Very few people really understand how to treat anorexia nervosa. This is why so many people who need help fall between the cracks
First you need to understand all the treatments and what they do.
Second, you need a therapist with the skills to use these therapies and the emotional strength to help people who may not wish to change.
The therapist will need emotional qualities of firmness with compassion and who knows how to talk to the anorexic Voice.
If you need treatment and you have been consigned to a waiting list you can get help in the meanwhile by getting us to build you a scaffold of support.
If you want to know more about treatment, click here and remember help is only a phone call away.
Watching Jesy do her programme on body trolling, all of us here were nearly in tears. How brave of her to do this and I hope that one day she will look back on this time and feel good about herself. Poor body image is called Body Dysmorphia and the need for changing your nose, lips or anything else is a symptom. Eating disorders is always about poor body image. It broke my heart to learn that Jesy starved for a week to look thinner on a show. Jesy – this will only make you crave food even more. Katie Hopkins, I rate some of your ideas – but calling Jesy a chub is a crime, for which I would willingly hang you out to dry or put you in the stocks. A 9-year-old child I know, who is as thin as a reed, was fat-shamed “for fun” online a month ago. I have something on this website information section about body image if you would like to read it. https://eating-disorders.org.uk/information/body-image/
And we can treat poor body image too. Is your body the real problem or your OPINIONS about your body? Do you need HELP with internet bullying? Don’t suffer in silence. Don’t wage war on your body. Ask for help. Call us 0845 838 2040 This is something we can treat .
Are you vegan because you love animals, or is it a way to lose weight? Do you feel deep deep down that vegan-eating will prevent weight gain? Do you feel dirty if you eat fish, meat or eggs? Have you ideas of saving the planet? If you do, learn how plant based diets contribute to affecting the biosphere. Its more complicated than you think.
Victoria Lambert writes in the Telegraph. “When I first went back to eating fish after a year of strict veganism, I noticed the effect quite fast. I felt more alert and aware as though someone had woken me up.
My experience replicated that of actor Anne Hathaway who said she felt like her brain had “rebooted” when she returned to eating fish after some years on a plant based diet.
Now a new report in the journal BMJ Nutrition, Prevention & Health suggests that our instinctive dietary changes may be grounded in fact. Dr Emma Derbyshire has warned that vegans may be storing up health problems for themselves and even future generations.
Dr Derbyshire is concerned that vegans cannot access the amino acid choline which is essential for the health and development of our brains.
“Plant-based diets are great and brilliant for the environment,” she says. “But in terms of reducing intake of choline – which is vital for foetal brain development – no-one had given it much thought.”
Choline is not the only nutrient a vegan diet can lack, says consultant dietitian Sophie Medlin, a lecturer in Nutrition and Dietetics at King’s College London.
“Anyone following a plant-based diet,” says Medlin, “is likely to have sub-optimal levels of Vitamin B12 and an essential fatty acid called DHA. These are vital for the health of our neurons or brain cells.”
Deficiency symptoms include brain fog, short-term memory loss, changes in mood, difficulty sleeping, agitation and anxiety.
Choline, DHA and B12 have one other thing in common: they cannot be made in the body and only accessed in meat, fish, algae or dairy directly.
Vegan supplements do exist: DHA can be found in an algae supplement and B12 via an oral spray. Choline is more complicated as it is only available as a powder to be added to food but supplies are unregulated and, says Medlin, its’ impossible to know how much you need to take.
For those of us who have taken veganism on as a dietary change hoping to feel better, Medlin suggests introducing a little meat or daily, via a glass of milk or a portion of oily fish.
However for those doing it for ethical reasons she says: “I’d like to see The Vegan Society getting more involved. They need to warn of the risks and signs of deficiency and how that can be overcome in a properly vegan way.
“Giving up being vegan is difficult if you are committed to animal welfare. So vegans need to be shown all the options to support them. But if they want to avoid brain fog, they need to know the risks that they are running of serious nutritional deficiency.”
A report came in about a young person going blind because of their eating difficulties. Today, I also had a phone call from the parent of a 5-year old autistic boy who will only eat crackers and is not getting the right help from his therapist.
