“I hate this, I hate this. To eat is to die, and to starve is to live, But starving is slowly killing yourself. To be as light as air, To be as a whiff of smoke, To move gracefully and float and curl up and around the others. To become transparent and to disappear, I will accept that air that is within me, it is all I need to survive, Drunk on water. Feeding on the air. Reducing and disappearing until I am nothing, but gone”

These are the poignant and powerful words of a young woman struggling with Anorexia Nervosa from Ana’s Underground Grotto.

Eating Disorders are complex disorders in presentation and in terms of treatment. They are characterised by severe disturbances in eating, causing emotional and psychological distress and having profound longterm physical consequences. It is an error to approach the condition focused primarily on food. It is vital to hold in mind that restricting the intake of food or bingeing on food, has become the mechanism to cope with feelings too uncomfortable to speak about, or feelings which arise from an event or memory which is buried in the unconscious mind.

Statistics show that 200,000 people in Ireland may be affected by an eating disorder, showing that this is a serious issue that needs to be addressed. Research also shows that about 400 new cases arise each year, and this represents 80 deaths annually. Worryingly 500 of those diagnosed with Anorexia will die of medical complications or by suicide. Eating disorders are most prevalent in 15-40 year old females and it is estimated that in Ireland approximately 15,000 have developed Bulimia Nervosa. This figure is difficult to corroborate since the disorder is often kept extremely secret. Although predominantly the disorder is prevalent in women, one in ten diagnosed cases, are male.

Through my work with people struggling with Eating Disorders I have learnt several things. There are three characteristics which are particularly marked in the individual:

  • An intense sense of morality, leading to strong feelings of guilt
  • An extreme sensitivity to other’s needs and feelings
  • A profound sense of their own worthlessness

This sense of worthlessness precedes the onset of the disorder and indeed may have developed as some kind of protection mechanism. Within the family there may be an expectation of high achievement or at the very least the individual places high expectations upon him or herself. Certainly the media has a role to play in depicting ‘slimness’ or ‘body perfection’ as an ideal to be pursued, but often within the family there is also an intolerance of weight gain, so the individual is receiving this message about their body from within and outside of the family. If an individual is physically very unwell as a result of the disorder then hospitalisation is recommended until a sustainable BMI can be established. It is at this point that speaking to a therapist can be timely and valuable.

I am always impressed with the force of will and determination that an individual coping with an Eating Disorder, particularly Anorexia, displays. They are usually able to push their bodies to great extremes, often working, studying extensively and exercising for long periods of time while all the time feeling extremely hungry, because they are starving themselves. I am impressed because if the individual could only turn this ferocious will power outwards rather than against themselves they are capable of achieving extraordinary greatness. Unfortunately their absence of self worth hinders this. This low self esteem can present as:

  • Feelings of helplessness
  • Feelings of being ineffective and a failure
  • A tendency to seek external validation – usually through seeing a low figure on the scales
  • An extreme sensitivity to criticism

Sufferers have spoken about feeling consumed by their illness, feeling utter despair, feeling misunderstood, alone and vulnerable. Sufferers are also honest about the artificial high, gained through starvation and obsessive exercising and although cognitively he or she will acknowledge that they realise they should eat, they feel they simply cannot. The word ‘SHOULD’ is a strong feature of this disorder. It points again to the extreme feelings of negatively that the individual inflicts upon themselves.

Encouragingly, one individual described Anorexia as a state of mind not a state of being. This brings us back to the crucial realisation that losing or gaining weight is not the issue, what is at stake is that the weight of the body is a signal that all is not well within the mental life of the person. Something needs to be spoken about more thoroughly. This may be a bereavement in the family, a trauma that has not been dealt with, a feeling of being overlooked or neglected within a family or even fear of the future and how an individual will manage living as an adult. If any of these issues or others can be talked through with a qualified therapist there is the very real possibility of motivating that indomitable spirit and determination towards flourishing and not towards vanishing.

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