Anorexia bulimia

Bulimia is an eating disorder that is written about and spoken about much more now than in previous decades. It was only actually officially recognised in 1979, but is surprisingly common. The name ‘Bulimia Nervosa’ literally means ‘ox like hunger’ and refers to the episodes sufferers will have where they binge eat sometimes large quantities of food.

Bulimia has three main features, which operate in a cycle which becomes very hard to escape from. Sufferers have a very low self-esteem, and place a lot of importance on their weight and appearance. They generally feel convinced they are very overweight – although in fact most sufferers are at or near normal weight. They resolve therefore to go on a diet, and set themselves very strict rules over what foods they should and should not eat. Typically they will form a list of foods which are ‘forbidden’ – foods which they feel they should never eat. These generally include all the nice, indulgent foods, like chocolate, ice cream, cakes, biscuits, cheese etc. The problem is that once they start to deny themselves these foods, they inevitably start to crave them. However, typically they are able to keep this control up for a while and stick to their strict diet. Some people may lose some weight, and at first they may feel wonderful and that they have gained control over their eating.


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a normal life

Anorexia affects people of all ages and backgrounds, women AND men. It has often been thought of as a ‘woman’s’ problem but in fact around 10% of cases in treatment are men, and many more probably struggle in silence, or fail to get diagnosed. Anorexia usually starts in the early teenage years, but cases in younger children are increasingly common. Anorexia is a very serious problem, partly because of the physical effects of being too thin, but also because it brings with it a terrible sense of despair and loss of hope. People suffering often feel totally trapped, and fear that they will never be able to live a normal life. This isn’t actually true – with the right help and treatment the majority will recover, though it may be a long journey to full recovery.

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purging food

Some people with anorexia do simply restrict their eating and eat very little. More common however, is for that control to occasionally break down, and for them to either ‘allow’ themselves to eat, or to feel a sense of having lost control and eaten. If this happens then they may try to do something to purge the food – try to stop it being absorbed – because they are so scared of gaining weight and getting fat. Some people who have struggled with anorexia for a long time start to slip into more and more cycles of bingeing and purging food (for more information about this, see ‘what is bulimia?’). This is because the body, once it is starving, longs for food, and in the long term many people are unable to keep up the strict control they aim for over food.

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struggling with anorexia

Someone struggling with anorexia restricts what they eat dramatically, in an attempt to lose weight. It may start as a ‘normal’ diet, but then becomes something much more serious. Sufferers lose a lot of weight, and often become dangerously thin – but they are unable to see just how thin they are and often still feel convinced that they are fat and need to lose more weight. They also feel terrified of putting on weight, and continue to eat very little because of a terrible fear of putting on weight. They feel convinced that if they were to eat normally like those around them, they would put on weight very quickly and end up overweight.

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Anorexia Nervosa

Anorexia Nervosa is probably the most well known eating disorder, because over the years it has tended to get more attention in magazines and on tv. The name Anorexia Nervosa means someone who has lost their appetite for ‘nervous’ – or psychological – reasons. This isn’t really accurate because in fact people with anorexia are still hungry – though they may not admit it even to themselves. Instead they have managed to conquer their appetite through tremendous will power and control. At first this sense of being in control is intoxicating – but later on sufferers begin to realise that in fact somewhere they have lost control because the fears and anxieties linked with the illness have become so powerful.

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eating disorder can affect ANYONE

Eating disorders seem to be all about food, but often they are not. They are complicated disorders which can be very frightening when you first come across them.

Eating disorders are increasingly common. Although official statistics say that around 2% of the female population are struggling with an eating disorder, recent studies amongst some groups such as teenage girls reveal much higher rates. An eating disorder can affect ANYONE: men and women, boys and girls.

Whilat some eating disorders may be obvious (perhaps becuase someone looks very ill), usually you cannot tell someone has an eating disorder just by looking at them. Sufferers may be at or near normal weight, underwieght or overweight.