So, let’s make it clear what ARFID is, what causes it,
and what to do about it.
ARFID is a name given to a cluster of eating difficulties. It means Avoidant Restrictive Eating Disorder.
It exists in children who are called fussy eaters and it exists in adults in
various forms. I (Deanne Jade) am an eating disorder specialist and I am a
Selective Eater, there are many foods I just don’t eat because of texture or
taste. But I eat well. You could call me an ARFID case, but I am healthy fit
and very well fed.
An eating disorder is SPECIFICALLY eating disturbances which are motivated by
the need to control weight and shape. Not all ARFID behaviours thus satisfy the
definition of being a classical eating disorder like anorexia or bulimia. ARFID
is a name given to a cluster of conditions which are different. These could include
ANOREXIA NERVOSA in a child. Children as young as 5 can get
anorexia. The diagnosis is only valid if the eating motivations are fear of
weight gain. Children with anorexia don’t usually complain of feeling fat; they
are more likely to complain of tummy aches. It takes a specialist to tease out
the weight control issues that are affecting their desire to eat.
SELECTIVE EATING – where a child will only eat bread and jam
or crackers. Selective eating is normal in children due to something we call
neophobia (fear of eating what is unfamiliar). It can be very dangerous or mild
and often changes as a child ages. The REASONS are very diverse. Some children
might have early traumatic experiences with choking, swallowing difficulties if
given food lumps too soon fear of being sick which they associate with certain
foods, or they just haven’t been well trained in eating a wide variety of
foods. It is easier for a child to eat a wide variety of foods if their mother
has eaten widely and well during pregnancy and breast feeding.
Selective eating can emerge due to unhelpful parenting,
family poverty where parents only give children food they will eat. They cannot
afford to buy vegetables and have them discarded. Parents who want their child to eat often don’t
know how to persuade their child to try something they dislike and give up too
easily or use the wrong skills such as shouting or bribery which often doesn’t work.
SELECTIVE EATING OR ANOREXIA – AUTISM
Arfid behaviours are common in autistic people of all ages; autistics typically have a narrow range of foods they feel able to eat. They may avoid certain colours, only eating yellow food, and commonly experience panic if they are asked to eat anything unfamiliar. The primary problems in autism include what psychologists call “central coherence”- this means problems with how the brain is wired. Wiring is not an illness but it can help make people ill; they find it hard to shift out of persistent unhelpful behaviour. Another primary problem in people living with neuro-divergence is sensory hypersensitivity that makes certain textures hard to bear.
ORTHOREXIA could be viewed as a form of ARFID. Orthorexia is
where people restrict the types of food that they are willing to eat because they
think it is bad for them. They may for various
reasons start to cut out meat, dairy food, wheat, all carbohydrate because they
have developed fixations that such eating is wrong, or they are allergic.
Orthorexia is associated with anxiety and in some people orthorexia is linked
to weight control, being just another
way of being on a diet. Orthorexia in those cases is a classical eating disorder
not unlike anorexia. It is a problem when it interferes with life and general
happiness. Orthorexia is explained more fully elsewhere on our website.
CHILDHOOD FOOD AVOIDANCE EMOTIONAL DISORDER is not anorexia;
it is a stress response, sometimes to drama or adverse experiences during
childhood. It is more common in sensitive children. We cannot make assumptions
about whether the problem is in the family or in the personality of a child or
their environment. A careful assessment must be made.
PERVASIVE REFUSAL to eat is present when a child is unable
to take care of themselves in any way and is often the effect of trauma and
abuse.
OTHER CAUSES OF ARFID
Restrictive eating can exist in people with other mental
health difficulties like schizophrenia where for example, people have delusions
about food in general or certain types of food. Delusions of being poisoned can
lead some mentally fragile people to avoid eating.
WHAT TO DO ABOUT IT: CHILDREN
Since ARFID takes many forms, the first thing to do with a child
is to see a GP, to express your concerns. A GP should track a child’s weight
and growth to make sure that they continue to thrive. A GP can see if there are
physical problems; it would be wrong to assume that the eating is entirely
emotional.
