Unpacking Eating Disorders; The Top 5 Things You Need to Know
I am Clodagh:
I am a yogi; a mindfulness specialist; an entrepreneur; a feminist; a teacher; and a writer.
I am pro-choice, pro-democracy and pro-pineapple on pizza.
I am: a daughter; a granddaughter; a sister; a niece; a cousin; a friend; and a confidant.
I am: an ex-waitress; ex-lifeguard; ex-actress; ex-sales-person; ex-drug-taker and binge-drinker; ex-catholic and ex-girlfriend.
I am many things. One of which, is an Anorexic.
I have suffered from an eating disorder for almost ten years. It started small, growing until my first hospitalisation three years ago. After a difficult and challenging time in my life, I relapsed. Before I even knew it, anorexia had me in its grasp again and I needed in-patient treatment once more. I spent two months in treatment and left hospital still at a very low BMI (Body Mass Index). Your height and weight are factored into an equation and the number yielded is your body mass index. This is the primary way in which the medical field assess your health with regard to your weight. A healthy BMI is considered to be anything between 19 and 25, while anything below this is underweight and above is considered overweight. Once you go over 30 you are considered to be within the range of obesity, while anything below 17.5 may be considered as severely underweight, or anorexic. When entering treatment last November my BMI was in the 14 range, on discharge I had moved up into the 16 range. Almost two months since my discharge I am still making progress towards a healthy BMI; ounce by ounce, week by week, I am getting there. I have resumed teaching yoga, I'm studying to be a CBT (Cognitive Behavioral Therapy) and Mindfulness Therapist and though each day stands alone in the recovery process, I am on the right track. Soon I'll be able to go back to the gym, something I love that drives and empowers me, and that is a huge motivation. Another huge motivation has been my blog. Sharing my journey and hearing from so many different people, whether it be to offer support or to tell me their own story, has been one of the most humbling and rewarding experiences of my life, and also one of the top motivators for me in working towards full health and freedom again.
I've learned a lot: from my own experiences; those of the other amazing men and women I had the privilege of meeting while in treatment; and the stories of those who have reached out to me after hearing my story. So, let's try and unpack this a little bit and shine a light into the dark corners where eating disorders set up their camp, who they infect, how they do it, why they do it, and what we can do about it.
1. Eating Disorders Do Not Discriminate
Being skinny does not make you anorexic. Looking 'normal' does not mean you do not have an eating disorder. Eating disorders are not just a disease for teenage girls. People who are overweight are just as likely to have an eating disorder as those who are underweight. Anorexia is not a crash diet. Eating disorders are not rooted in vanity. An eating disorder is not 'just a phase'.
There are so many different types and subtypes of eating disorders, but when I'm talking about them I tend to be referring to what I call The Big 4;
⦁ Anorexia Nervosa
⦁ Bulimia Nervosa
⦁ Binge Eating Disorder
Those with anorexia tend to severely reduce their caloric intake, this is the common factor, though some subtypes may engage in other behaviours also, such as purging or over-exercising. Bulimia patients will often restrict for a period of time and then engage in a period of bingeing; that is a huge number of calories in one sitting, which they will purge or throw-up. This behaviour could be repeated over and over again, sometimes for days at a time. Orthorexia refers to an extreme addiction to exercise as a way to manage or manipulate one's shape or weight. Binge eating disorder consists of eating huge numbers of calories, either in one go or throughout the day, but the sufferer does not purge.
Eating disorders are absolutely not just a passing phase or a crash diet. They affect people of all ages. At 25 during my last admission, I was somewhere in the middle in terms of age range. The oldest woman I have been in the hospital with was in her sixties. I have also met many men struggling with an eating disorder. The nurses told me that it's not uncommon for men to outnumber women on the unit. There is a growing pressure on young men to look a certain way; it's clearly having an effect. Men presenting with signs of an eating disorder need to be taken just as seriously as women.
Culturally, there is a huge surge in the health and fitness industry at the moment, which is fantastic, but we need to be mindful that anything done to excess is harmful. I suspect that there are far more people suffering from orthorexia than we realise. People that we can follow on our Twitter and Instagram feeds, going to the gym seven days a week, eating to an exact and uncompromising meal plan every day to keep their 'macros' in check. Of course, these people are extremely healthy, but, I would question the long-term sustainability and repercussions of their actions.
It comes down to one question- why? What is the driving force?
2. Eating Disorders are Not Just About Physical Appearance
While for most people eating disorders begin with a diet, which is not always the case. For me, I experienced years of eating-disordered behaviour before background strain in my life turned that behaviour into a coping mechanism. I was living my dream (I thought) as an actor, I was living in a nice house, I still had to work in a restaurant to make up enough money for my rent but in general I was living a good life. An exciting and thrilling life to those looking in, but I was in hell. Depression and anxiety crept up on me slowly until all of a sudden they were the biggest part of my life; though I suffered with them for so long, it was like one day I woke up and I couldn't move with the weight of them. Counting calories became the mechanism by which I was able to stay living my life for the length of time that I did. The feeling of physical emptiness brought emotional numbness, relief from the sadness. Putting my body into starvation mode gave me the energy to stay going when depression wanted me to lie down and sleep for a thousand years. I also developed OCD, cleaning my house in every spare sleepless moment, to avoid thinking, feeling, and most importantly, eating. It was always important to me as an actor to maintain a healthy figure, but I had gone too far. Sadly, I didn't even know it. Everyone told me I looked amazing and wanted to know what diet I was on, I got more praise than I ever did when I looked healthy.
