Beating Anorexia

This is a story about one young woman’s triumph over Anorexia, one of the most serious conditions affecting young people today.  I met her when she came to me for therapy, she was at her wits end, having tried a variety of interventions already, including counselling, and Relate.  We will call her Mrs H for anonymity.

Mrs H was desperately upset about the fact that her husband had left her for another woman a year ago.  He had been having emotional difficulties himself at the time and quickly realised that he had made a serious mistake.  The two had got back together again, but Mrs H could not rid herself of her own feelings of abandonment, and inadequacy, and had developed a compulsion to talk to ‘the other woman’.   The consequences of this were that Mrs H was displaying all the symptoms of Anorexia Nervosa – her weight had dropped to 6.5 stones, her hair was falling out, she cried all the time and was indulging in obsessive exercise regimes.

These days most of us are familiar with the phrases ‘eating disorders’ and ‘Anorexia Nervosa’, which is a sad reflection on how commonplace these illnesses have become.  But just how commonplace are they?
 
Here are some frightening statistics:

* Eating disorders are responsible for the highest number of deaths from psychiatric illness.    
* The Eating Disorders Association estimates that about 165,000 people in the UK have eating disorders with 10% dying as a result, but experts believe it could be higher.
* Most sufferers are women, but one in 10 are now men.’
http://news.bbc.co.uk/1/hi/health/medical_notes/1079435.stm

For conditions that are so commonplace, how do we know when someone is at risk?  Fo instance, would you know if one of your friends, or a member of your family, was falling prey to this illness?  At what point do friends and family recognise that something out of ordinary is taking place?  What are the telling signs?  And would you know what to do?

Here are the most common symptoms:

* Deliberately losing weight
* Thinking they are much fatter than they really are and that their body is out of proportion
* often wearing baggy clothes to hide how thin they really are
* tending not to be honest about how much they eat, and about everything to do with food.
* Wanting to eat and feeling hungry, but terrified of the consequences of eating
* Hating the way they look, feeling they are ugly, fat and unlovable
* Preoccupation with how they look, spending hours deciding what to wear
* Punishing themselves when they do eat something they feel they shouldn’t

Mrs H: ‘My eating disorder started when my husband left me…….I lost a lot of weight, I just couldn’t eat, even if I wanted to, I was so heartbroken…..I thought I looked good at six and a half stone – but my friends and family didn’t.’

Interestingly, Mrs H’s symptoms worsened when her husband returned to her:

Mrs H: ‘I was so afraid of putting on weight, I thought he would leave me again….I started to put weight back on naturally, but it freaked me out – I started obsessing about the way I looked, I exercised a lot, constantly looked in the mirror, pinching and squeezing the fat away, I spent hours crying.’

There are severe health risks associated with this disorder, mainly caused by the undereating (starvation). Problems that may occur include the following:

* Amenorrhoea - Menstrual periods usually stop.
* Thinning of the bones (osteoporosis) caused by calcium and vitamin D deficiency. This can lead to easily fractured bones.
* Swelling of hands, feet and face (due to fluid disturbances).
* Anaemia.
* Depression.
* Delayed puberty, stunted growth and delayed physical development if anorexia occurs in younger age groups.
* Loss of sex drive (libido). http://www.patient.co.uk/showdoc/23069106/

In terms of treatment for Anorexia, there are various approaches depending upon the  theoretical background of the clinicians.  Most would agree that a multi-dimensional approach is essential in both assessment and treatment.

As a society, we are becoming increasingly obsessive and/or addictive in our behaviours.  Never have we been more aware of the effects of irregular eating habits than we are today, and what I find very disturbing is the propensity we seem to have for self-injurious conditions such as anorexia nervosa, bulimia nervosa, and also over-eating.

‘According to the Mental Health Foundation current estimates suggest that up to 1 per cent of women in the UK between the ages of 15 and 30 suffer from anorexia nervosa, and between 1 and 2 per cent suffer from bulimia nervosa. As many cases of eating disorder are unreported or undiagnosed, the actual figures are likely to be much higher. Eating disorders are much more likely to occur among women than men. However, for anorexia, there is also evidence to suggest that in the younger age group (7–14 years), up to 25 per cent of cases are boys.’ http://www.counselling-directory.org.uk/eating.html

What is the outlook (prognosis)?

Studies where people with anorexia have been followed up for a number of years show the following:

* About 4 in 10 fully recover.
* About 3-4 in 10 improve, but continue to have some eating problems, but not full blown anorexia. About 2 in 10 continue to have anorexia.
* Some develop bulimia nervosa instead. About 1 in 20 will have died from causes related to anorexia. Causes of death include infections, dehydration, blood chemistry problems (such as low potassium levels) and suicide.

Why is there such an increase in the incidence of these eating patterns?    Is Anorexia or Bulimia the result of becoming excessively image-conscious or controlling?  Or is there something else?

