talking about eating disorders - Learn With Unite

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Version 4_16.09.10_2249 talking about eating disorders 2 Version 4_16.09.10_2249 Published by NHS Health Scotland Edinburgh Office Woodburn House Canaan Lane Edinburgh EH10 4SG Glasgow Office Elphinstone House 65 West Regent Street Glasgow G2 2AF © NHS Health Scotland, 2007, 2010 ISBN: 978-1-84485-375-5 All rights reserved. Material contained in this publication may not be reproduced in whole or part without prior permission of NHS Health Scotland (or other copyright owners). While every effort is made to ensure that the information given here is accurate, no legal responsibility is accepted for any errors, omissions or misleading statements. NHS Health Scotland is a WHO Collaborating Centre for Health Promotion and Public Health Development. Original text: Geraldine Abrahams Research: Scott Porter We are happy to consider requests for other languages or formats. Please contact 0131 536 5500 or email [email protected] This booklet reflects many discussions, suggestions and comments made by health professionals, professional bodies, lay and voluntary organisations, people with eating disorders and their friends and family. NHS Health Scotland would like to thank all of those who contributed in any way to the development of this booklet, for so willingly giving their time, and sharing their expertise and experience. All the quotes in this booklet are from real people. Version 4_16.09.10_2249 introduction Food is an essential part of our lives; we need it to survive. When we are under stress, our appetite and the way we view food are often affected. We may lose interest in eating, we may eat more than usual, or crave certain types of food. Very often this will pass when our lives return to normal and the difficulties are resolved. However, for some of us food can become an overwhelming concern which comes to dominate our lives. It may get to the stage where food is all we think about – either so that we can control our intake of food to the extent of avoiding eating, or so that we can try to satisfy our need to eat and eat. This booklet is written for people who use food in these ways to cope with distressing feelings. It provides some basic information for those who themselves are experiencing an eating disorder, or for whom eating causes distress, as well as for their families and friends. At the end of the booklet we suggest some sources of further help including references to other reading material and to organisations. The internet is a useful resource for people needing help for their (or someone else’s) eating disorder and a selection of websites has been included. However, use of the internet can also be dangerous – make sure you only access trusted health sites. 1 2 Version 4_16.09.10_2249 what are eating disorders? A preoccupation with food can conceal all sorts of confused and painful feelings. It may seem to be the only way we can cope with stress or uncertainty in our lives. It may seem to be the only way we can express the turmoil and confusion inside us. It is very common for people – especially women – to be unhappy about their weight and shape. We are constantly being urged by advertising and by the media to believe that ‘slim’ means ‘beautiful’ and ‘fat’ equals ‘unattractive and undesirable’. We are given more and more advice about the types of food that are good for us. Not surprisingly, many of us are becoming increasingly aware of our appearance and of what we eat. In an effort to lose weight, which we are told will improve our looks, we may adjust how much we eat and what we eat. This can make us very dissatisfied with ourselves but it does not usually stop us getting on with our everyday lives. However, those of us who have eating disorders find that our lives revolve around food in terms of planning what to eat and how to avoid eating, or how to rid ourselves of what we have eaten. ‘I had just left university, had no job and felt as if I was adrift on the ocean. I felt helpless, frightened. The only thing I could control was my own body and what it consumed. That became more and more important. It was the only thing that made me feel safe.’ 3 Version 4_16.09.10_2249 But while this way of behaving may help us get by for a time, it only creates further distress. Not only can we do real harm to our bodies, we may also be plagued by feelings of anxiety or guilt about our eating. Both men and women are affected by eating disorders, although women far outnumber men. Each person’s experience will be unique, but all eating disorders can have serious effects on our bodies as our weight drops, rises or fluctuates: • We may find our usual sleep pattern is disturbed. • We may feel very depressed or lethargic. • After many years our bodies can become damaged. We may have to live with a weak heart or kidney. However, if treated early our bodies can fully recover. • Women may have problems conceiving because the menstrual cycle is disturbed. • We increase our chance of osteoporosis in later life. Osteoporosis means that our bones become brittle and more likely to break. • With one type of eating disorder: anorexia nervosa, we are likely to be extremely sensitive to cold. ‘I really hate myself for what I’m doing. I binge and binge and then starve for days to compensate, but I don’t know how to get out of it. It has become a way of life.’ 4 Version 4_16.09.10_2249 We gradually become more and more fixed in our attitudes to food and more rigid about following the eating routines we have started. It grows increasingly difficult to break out of these patterns. For much of the time we may not even want to, because living our lives in any other way seems unimaginable. There are three main forms of eating disorder – anorexia nervosa, bulimia nervosa and overeating or binge eating. People with eating disorders often have other issues like depression or anxiety (see Talking about Depression or Talking about Anxiety). anorexia nervosa Anorexia nervosa is most common among young women on the verge of adulthood, but can also affect people in other age groups. An older person who has successfully managed an eating disorder may find a major life change causes it to start again. However it is unusual for someone to develop an eating disorder for the first time in later life. Anorexics are often thought of as only being female. This is misleading. Boys and men can also be anorexic and the numbers are increasing. We should also not be misled into viewing anorexia as an excessive form of slimming. It is much more than that. ‘It’s like you’re holding two conflicting things in your head at once. You want to get better, put on weight. You know you have to and at the same time you’d do anything to avoid the next meal, the next bit of food you put in your mouth.’ 