder and are often not personal. Try not to get into confrontations, get angry or use emotional blackmail
 Get support for yourself – this also teaches your child that it’s healthy to ask for help; it will also make you more able to cope with your child
 Draw limits for unacceptable behaviour – when things are calm make a plan with your child how you will both cope when times are fraught
 Encourage your child to get professional help and be part of the process
 Learn and understand about eating disorders
 Don’t ignore warning signs – encourage your child to talk, and listen to them
 Try to keep doing normal things together – without the eating disorder being the main focus
 Firmness needs to be combined with explanation and encouragement rather than threats or punishment

Statistics the from USA (Association for Anorexia Nervosa & Associated Disorders)

 More people die from eating disorders than any other mental health condition
 For women aged 15-24 the death rate from anorexia is 12 times higher than all other causes of death (American Journal of Psychiatry Vol. 152 (7), July 1995, p. 1073-1074, Sullivan, Patrick F.y)
 20% of those with chronic eating disorders will die prematurely from associated symptoms (www.b-eat.co.uk)
 On a more positive note – just under half of patients who get treatment will recover fully (www.b-eat.co.uk)

Wendy Bramham, July 2013, for BBC Wiltshire