It is probably fair to say that all of these influences play a part, but there are subtle differences.  For instance, over-eating has an underlying association with comfort, warmth, love and rewards.  As newly born infants, we, as a species, are completely dependent for everything – we have a built in mechanism to alert those around us to our needs – we cry – to be cleaned, to be fed, and to have any other basic needs attended to.  The time when we are most comfortable is when we are being fed – we are held close, cuddled, our tummies our filled so the pain of hunger is assuaged and we are warm and satisfied.  We are also in control of our environment and feel ‘replete’. 
This association with food is reinforced throughout our very early development.  It should be no surprise then that we easily fall into the behaviour of seeking out food later in life when we are in need of those feelings of comfort – whatever the reason.  The ‘sugar-rush’ experienced with sweet foods makes these prime candidates for ‘comfort-eating’.

Anorexia and Bulimia can both be associated with feelings of disempowerment, inadequacy, and feeling out of control.  As vulnerable youngsters, the messages we receive from others affect our self-image and our self-worth.  If we are constantly undermined, or if we feel powerless, then this will trigger a behavioural response which will be specific to each personality, but that will inevitably involve some sort of controlling element.  If this behavioural response continues unchecked, it becomes automatic and then difficult to stop – but not impossible.

For those who have no problem with over-eating or with maintaining a healthy body weight, the problem has a simple remedy – just reduce the amount you eat – or -  eat more.  So why is it not that easy?

I believe it is because the issue is not about the food, but about low self-worth and low self-esteem – feeling of no value, unwanted, unattractive, and unable to achieve.  If these things are true, then how have we managed to create a population of people who feel inadequate, and what can we do about it? 

As far as I can tell, there has never been a period in history where life-styles have been so easy and yet morale has been so low – everywhere we turn we see examples of people seeking some sort of control over their lives.  The rising prevalence of life coaches, cosmetic surgery, therapies, recovery programmes, and dietary aids, indicates a whole society that is low in self-worth and feeling disempowered. 

Firstly, there is no one ‘cure-all’ – every person is different, although their behaviours may resemble those of others.  This is because there is a finite number of possible behaviours that our species can execute.  Also people change  - so any regime that is rigid will, inevitably, be time-limited.

How can we then empower each person to meet challenges, to value themselves, and maintain their recovery in a world that continuously challenges?  This process requires: a high degree of intuition; empathy; skill; flexibility; versatility; but most of all realism.  It is essential to understand that when a particular behaviour is triggered and becomes deep-seated and habitual ie automatic, there may always be that propensity to revert to that same habitual behaviour in times of crisis or boredom.  So any intervention must be structured to engage the person fully, whilst being sufficiently flexible and versatile to move with her/him as he/she develops and adapts – and it must provide a strategy for life!

My own approach begins with some detective work:

1. Identify the behaviour
2. What is its function ie what does it do for the person
3. Identify any actual and potential triggers that cause the behavioural response
4. Identify when the behaviour occurs (frequency, time of day) along with any patterns or cycling
5. Locate the origins of the behaviour – what is the first memory of it
6. Identify the emotional associations – before, during and after

It continues with selecting the therapeutic techniques:

a) assess the person’s current emotional state through interview and observation
b) provide appropriate support to reduce any anxieties – (clinical hypnosis is a wonderful drug-free method for this)
c) negotiate a plan of action with the individual – identify goals and small achievable steps
d) ensure that self-worth and self-image are restored to acceptable levels
e) introduce practical strategies that are appropriate to the person’s life style and issues
f) re-visit the origins of the behaviour safely under hypnosis – and repeat this process, thereby reaching a resolution for each aspect

The above steps may need to be repeated a number of times in order to address all of the issues for someone – it is a complex process just as people are complex.  However, gradually the triggers for the behaviour become desensitised, then we are left with the habit/addiction/obsession which must be re-structured into something harmless. For the anorexic this must be an activity that reinforces their control, and for the comfort eater this must be something that provides an equal level of comfort in times of stress or boredom.  In both cases the strategy must be negotiated with the person so that it is both achievable and acceptable both in the short and long term, and it must be practised so that it becomes second nature to them. 

The point to remember is that learned behaviours can be supplanted by new learned behaviours – with the correct facilitation.

Over a period of 10 weeks (weekly visits), using a variety of techniques drawn from Cognitive Behavioural Therapy, EMDR, and Psychoanalysis,  Mrs H worked through each aspect of her mental state – her attitudes towards herself, her husband, her children and also her own upbringing.  By reframing some of her beliefs, providing her with anchors and helping her establish a daily structure, she was able to reduce her anxiety and feelings of inadequacy.  I watched this young woman blossom into a confident, happy, well balanced human being.  Seeing her delight at being able to enjoy life with her family, without becoming obsessive or self-punishing, was a truly wonderful experience. 

If I have any message for anyone out there who is suffering, it is this – you have the inner resources to resolve your issues, you just need to find the right therapist to facilitate that for you. 

Personal Empowerment Therapy: Dr Dawn Heather, Camborne Complementary Healing Centre:
Tel: 01209 711504 www.dawnheather.com
email: dawn@dawnheather.com

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