5 Version 4_16.09.10_2249 In our teenage years it can feel as if life is very challenging and very uncertain. It may feel as if we are going to be overwhelmed by new demands and expectations on different levels: • Intellectual, as we make decisions about our future. • Emotional, as we establish our independence from our families. • Sexual, as we explore our physical needs in close relationships. Making sense of what is going on, and making choices for ourselves is not easy. Yet one area where we can assert control is over what we eat. It can give us a great sense of satisfaction to push our bodies to the limit and survive on less and less nourishment. We may deeply resent other people’s concern about how little we eat, and resist their efforts to get us to eat more. Gradually the way we see ourselves becomes distorted. Others tell us we are painfully, even dangerously, thin yet the slightest gain in weight throws us into a panic and makes us feel bloated and fat. ‘I became really deceitful – an expert liar: I’d say I’d just eaten, or had a bug. I’d stay at home rather than face going somewhere if I knew there’d be food.’ 6 Version 4_16.09.10_2249 People with anorexia nervosa: • Weigh less than would be expected (a body mass index of 17.5 or less is common) and keep their weight down by avoiding ‘fattening’ foods as well as getting rid of food by vomiting, using laxatives, exercising or simply not eating. • Skip meals, avoid certain foods and refuse to eat with others. Offer to cook dishes for friends and family to hide the fact they are not eating. • Have cold hands and feet, feel faint and suffer from hair loss. • Refuse to believe that they aren’t overweight and may dress in baggy clothes. • Dread being ‘fat’ to the point where their main aim in life is to control their weight. bulimia nervosa Bulimia nervosa is less obvious than anorexia nervosa in that other people would not necessarily know someone was affected from their appearance alone. Indeed we may seem to be coping well with life, and look happy and confident when really we may feel very different. We may feel very unsure of ourselves, and frightened of not achieving what’s expected of us. We may desperately want reassurance and acceptance. 7 Version 4_16.09.10_2249 People with bulimia nervosa: • Have a persistent preoccupation with eating, and an irresistible craving for food. Someone who has bulimia nervosa will have repeated bouts of overeating, secretly consuming huge amounts of food in a very short time. • Try to offset the ‘fattening’ effects of food by making themselves vomit, purging and starving themselves, and using drugs to suppress their appetites. • Set themselves a desired weight that is well below what is considered to be healthy because they dread being fat. • Are commonly found to have had anorexia nervosa at an earlier time. For people with bulimia nervosa, eating may seem like the only way to satisfy needs and calm uncertainties. We may find ourselves eating huge amounts of food and then, because of the guilt and disgust we feel, dispose of it by vomiting or using laxatives. It is like a trap, not knowing how to cope and at the same time feeling ashamed and revolted at how our lives are evolving. Withdrawal from other people and increasing isolation seems to confirm the lack of congeniality and attractiveness. 8 Version 4_16.09.10_2249 binge eating disorder Some of us may find it hard to regulate what we eat, particularly if we are upset or distressed. Two per cent of adult women are affected to some extent by binge eating. Eating large amounts even when we do not feel hungry appears to help block out disturbing feelings. Such a ‘binge’ is often followed by a determination to eat more carefully, and periods of cutting down on food intake to compensate for past excesses. Binge eating disorder is similar to bulimia nervosa but it does not involve vomiting or taking laxatives and other drugs to prevent weight gain. People with a binge eating disorder are often overweight. understanding eating disorders There are various possible factors that may contribute to the development of an eating disorder and the way in which these factors combine will be different for each individual. Different reasons may operate at different stages of the development of the disorder: something that may act as an initial trigger may be less important later on while other factors may come in to play as the disorder begins to take hold. We may be prone to an eating disorder because of our family history or we may be responding in later years to something unpleasant that happened in childhood. ‘After I split up with my boyfriend – it was the evenings that were the worst. I’d feel so empty and lonely. I’d just start off with one small snack, and then I’d keep on and on, eating anything at all.’ 9 Version 4_16.09.10_2249 Many of the physical, psychological and social changes that happen because of eating disorders, such as malnourishment or feelings of worthlessness, can themselves become factors which then further reinforce the eating disorder, creating a vicious circle where it becomes difficult to separate out cause and effect. It may also occur at a time when we are uncertain of how to cope with major changes. We may face important decisions about what to do next as one chapter of our lives comes to an end. We may then turn to food to console ourselves, or to deny ourselves so that we feel safe and in control at last. Society’s preoccupation with looking slim may be another factor. The assumption that we should all aim to look like the willowy models on the fashion pages can put severe pressure on us to conform so that we are acceptable and accepted. There are other