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self-hatred

Eating problems are about more than just food. They begin when someone starts to believe that their life would be different were they thinner. Their weight, size and shape become a scapegoat for all that they struggle with in their life and self-hatred is not far behind. They resolve to lose weight, generally unable to see their real shape as many do not really need to lose any at all. Strict rules about what to eat (or not to eat) are made. Some are successful in restricting their eating, and sometimes exercising fanatically, and become caught up in the intoxicating high they get as they see themselves losing weight. But as their life does not improve and the problems they suffer do not go away they resolve to lose more weight. It becomes a mirage: something they see but can never quite get to. They think ‘if only I could lose another few pounds it would all be ok’, but each time they achieve their aim, they make a new resolve to lose yet more weight. For others, the strict diet is doomed to fail. Their starving bodies demanding food lead them to crave the very things they feel they should not eat. Eventually that control breaks down and they start to binge eat. Terrified of putting on weight they try to find something they can do to get rid of what they have eaten – so they exercise, make themselves sick or abuse diet pills or laxatives. This however simply makes the binging worse and soon a vicious cycle has built up. Still more react to their binging by developing a new resolve. They try the latest diet, eating plan or exercise regime in a hope that it will stop their binge eating. But they continue to set themselves unrealistic goals, and therefore are doomed to fail.

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self-harm

Alongside the issues of weight and healthy eating, other issues are prevalent in our society and are issues we regularly encounter at ABC. Self harm is a serious problem, particularly amongst young people, and as the Uk continues to have the highest rates of self-harm in Europe, increasing numbers of those who contact us about eating problems also need support and information about self-harm. Wider issues such as stress, depression, loneliness and struggles with low self-esteem fuel eating problems, with 60% of teenage girls and around ¼ of adults believing they would be happier if they were thinner. As adult responsibilities and pressures are taken on younger and younger, many children find themselves ill-equipped to cope with them, and therefore are vulnerable to the lie that losing weight might make them feel happier and more in control.

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victims of obsession

Clinical problems with eating are also becoming more common. Eating disorders such as anorexia, bulimia and binge eating disorder are now issues that need to be addressed by all GPs, and studies suggest that the average GP will have several people on his/her list who are struggling with an eating disorder. Younger children, some as young as 8 or 9, are becoming the early victims of our obsession with our weight, as they misunderstand the rules they hear, and fall under the tempting spell of trying to control their diet to win the things they so long for: confidence, popularity and happiness. For most of our teenage girls, the majority of women, and for many men, feeling bad about the way they look has become part of normal life. 90% of women say they do not like their body, with over half going as far as to say that they hate it. Over a quarter say they worry about their body every day. 90% of teenage girls admit that they hate their body and want to lose a lot of weight – over half of them wishing they could drop over a stone, even though they are not overweight at all. Their aims are extreme and represent weights that would be very unhealthy, well within the boundaries of anorexia, and unachievable without some extreme control and restriction of their diet. These pressures are hitting teenagers younger and younger, with 2/3 of under 13s already having been on a diet.

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commonplace

Problems around what we eat have become commonplace. Whilst we live in a culture increasingly obsessed by healthy eating and diets, the truth is that most people are failing in their attempt to gain control of their weight. Millions of people in this country alone (one study estimates over 13 million) are trapped in a cycle of permanent dieting, and the depression and psychological problems that accompany it. The diets are not working. One third of people who diet actually end up putting on more weight rather than losing it and only one in a hundred actually lose the weight they hoped to. The only group of people gaining from our obsession over weight is the diet industry, making millions from the suffering of so many.

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obesity levels

The eating patterns of the people in this country have been placed under the spotlight recently. With news of soaring obesity levels, and concerns about the health of the nation, a government white paper released giving advice on improving our diet and lifestyles, and continuing media focus on body image and appearance issues, it is hard not to be aware of the pressure on everyone about the way we look.

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characteristics

If we are to get to grips with what is happening in our own society, we need to understand the truth about eating disorders and those who suffer with them. Genetic studies have found some characteristics which seem to be associated with an increased risk of some eating disorders but there is no ‘anorexic gene’. Instead these are physical and psychological factors which mean that someone is ‘capable’ of developing an eating disorder; that they are fertile soil should the seeds of an eating disorder be sown. The same characteristics are present in many people who do not and have never had eating disorder. Indeed some are associated with great success and achievement in life. Sufferers are not ‘abnormal’ people whose biology dooms them to struggle with their eating forever. They are simply normal people placed under extraordinary pressure who have slipped under the spell of perhaps the ultimate lie of this age: that being thinner will make you happy. As many as a quarter of adult women and 9 out of ten teenager girls believe this and some of those start to try to control and restrict their eating in the belief that they have found a strategy that will help them to cope. Instead of course it causes more problems than it ever solves.

