Tips For Working With Anorexia

A “Positive Disposition to Recover”.

Even if someone volunteers for treatment, if is often to seek relief from preoccupation with food, depression or physical symptoms. It could be due to rising concern about the risks of anorexia or to avoid the side effects such as infertility.  Does this represent a real positive disposition to recover from the illness (whatever that means)?

Recovery from anorexia  is not just about gaining weight. In many cases being willing to gain some weight is “conditional” on continuing to eat a very limited diet, often vegetarian or low in carbohydrate and fat. 

Eating more is often conditional on continuing to exercise a great deal. There  is a great debate about what constitutes “excessive exercise” and our opinions are clouded by views about the dangers of sedentary behaviour and the general approval which is given to people who “go to the gym”. 

So what is really a positive disposition to recover?  Many of the features of anorexia just will NOT go away if someone remains underweight. Cravings, depression, preoccupation with food and health risks do not go away if weight remains low. Many people want rid of the bad aspects of anorexia while continuing to have its benefits like staying abnormally  thin. That’s not easy to work with. People will not want to look like you.

A “positive disposition” should include the desire to be free from compulsion to exercise, and the ability to eat a wide diet, with other people, and freedom from the constant chatter about what foods can and cannot be eaten. A positive disposition will include the desire to welcome the feeling of food inside your stomach. This will never be possible if weight is low.

 Secretly though, I wonder how possible this kind of recovery really is –  because all  of these recovery outcomes are inconsistent with what gets someone into anorexia into the first place. The anorexic  desire for simplicity, the fearfulness, the ascetic drives –  are not features that can just “disappear”. These are aspects of personality which must persist forever. You cannot argue someone out of their basic personality.

So I’m not sure that I can demand a positive disposition to recover in what would suit me, and my expectations cannot be too high. I think that people and therapists must come to some sort of compromise with anorexia over what will be kept and what can go away for someone to live more happily. Experts might disagree with me.

Force Feeding The Anorexic

Anorexia And “Force Feeding”- Self Determination Or Self Annihilation

A while ago I was listening to LBC radio. The subject was  a decision in favour of the so-called force feeding  of patient E.  On Saturday Norman Lamont suggested that the decision to force feed could be an intrusion on her right to self determination . What complicates this case is that the parents of this young medical student,- anorexic since eleven  years of age-wants their daughter to be left to die with dignity.

There is nothing dignified about anorexia or any other mental health condition for that matter. Also, I just wish that people would STOP using the term “force feeding”, which reminds us of the traumas inflicted on suffragettes on hunger strike to obtain the vote for British women. I just wish that people would use the proper term, which is ENTERAL FEEDING.

Many clinicians have been writing in favour of the judge’s decision on Linked In.  We talk to each other about things we know, which is that low weight impairs the ability to think clearly. That at low weights the anorexic voice drowns out logic, reason and happiness.

But not-one said it better than Kate, who came nervously to the radio to express her point of view. Kate has been anorexic since age 9 and in hospital many times during her young years. She said “I have no idea why I just didn’t want to eat, but I didn’t, and there were times when I would have been very happy to just fade away.

But they didn’t let me, and there were times when I was on a section and they threatened me with the tube…. No it wasn’t a threat, it was just something they said would happen but it felt like a threat at the time. Having no control over what they put in it was the worst thing imaginable for me.

But I somehow got to the age of 20 and I said to myself, I’m sick and tired of this anorexia. It took 11 years for me to admit I had a problem. So I made myself start to eat. I’m 24 now and life is so much better.  Life isn’t a bed of roses but anorexia is very hard work; and I had enough.

I spoke to my father about it and he admitted that he had something like me when he was in his teens, but being a man nothing was said or done about it.”

The interviewer asked, “Everyone is saying that it’s all the pressure on young girls to be slim, in magazines and so on?”

“Oh no”, she said, “When I was nine I hadn’t even seen a magazine. It’s nothing to do with magazines and models, it’s just the way the brain is wired”.

So there you have it from the people who really count. Clinicians know very little. Listen to the people who have looked into the pit and been dragged into the light, kicking and screaming. At all costs we have to arbitrate in favour of the wish to live.

Anorexia In Children NOT Increasing?

Some people who have an interest in shock horror headlines (why?) have made a big deal about a so-called increase in eating disorders in young children.

I’ve always  hesitated to agree with all the hype and panic.

Lets look at the evidence. On 31st July the Sunday Telegraph ran the headline “Hundreds of preteen children treated for eating disorders….. including 197 children between the ages of five and nine, with cases within this age group almost doubling over the period.”