There are things that parents can do at home. Children don’t
respond well to bribery or threats. If parents regularly give pea-size portions
of disliked food and gently insist that these are eaten, over time (keep going)
the child will learn to accept and tolerate new tastes. Thee should be no
attempts to fill up with foods high in sugar, like cakes and biscuits, although
parents are rightly afraid that their child is not getting enough. If you are very worried, find a way to supplement
a meagre diet with appropriate vitamins and an omega 3 supplement which is
important for brain health.
Getting a child to cook with / for the family is a useful
way to broaden their familiarity with new foods. You can do this with a child
as young as 4 or 5 starting with things that are easy like making a smoothie
(healthy) which contains a range of fruits and vegetables. We recently made
carrot ice cream which our children loved.
Children live what they learn, so they will watch what their
parents eat (show enthusiasm about healthful foods). It may be helpful to learn
skills to hide vegetables in food, or use other tricks to ensure a child eats a
less
diet. Some children grow out of ARFID, but not all.
IF THE SITUATION IS WORRYING
If a GP is worried, the next step would be to ask for an
appointment with a child psychologist who will do a proper emotional risk
assessment, to find out what KIND of ARFID is present. The psychologist should be able to advise on
strategies to help a child eat better. CBT is useful to deal with some forms of ARFID
but this is mostly for adolescents and adults.
If you have concerns about inadequate help, please call us
for some advice. We have some therapists who are qualified to work with
children. Call 0845 838 2040 and speak
to someone who cares.
Are you a teenager between 16-19 years old and struggling with your weight? Are you a parent worried about your overweight teenagers?
Following our previous Channel 4
series ‘Shut Ins’, Blink Films are looking for people to take part in a
programme tracking the lives of teenagers who have become seriously overweight
and are at risk of heading towards health issues as young adults. We will be
working with some of the country’s leading medical professionals and we may be
able to help you with expert treatment and support.
You might have struggled to seek or
find support from health care authorities. Or perhaps you struggle to change
eating habits for psychological reasons and need the courage to make a brave
lifestyle change.
All of us here at the office are inundated with Anorexia Blogs, posts and stories. We welcome your writing in hope to treat anorexia, and we know that writing about anorexia helps you if you are suffering.
This is an account of Anorexia written by Lizzie Porter. It is Eating Disorder Awareness time again and we wonder if what you are writing helps others, or helps them to reach out.
We get very sad reading all this ourselves. But it is OK if this helps us to treat anorexia or if this helps you to recover. Or if it adds to our awareness and understanding of the disease.
I do not think that any descriptions aid understanding because people with anorexia do not really understand themselves; they just describe in a lot of very colourful detail. A starving being is stripped of self awareness. It is up to us psychotherapists to know about the nature of the Voice and to know what else is hidden underneath this condition. It is the hidden material which is not in awareness.
I have talked today to a journalist about pro anorexia websites and what is bad and good about them. I explained about anorexia and what it means if you have it. It isn’t just a wish to be thin and you can’t treat it with threats and promises. It is like Aids of the soul.
If reading Lizzie’s article helps you, along with all the other books and stories, then we will keep on sharing your stories. Please, please, please, please, however send us more stories about what helped you to recover. Please use your suffering to help others recover, if you can. I recovered from anorexia many years ago and it is simply a shadow memory. I do not give it house room any more. The wish to be thin never goes away, but the Voice now bounces off a different life for which I am always grateful.
Deanne says, when I see a story like this I really feel sad. How horrible to be trapped inside this condition for such a long time, and how lonely this lady is. I would like to help her but she thinks she is beyond help. If any reader would like to reach out to Emma Jane please let me know at admin@ncfed.com
ANOREXIA – ‘an ill and morbid state of the spirits, like a skeleton only clad in skin’.
I remember thinking of anorexia as my ‘secret friend’.I even gave her a name.
“Marnie”.Anorexia is MOST DEFINITELY NOT a friend. Unless you think of a friend as being wholly destructive, deadly, lethal, fatal.
Looking back, I still have a very clear memory of the day I decided to just eat Ryvitas. I’m not entirely sure why I picked this particular day, whether there was any great significance in it, or if the little demon that had been quiet enough in my head, had suddenly decided to have a voice and spring into life. And like the friend that I thought it was, I stopped and listened, heeding the advice that it gave me.