Several doctors have asked me my weight over the last few years and I have had to tell them that I don't know; I don't own a scales. They were more than shocked, they wanted to know what my motivation was in continuing to get thinner and thinner, how I measured it and how my actual weight was not an active factor in my anorexia. The thing was, I didn't care how much I weighed, I still don't. As far as I'm concerned, that's only a number and knowledge of it wasn't necessary for my eating disorder to be effective in numbing and controlling my emotions and thoughts. For me, my eating disorder is a secondary problem, a response to bigger psychological problems. For others their eating disorder may lead to other issues such as depression or anxiety, resulting from the desperate effort of maintaining an impossible dietary regime.
3. Eating Disorders Rarely Stand Alone
The vast majority of eating disorder patients tend to be dual diagnosis patients; that is, they have what is known as a comorbid disorder. Simply put, almost no one has 'just' an eating disorder. The most common comorbid illnesses include;
⦁ depression, dysthymia, panic and anxiety disorders, post-traumatic stress disorder(PTSD), obsessive-compulsive disorder (OCD), borderline personality disorder, bipolar disorder, sleep disorders, body dysmorphic disorder & substance abuse or dependence
Treating an eating disorder is not a simple case of regulating eating and moving towards a healthy weight, whether that be by losing or gaining. Most people with eating disorders actually maintain a healthy weight, so it's easier to see, within this constant, that weight is not the be all and end all of the issue. Regular eating is much more important; it helps to regulate everything within the body. With regular eating comes an active metabolism, a constant flow of energy rather than peaks and troughs, even blood sugar levels, regular electrolyte levels (crucial for heart function), more stable mood, better concentration, better dialectical thinking, better chance at establishing a regular sleep pattern.
Physically treating the eating disorder has to be the first port of call for health reasons, but it is not the defining factor in recovery. Nothing else can take place until a certain level of health is restored, but that is just the foundation upon which, the rest of recovery is built. Bearing in mind the high frequency and severity of comorbid illnesses, it's not surprising that psychological help is crucial. I regularly see my psychologist as well as my psychiatrist to deal with my depression, anxiety, OCD, insomnia, body dysmorphic disorder. I am on medication, which some people may need (though not all) and I am careful to take my medication as it's prescribed. Making the decision to take medication is not one to be made lightly and one which is made all the more difficult by the stigma attached to taking psychiatric medications. I can only speak for myself, but my recovery would not be possible without medication and I would urge you to remember that your doctors don't tend to prescribe it lightly. Medication and psychological help in dealing with the roots of my eating disorder are as crucial, if not more so than my weight restoration. Weight is just the tip of the iceberg; the reasons why, the pain, discomfort, low self-esteem, body image issues, depression, anxiety and other such underlying issues are where the real work has to be done. Unfortunately, this is another area that garners high stigma, but as I always say, I've spent the last 26 years learning how to love myself and I don't have that time to invest in anyone else. Screw what anyone else thinks, never mind the people that think you're 'crazy' or that you just need to 'snap out of it'. This life is yours, not theirs, and you only get one. You didn't choose to have an eating disorder any more than someone chose to be diabetic. You will feel guilty at some point, you will feel like you deserve it, your self-worth will plummet, but you have to keep reminding yourself that we are not defined by our fall; we are defined by our rise.
4. Eating Disorders Don't Just Change Your Exterior
Your physical appearance is the least of things affected by an eating disorder. Apart from all of the mental problems it either precipitates or worsens, an eating disorder ravages your body in all of the worst ways. It's no small thing that anorexia has the highest mortality rate of any mental illness. Your body has to work as hard as it can on the inside as you are. While you're healing your mind, your body is working to repair the damage caused by starvation, bingeing and purging, overeating and/or over exercising. Just some of the side-effects of an eating disorder include;
⦁ Gastrointestinal diseases such as Irritable Bowel Syndrome and Inflammatory Bowel Disease. Further issues include poor gut motility, recurrent heartburn and indigestion, chronic constipation, flatulence and incontinence.
⦁ Malnutrition, which can be the cause of various complications such as leukocytosis, leukopenia, thrombocytosis and anaemia
⦁ Low or fluctuating levels of electrolytes such as potassium, chlorine and sodium, which are critical in maintaining effective heart activity. Complications with the heart can include arrhythmias, abnormally slow heartbeat, low blood pressure, decreased size of the heart muscle, reduced heart volume, mitral valve prolapse, myocardial fibrosis, and pericardial effusion.