How do journalists get this information? Its easy and cheap. and often relies on reporting cards filled in by consultants to monitor rare conditions (2011;198:295-301). So is health information like this, obtained by freedom of information requests, accurate and useful?

Rachel Bryant-Waugh (consultant clinical psychologist /joint head of the feeding and eating disorders service at Great Ormond Street Hospital in London) said, “I think that there is a fundamental difficulty in confusing terms: it’s easy to see how these things get a bit muddled, and it then comes across in a way that is slightly misleading. It is very unlikely indeed that 5-7 year olds present with anorexia nervosa. … But they may have low weight and significant eating difficulties for many other reasons – for example, illness, gastrointestinal problems …..or a range of psychological factors. Such children might present with eating difficulties as the main problem, but they do not have anorexia or bulimia “.

So, when journalists use the Freedom of Information Act to ask for the numbers of children with “eating disorders”, they are not being specific enough to enable concrete conclusions. Waugh says…”Eating is a very complex behaviour in terms of all the processes required: many specialities care for children with eating problems. Formal eating disorders – that is, anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS) – are relatively rare in young children. However, they may be increasing in middle childhood. But the lack of consistent terminology means that there is a large difficulty in drawing conclusions here.” 

Mark Berelowitz, consultant child and adolescent psychiatrist at the Royal Free in London agrees. “The DSM puts eating disorders into two categories, one is eating disorders-anorexia, bulimia, EDNOS.  The other is feeding and eating disorders of infancy and early childhood. Its not clear that information given to journalists related to anorexia nervosa or the vast number of other conditions much more common in young children, like failure to thrive and other problems. 

The other thing is that with the best will in the world its hard to produce good data quickly during the summer holidays and in a short time scale: and ordinarily need to be scrutinised carefully before they’re submitted, and I would have been astonished if any trust would have high quality data at its fingertips”.

Of the apparent rise in anorexia diagnoses in the very young he said, “When you come across this seeming threefold rise you have to ask yourself how good are the data: if you project the rate forward you would get an absurd number”. 

It seems that journalists aren’t asking the right questions and the NHS Trusts are not giving accurate answers. “The data they got was from ALL FEEDING DISORDERS, and then in the press this was expressed effectively as anorexia nervosa. I suspect that if the Sunday Telegraph had asked the Royal College of Paediatrics and Child Health or any specific clinical service how many patients had these disorders in these young age groups we’d have very different numbers.”

So lets not alarm parents and doctors and lets not tar all children with funny eating issues with the same brush. It makes Good Press but it is…. LIES

Two Die From Dieting

Laura Willmot dies from anorexic collapse one week after being sent home by her doctors.

In another world, a millionaire’s ex wife freezes to death in her car after her wine binge. In a barely noticed throwaway remark, her husband noted that “we ate separately, she was always on one sort of diet or another”. Living these separate lives, the couple drift apart. Had they remained together, she would not have met her lonely end in the cold.

Most people are going to be drawn toward the sad demise of Laura. Her untimely end simply brings about more questions;

Why, – when family treatment is known to be so helpful in anorexia, does her right to confidentiality trump the continued involvement of her parents? Anorexia is KNOWN to be a particular kind of madness, obliging sufferers to avoid treatment or accepting only that kind of treatment that is never going to work. Even if someone is biologically 18 years of age, we KNOW that anorexia freezes emotional time, and they are probably just as old as they ever were when they first became ill.

Why would a psychiatrist Dr Herzig trust a patient to make her own decision, knowing that her brain is dulled by lack of nutrition and a shrieking anorexic voice.

Why doesn’t the NHS insist on enteral feeding  over and over again until the patient has the strength and the will to fight their illness or get sick of repeated hospital admissions. If we can just keep someone alive for long enough, they do fight their illness and they do struggle toward a life of better health and more connection. It takes a long time, but it does happen.

Where anorexia is concerned, Laura’s case highlights the fact that intractable anorexia is a devil to treat despite all the lovely new theories we have. However I have seen some desperate cases recover. One lady I know  spent almost 18 years in and out of hospital,  but started to get better shorly after I spoke to her. I’m still not sure what I did. She is now on my training, learning how to help others in a proper way.

Where dieting wives are concerned, please stop it. Eat with your partner and with your children. Celebrate your lives with food, talking, sharing, whatever. Don’t let diets rule your life.

Two lives wasted. It doesn’t have to be like this.





Vogue Bans Catwalk Models

Today there is a big fuss about anorexia in the press. Does this make it even more important to ban underweight models from our catwalks. Or is anorexia nothing to do with the size of models. You might like to see what I have written on my Eating Angel Blog