I had always had a rather fractious relationship with food, having been bullied mercilessly throughout most of my school life for being ‘the fat girl’, the person that no one wanted to be friends with, like I was some sort of freak of nature, an eyesore, a figure of fun. AND THAT HURT, A LOT.
I suppose I comfort ate. My childhood was fraught with severe trauma and abuse. Those scars having manifested themselves deeply, resulting in complex mental health issues, and at the time I turned to food as a source of comfort, something to enjoy.
On the day that I decided to severely restrict my food intake, I naively thought that I just
didn’t like food anymore. It was no longer the source of joy and comfort that it once had
been. Now it represented the devil, something wholly unlikeable, repugnant and a luxury I should no longer partake in and enjoy.
At the time it caused my family great upset. They just thought it was a phase, that I was
being difficult, dramatic and attention seeking. They seemed to make no effort to understand AT ALL.
I loved watching my body change shape. Hip bones appeared, something that I had never experienced before, I had cheek bones and I felt like I was finally getting the body that I had craved as a school girl, only many years too late.
The trouble was once I started to control my eating, I found that I was unable to stop. The control took over my WHOLE LIFE. It was all consuming and it was all I ever thought about. Eventually I got to a stage where my body weight became so low that I was unable to work, to live everyday life. My first hospital admission beckoned.
I was absolutely devastated when this happened. I had to leave my beloved cat at home and I was so upset that I had failed him, just like my family had failed me. I HATED MYSELF.
My admission lasted approximately 4 months. I attended all of the therapy classes and learnt a lot about myself and anorexia. It was no fairy story, believe you and me.
The day I got discharged I was so happy. Happy to be alive and happy to be reunited with my gorgeous cat again.
And I recovered. I stayed well for many years. I think I was so frightened of relapsing that I put my head down, plugged away at my recovery and made really good progress.
And then many years later, things began to go wrong.
My stepfather died after years of battling with alcoholism. I was absolutely devastated. I felt like I was to blame, that I should haven’t done more to help him. But if someone won’t accept their issues and that they need help, then you are very limited as to what you can do.
I had already begun to struggle with my eating but my mental state began to rapidly
deteriorate. I literally felt like I was drowning every minute of the day. There was no let-up.
In what turned out to be my last day at work, I threatened to jump out of the window unless I was allowed to go home. I became totally and utterly hysterical. I knew for a while that my head wasn’t feeling well but I didn’t really understand the messages that it was giving me, or that I was seriously very unwell.
I felt like I was living in some weird, blurry haze. Nothing made sense to me anymore. I
became very impulsive and tried to kill myself on several occasions. Thankfully I didn’t
succeed. My Doctor was and still is absolutely amazing. I remember going to see him after my breakdown. He asked me what had happened. I said “I don’t know but I know I’m not very well”. A whole load of jumbled up words and sentences came flooding out of my mouth.
That was one of the very few occasions where I saw him panic about my state of mind.
As a form of control, my old ‘friend’ Marnie completely took over my head before I had even
realised it. I HAD TO CONTROL EVERYTHING. It was the only thing that I had left in my life.
Week after week, I lost weight. I just couldn’t stop myself, secretly elated when the scales dropped further each time that my Doctor weighed me. He kept asking me to stabilise my weight and I would smile and say that I would try, but had no intention of ever doing it at all.
And then the morning came where I was weighed and it had dropped to such a level that it was beyond dangerous now. I felt too tired and ill to care anymore. I just couldn’t carry on
‘living’ like this. Except I wasn’t even living, I was just existing and barely able to do that now.
So the next day I met my EDS Consultant and my Doctor at my house. They wanted to
admit me that day, that potentially I had just 2 days to live. I refused as I needed to sort out who would look after my little rescue cat and my horse. My whole world was coming crashing down around me. The 2 things I loved more than anything else, and yet again I had failed, BIG TIME. I have massive abandonment issues after my childhood, and here I was abandoning them. On what was deemed my 2nd day left to live, I was admitted to hospital. No level of understanding or support from my family whatsoever. I was so poorly that nobody expected me to survive the weekend, BUT I DID. T and Ro, my cat and horse, gave me the willpower to fight, fight to survive, to live. I JUST COULDN’T LEAVE THEM FOREVER.