sorts of expectations, which may make us very uneasy. Perhaps we feel pushed into achieving, into living up to other people’s standards. Sometimes achievement can appear all-important, so we may push ourselves harder and harder because we do not know how else to define ourselves as individuals. Women may feel obliged to fit in with the roles society expects of them, yet with all the different images to live up to – the sex object, the mother and wife, the career woman – it is difficult for them to define their roles, to acknowledge their own needs and to recognise what they really want. 10 Version 4_16.09.10_2249 Relationships that are important to us can sometimes cause us distress. In some families, young people may find it hard to assert their own individuality as they grow up. Food may become part of their way of trying to claim their independence. In families that tend to be protective of one another this can lead to growing anxiety making it more difficult for young people to lead a separate life as a grown up. In other situations when young people have been badly treated or abused, they may see themselves as worthless. We may find comfort in controlling our eating when everything else in our lives is out of control. For men it can be difficult to come forward and seek help for an eating disorder. It is still considered by some to be a ‘woman’s disease’ although the reasons men develop a disorder tend to be no different from the reasons women or children do. The signs of a disorder may vary between the sexes making it harder for friends or family to suggest to men that they seek help. Whatever the reason for it, the fear of not being able to cope and of being overwhelmed is something experienced by many people who develop an eating disorder. We feel so unsure of ourselves, so powerless and unable to express what we want in other ways that we become totally pre-occupied with food and eating. This is more than just seeking comfort. It is an attempt to escape or to control our deepest insecurities. Yet it is a false solution since we become more trapped than ever. 11 Version 4_16.09.10_2249 what you can do Overcoming eating disorders generally starts with helping ourselves, and if we have some guidance and support with a self-help programme, it will enhance our chances of success. There are many self-help groups around, and many good self-help books and computer based self-help programmes. But we may feel that what we can do on our own is not enough, that it is too hard to be open about our fears and anxieties and take up help from people we do not yet know or trust. But we may find on the other hand that it can also be an enormous relief to accept help. There are various sources of support available, and a good starting point might be an organisation called ‘beat’. Details can be found for this and other organisations at the end of the booklet. We can do a lot to help ourselves. Even if we feel very uncertain about wanting to change things, we can take some small first steps. It is likely to be a long slow process, so it is important not to expect too much of ourselves. What works for each of us may be different, but these are some things that may help: • Join a self-help group and read self-help books about eating disorders. • Find ways of ‘spoiling’ yourself (apart from with food). Do things you enjoy, or used to enjoy but perhaps have not been able to do for a while. 12 Version 4_16.09.10_2249 • Focus your energy into different channels. Find things you are good at, and that give you satisfaction. • Try to make sure you get a chance to do what you want, not just what other people want, at least some of the time. • Try not to become over-concerned about reaching a target weight. You are making good progress if you are getting to the point of liking yourself and being more at ease with yourself. Inevitably there will be ups and downs. In times of crisis, you may find you go back to the ‘old ways’ but this is usually just a phase that will pass. As our lives become less and less focused on ourselves and what we eat, we may be pleasantly surprised to find how much scope there is to spend our time in more fulfilling ways. getting help from others Accepting there is something wrong and that we need help can be extremely difficult. We may have struggled so hard for a long time to cope by ourselves that offers of help can be very threatening. The more ‘Some people use drink or cigarettes when things get rough. With me, it’s my eating which goes haywire. I find it really hard to eat for days on end if I’m stressed, but I now know that won’t last.’ ‘It was a huge relief in the end, when someone else stepped in and helped me. I knew I couldn’t go on as I was.’ 13 Version 4_16.09.10_2249 concerned those close to us are, the more they may pressurise us into accepting help. It can feel like we are being backed into a corner. There are situations where an eating disorder becomes life-threatening, and action may have to be taken to preserve someone’s life even without their consent. However, it is important that we find help that suits our own particular needs, when we are ready. There are different sources of support available, each offering different kinds of help. It is worth contacting the organisations listed later in this booklet to find out what is available in your area. counselling and psychotherapy People sometimes find it hard to talk about their difficulties but it is important to seek help and support. Counselling and psychotherapy give people the chance to talk through problems. Both focus on present day feelings and difficulties, which may be current or rooted in the past, and enable us to take more control of our life and to cope in the longer term. It helps to know we have someone we can trust, who will listen to us, and be a contact with the world. But making real changes sometimes requires more than counselling. It is important to find a counsellor or therapist you can relate to, and trust. For those of us with an eating disorder, the pre-occupation with food can be ‘I felt terrible, life was dreadful. The pain and hunger were overwhelming. I felt very frightened. I realised I could die... I knew I needed help. Someone to trust, someone who could understand what I was feeling.’