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stigmatised

Meanwhile, although eating disorders are so common, they are often misunderstood and stigmatised. Research finds that the public feel that individuals suffering with eating disorders are very different from them, much more so than those suffering from other mental health problems like drug/alcohol addictions, depression or panic attacks. They rate sufferers more negatively than those suffering with schizophrenia, bipolar disorder major depression and chronic physical conditions like asthma. They feel that those with eating disorders in general, and anorexia in particular are more to blame for their condition, more able to pull themselves together, and are more likely to be attention seeking. Sufferers are described as difficult to understand or talk to. Perhaps it is not surprising now that for celebrities, being accused of having an eating disorder is such a serious business that it has lead to legal challenges. We live to chase a mirage as we are encouraged to aim at a goal of absolute control, precision and abstention, yet must do this without slipping into the negatively viewed eating disorders. Yet the reality is that without developing the behavioural characteristics of an eating disorder the vast majority of us will never achieve the ideal we are led to seek.

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lack of information

All this is not because of a lack of information on healthy eating. In fact this has become such a key issue that the major supermarkets are now involved in schemes labelling foods to inform people about what is in them, all as part of helping people put together a healthy diet. But with the current focus on avoiding obesity we have forgotten the huge and growing sector of the population who struggle with serious eating problems. Government estimates state that without action we will see 12 million obese people by the year 2010. However recent figures suggest that right now there are already over 11 million people in this country struggling with ‘psychological problems or issues over food[1]’ – and that this group is growing rapidly. In fact many of those who are obese also have an underlying eating disorder. These issues do not only affect teenage girls. Rates of eating distress and body concerns amongst men and boys are increasing. Meanwhile it is becoming less and less unusual to see eating disorders developing in both younger children, and in women in their 30’s and 40’s. Eating disorders are not minor ailments. They are not a cultural trend that can be ignored and left to take its course. They are serious psychological disorders that can have catastrophic medical consequences. Eating disorders kill more under 18s than any other psychiatric condition and still more lives are lost to suicide related to an eating disorder or body image problem. Every one of these is a tragedy that could have been prevented.

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epidemic

Within this country there exists an epidemic of concern, anxiety and obsession regarding weight. As we move further into the first decade of the 21st century, the issue that concerns us most has become not just the numbers of people suffering with eating disorders, but more the developing trend to deny that what the majority of women are going through is anything but normal. Therefore we see a culture that seeks to ‘normalize’ (ie say that this is part of normal life) behaviours such as constantly worrying about your body, obsessively counting calories, fat grams, or carbs for every meal you eat. A culture where over a quarter of adults are effectively on a permanent diet. A culture where sales of laxatives have increased by over 30% since 2001, a rise attributed to the thousands of young women who believe (incorrectly) that they may help them to stay slim. A culture where by the age of 7 nearly half of girls already believe that they should be thinner than they are, and by 14 a quarter will report that they are suffering from an eating disorder. We have become a nation obsessed with undereating and controlling our diet.

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eating disorders

The last twenty years have been momentous ones in the field of eating disorders. There have been big changes - like the official ‘discovery’ of bulimia nervosa in 1979 – and other more gradual changes, for example in the way that eating disorders are treated and understood. But the field of eating disorders is unique in psychiatry and psychology because of the way it is impossible to completely separate the disorders themselves from the culture in which they exist. We cannot think about distorted body image and low self esteem without considering the ideals to which people compare themselves. We cannot think about eating habits and diets without thinking about what is considered ‘normal’ eating. Therefore alongside the changes made in the field of eating disorders, perhaps the most significant and concerning developments are those that affect the way our culture is changing, and the impact that this has on those who are vulnerable.

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