More women are seeking treatment for eating disorders as mental health become less of a stigma. But many are in their 30s, 40s and 50s and their secret has had an enormous impact on their lives says Helen O’Callaghan
It wasn’t just one thing that finally drove Katie, 35, to seek help for her eating disorder. When her boyfriend said he couldn’t see a future together if she didn’t sort out her Jekyll and Hyde-type mood swings, it certainly propelled her towards therapy. So did reading a magazine article and answering yes, yes, yes to questions like ‘Do you use food for comfort?’ ‘Is food ruling your life?’ But even reaching rock bottom and attending therapy group sessions for bulimia didn’t convince Katie she had a problem. “I was detached from the others. I identified with what they were doing – it comforted me, knowing I wasn’t the only one doing these things – but I thought I’m not really one of these people.” In the UK, NHS figures show soaring numbers of young people being hospitalised for eating disorders. Approximately 650 under-19s in England were admitted in 2003-’04 – by 2013-’14, numbers had shot up 172%. More than 90% were girls and young women.
Here, the Department of Health estimates 200,000 people may be affected by eating disorders. Dr Sarah Prasad is consultant psychiatrist at St Patrick’s Mental Health Services, which sees very high referral rates to its adult eating disorder service. Figures are slightly up on last year, she reports. In 2014, 138 patients were admitted, 126 of them women. This year, by early September 2015, there have been 119 referrals. With the majority of cases aged 18-25, Dr Prasad is seeing increasingly severe symptoms. “Patients are significantly underweight. They’ve had their symptoms considerable lengths of time.” Bodywhys services manager Harriet Parsons says numbers contacting them have increased in the last 18 months. She attributes it to stigma-reducing campaigns around mental health. “There’s a growing trend towards reaching out for help and talking about mental health issues generally. People recognise what they’re doing is a sign something else is going on for them.”
When first attending group therapy, Dubliner Katie admits she was only “dabbling” in recovery. She still felt “stuck” – she wasn’t dealing with the emotional issues underlying her eating disorder. Even as a five-year-old, eating hadn’t been straightforward. “There was very little I’d eat. At school, I’d rather eat on my own or hiding behind my lunchbox.” Moving from the UK to Ireland when she was 10 was exciting but turned nightmarish after she fell foul of bullies. “I was severely bullied until age 17. My food hang-ups evolved. I began to find comfort in private eating.” Seeing her parents distressed by the bullying, she stopped confiding in them. Pretending to do homework, she’d retreat to her bedroom and eat high-calorie junk food she’d stashed away until she couldn’t physically consume anymore. She purged by vomiting. “I’d throw the wrappers in the fire or bring them in my schoolbag to put in the public bin.”
Through secondary school, huge amounts of food – eaten in single sittings – was a numbing drug, “stuffing down emotions that purging released”. Her self-loathing grew. “I already felt worthless. The bullies told me I was. The vicious binging/purging cycle re-confirmed it. It got so bad I considered committing a crime, bad enough I’d be put in prison but not bad enough to hurt someone – being in a physical prison might take me out of my mental prison.” She didn’t turn to crime and her bulimia subsided in her late teens – “I had a new boyfriend. I’d left school.” She found a banking job but by her early 20s was binging and purging daily with laxatives. “I was always chatty at work but I kept my distance outside it. Socialising was difficult.” At 23, she met her husband. They moved in together a year later. Katie’s erratic behaviour convinced him something was off. “He suspected something wasn’t right. I was trying to hide it – binging in the car but not buying the whole binge in one shop. I’d played havoc with my hormones. There was very little nutrition going in. I’d explode over something trivial. My behaviour was off the scale’.”
At 28, she sought help but initially couldn’t admit to an eating disorder. Approaching 30, she knew healing demanded a bigger leap, “getting stuck into the emotional stuff”. She went for one-on-one therapy. Shopping for a dress for her 30th birthday showed how far she’d come. “I was excited. Shopping had always been a nightmare. I dreaded changing room mirrors. I wasn’t obese but all I could see was rolls of fat. Now I started accepting my body wasn’t perfect, it never would be – and that was ok.” This milestone birthday felt like she was “unzipping all these layers – I felt light, free of the mechanisms I’d been using.”
Now a mum, she recalls once dreading motherhood. “It was the thought of being pregnant, having to eat, my body changing and burdening a child with behaviours I couldn’t control.” After her marriage and studying nutrition, Katie’s focus shifted from food as a drug to food as nutrition. “Instead of seeing my body as a blob, I began focusing on a little growing baby, giving him what he needed.” Her 11-month-old son has “completed” her. “All that other stuff doesn’t matter. Nurturing him is my focus.” Psychotherapist and eating disorder specialist Emma Murphy runs therapy groups for adults with bulimia and binge-eating disorder (this involves binge eating without vomiting or overexercising afterwards and is far more common than anorexia). Her clients are women, generally aged from mid-20s to mid-30s. Their eating disorder is well-hidden – most are normal weight or slightly under or over-weight. “They tend to be high achievers, perfectionists, black-and-white thinkers, often successful in their careers. They experience massive shame – ‘if people knew my secret, they’d hate me, I’m disgusting’,” says Murphy.
The catalyst for seeking help varies. A 50-year-old woman – binging on sweets in her bathroom and under a psychiatrist’s care because she’d tried to commit suicide – went for talk therapy after a friend suggested seeing someone new and objective could help. A 32-year-old sought help after her toddler witnessed her vomiting in the toilet.
Another big catalyst, says Murphy, is hitting age 40 or 50. “They’re single, haven’t had children. They realise the eating disorder has been their primary relationship, preventing them from having any other.”
*Emma Murphy will shortly give a 10-week course for Ending Emotional Eating in Monkstown, Co Cork. See Emma’s online program on www.eatingdisorderonlinecourse.com.
St Patrick’s Mental Health Services is set to open an adolescent mental health service (13-17 years) in Cork. It will assess and treat a wide variety of mental health issues. Enquiries: 021 461 4460.
A leading paediatrician has blamed the staggering rise in eating disorders on over-exposure to images of celebrities’ bodies.
Here, a 2012 survey found body image a burning issue for young people – 77% ranked it as important to them, 43% said they were dissatisfied with theirs and six out of 10 said they felt pressurised to look good for other people. Meanwhile, a 2013 survey reported children and adolescents spend up to six hours a day looking at screens.
Teens pout, preen and pose – like any professional model – for selfies they post on Facebook and Instagram. Marie Campion, director of the Marino Therapy Centre in Drumcondra, Dubin and author of Hope: Understanding Eating Disorders, believes selfies not only contribute to eating disorders but keep people stuck in obsessive eating behaviours.
“Posing has really become a past-time, an obsession. I have clients who spend hours posing, taking pictures. We have a culture of impressing – impressing one another is more important than who I am. Popularity has become such a strong value.”
Campion says selfies don’t cause eating disorders but believes putting a high value on popularity strips self-esteem. “Selfies encourage comparing, which leads to low self-esteem, which can lead to eating disorders.”
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