My admission lasted for 6 and a half months. During this time I did lots of writing and also wrote and recorded some songs. It’s strange how life takes you on all sorts of paths and journeys that are completely unexpected, but welcome nonetheless.
The worst thing was, was that I HATED GAINING A NORMAL BODY SHAPE again. Where were the bones I used to thrive on seeing? My once skeletal frame that I accepted was ‘normal’, had disappeared. We had body image lessons where they try to convince you that size is just a number and the importance of being healthy. My head just screamed the total opposite to me.
As soon as I was discharged, I stupidly acknowledged the voices in my head telling me to lose weight again, not loads but just enough so that I would feel happier again. I had grown up with the notion that thin girls are popular and have more friends.
So the weight started to fall off me again. I kept vowing to myself that I would stop. I wasn’t going to make myself ill again. That would be stupid, ridiculous after nearly killing myself only a few months previously.
Except when anorexia takes hold again, it has happened before you even realise it.
Suddenly you’re back to all consuming thoughts and taking back control again to very
dangerous levels. Because control is ALL YOU HAVE LEFT.
Nearly 3 years since my discharge and I’m sad to say that anorexia as well as BPD, bipolar and PTSD are STILL causing me great harm, hurt and distress.
I feel really sad that I have let things regress to this level again. I HATE IT AND HATE
MYSELF for allowing it to happen.
There are so many misconceptions and prejudgements surrounding mental health illness. You cannot see a person’s anguish and suffering like you would for a physical ailment. This is beyond frustrating. Mental illness is just so powerful and domineering. Anorexia is certainly no friend of yours either.
I live in hope that one day, either in the near or distant future, that someone will find the right key to open up my mind so they are able to help me. Until then, that box in my head remains very tightly shut. Emma-Jane Bradbury-Jackson
I am doing qualitative research on binge eating and emotions supervised by Zoe Boden. More specifically, my research includes interviewing 6-10 women who have had recurrent experiences of binge eating and have been diagnosed with any of the eating disorders. My research question is: how do women experience and make sense of their emotions before and after binge eating. As regards, the age range I would like you to be 18-30, to have a history of binge eating the previous 5 years and to have been in a recovery process for the last year.
I’ve been helping Buzzfeed to prepare an in-depth exposure of gym practices . Gyms are full of men and women who strive to be thin (and fit?); to shave off fat and to build muscle. Some of these people are overdoing exercise, or are too thin to work out. Some men are abusing steroids to beef up. Some gyms encourage this kind of muscle competition and advise people to take all sorts of pills and supplements that may help. This is just one step away from taking steroids, which can kill and maim.
Do gyms have a moral responsibility to single outpeople who may have an eating disorder, and tell them to stop coming?
Most gyms have a health questionnaire to fill in for members. But I would like to bet that trainers turn a blind eye to people who appear too thin to pound the treadmill or turn up for their daily 2 mile swim. On top of that, many people with life threatening eating disorders like bulimia, don’t look too thin at all.
If one gym expressed concern, I would also bet that an exercise addict with an eating disorder would just go somewhere else. Should gyms have a legal responsibility for clients who run on empty? I think they have a moral duty. Alongside their advertisements for classes, I would like them to have some health posters up, to guide people against exercise addiction and to help people who might have an eating disorder. They could train staff to talk to people in confidence and show them where to go for help.
People with eating disorders can be their own worst friends. I’ve heard people say; If no-one has taken me aside and worried about me, it means I am not thin enough, so tha’ts one good reason to keep starving. I’ve heard others deny that they have an exercise addiction; they are addicted to their own endorphins. Exercise addiction – are you or aren’t you… that’s another story for another day.
Gyms and for that matter, personal trainers, have a lot to answer for if they don’t know when and how to say “I’m worried about you- would you like to talk about this?”.I know someone who was driven into a serious eating disorder by a personal trainer who did not know what she was doing.
If this article is taken seriously by just one gym, it was worth writing. If you belong to a gym why not go and talk to someone who will be prepared to read it.