⦁ Either an under-active or over-active thyroid gland.
⦁ Osteopenia and Osteoporosis
⦁ Seizures and tremors
⦁ Constant pain in bones due to insufficient body fat, resulting in a frequent need to move around.
⦁ Lanugo- soft downy hair grown on the body in an attempt to conserve heat
⦁ Hair loss
⦁ Increased chance of developing arthritis and other bone-related diseases in later life.
⦁ Depletion of tissue throughout the body, including the brain. Reduced cognitive functioning, mental distortion, skewed outlook, poor concentration, short attention span.
⦁ Cessation of menstrual cycle in women
⦁ Reduced circulation leading to extreme cold, numbness in extremities, blue tinge at finger and toe tips, nose, around lips.
Regaining a healthy weight is crucial, and aesthetic appearance is at the very bottom of the list of reasons to recover. All of this internal damage begins happening even before a person may appear to have an eating disorder. After just a few days of disordered eating, your body begins to suffer and degrade on the inside. I can't count how many times I collapsed, often hurting myself, while in the throes of the disease. I still get bad headaches and head-rushes if I go up stairs or stand up too quickly. Sometimes this still causes me to collapse, though I don't lose consciousness. My circulation is permanently affected. I did minor damage to my kidneys due to inconsistent electrolyte levels. My thyroid is overactive. I am still anaemic even though I'm over the worst of the disease and need to take daily supplements. I suffer from indigestion and constipation. After eating a large meal I feel as though it's going to come back up. Stomach cramps and pains are an almost daily occurrence. My hands still tremor. It's still uncomfortable for me to sit in one place for too long.
What would be worth this? Being a size 6? I don't think so. I didn't choose this, but I'm unchoosing it.
5. Recovery is Not a Straight Line
An eating disorder is like an addiction. It is not a simple case of taking a course of antibiotics and getting better, or even doing an eating disorder programme. You don't skip out of the hospital, or from your final therapy session, weight-restored and 'cured'. In fact, and I'm sorry if this news hurts anyone, there is no such thing as cured. You will never be cured. You will never be free from this. You will have good times and you will have bad times, and in the bad times, it will try to rear its ugly head. Just like an alcoholic is always an alcoholic, you will always be in recovery. I'm not saying that's a bad place to be, it's a great place to be, but you can't make the mistake of thinking that that's it; you're done. Recovery does not go from A to B. It goes to E and Q and F and R and C and M and X and all the letters in between, and then it will go again. Recovery isn't something you achieve, it's something you choose and you have to make it a priority to choose it every day.
Relapse occurs in a third of people who receive treatment for the disorder and is greatest in the first six to eighteen months after a release from inpatient treatment. Not only am I one of those 1 in 3, I was also in recovery for two and a half years before my relapse hit me. Watching it happen a second time is horrifying- and that's what it feels like. It’s like you're just watching yourself make these old, familiar mistakes. It feels as if you’re watching an accident happen that can't be stopped. Because you've been through it before, you recognise what's happening, you notice that the voice in your head is no longer your own, that you are not only lying to the people around you. You're trying your best to lie to yourself too; though you can't. Maybe some people can, maybe some people don't realise what's happening, but I noticed, I realised early on, I was off the rails, miles and miles off. Probably not too far to go back- I just couldn't. The kilos fell away so quickly I was surprised in the beginning, then it became something better to focus on than the thoughts in my head. I only felt alive when I was teaching, it was like I had a focus on something other than the pain and it wasn't just a distraction, it was something I loved more than anything. When I was teaching I was invincible. The rest of the time I slept or moved from chair to couch to bed to chair to couch. I walked the hall. I curled in a ball, wrapped my arms around myself and tucked my fingers under my ribcage; there I felt grounded. Wherever I went, I needed to be holding onto some part of myself or I felt like I would just float away. If I had to sit anywhere for any length of time, my foot jigged uncontrollably the whole time. Eventually, my doctor wouldn't let me teach anymore. How had I ended up here? This place, this rock bottom was the rock I built my life on- I did my teacher training course, started teaching, bought my first car, started my own business, developed a new yoga programme for the elderly, started painting again, discovered weight-lifting and was at my fittest and most healthy in years. Suddenly, within the space of about five months I was right back on rock bottom again, squeezed in there between the ruins of everything I had spent the last two and a half years building; the life I had been trying to build for myself. Guilt, shame, disgust, regret, pain, embarrassment, I felt it all for letting myself fall back there again. But what did I say? No one chooses this. I can see that now. I can have compassion towards myself for relapsing. It doesn't make me a bad person. I fell down but I'm back up again, choosing recovery again, every minute, every meal, every day. As my man, Samuel Beckett, says, "Ever tried? Ever failed? No matter. Try again. Fail again. Fail better."
If you or anyone you know is suffering from an eating disorder, there are so many great websites out there. Also, feel free to contact me and I can do my best to guide you in the right direction. You're not alone and you don't have to be.