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Anorexia: The Reality Of Inpatient When You Want To Be Well

Eating disorders are complex illnesses, which makes the treatment of them hard. This is the experience of one individual struggling to recover, told through the lens of one morning on an inpatient ward in England. Desperate to recover, she was struggling to eat enough to do just that. A battle in her head became a battle in the dining room. But one that she had to keep fighting.

I just wanted to be happy.

But being a healthy, happy and functioning adult was not compatible with being a paranoid, scrawny, egocentric, broken, exhausted, insecure, fragile, stubborn, controlled, distressed, arrogant, guilty, depressed, consumed, fractured, broken, battered, dejected, emaciated, obsessed, righteous, pressured, afflicted, tormented, helpless, irresponsible, impotent, ill equipped, desexualised, distressed, twitchy, grumbling, hysterical, anxious fixated, incapable, controlled, ashamed, touchy, petulant, manourished, embarrassed, compromised, manipulative, neurotic, disturbed, selfish, worried, jealous, isolated, bewildered, panicky, hurting creature cast adrift in a self-inflicted ocean of flagellation.

And so this meant I had to change. Words that had once been so entrenched in my vocabulary started to become edged out. I can’t, won’t and don’t were repThe reality of inpatient when you want to be well laced by I choose, I have not previously, I can, I may, I do, and I am capable. It wasn’t an easy change, the adjustment of a whole lexicon that came with the illness, but slowly my dictionary was being rewritten.

I was starting to see my eating disorder as less of a binary state of being unhealthy or healthy, broken or fixed, ill or recovered, and more as a process in which I was constantly learning. At the start I had been so triggered by the competitive nature of those with eating disorders, wondering whether was less sick or more sick than them, and whether was failing when I ate. Recently something in head changed. I had decided to play a new game, and instigate new rules. It wasn’t about not having butter, only eating with a teaspoon, refusing carbohydrates unless I had exercised, but about living life. When someone came in and wept over their butter I did not long to be like them and nostalgically remember my severest days, but realised that I was further the path to recovery than them. When someone set for themselves a big scary challenge that was actually a subtle dig at the big scary food I had all the time, I welcomed the idea that I was becoming more normal, and that I could only do so by becoming less anorexic.

Running my fingers along the waistband of my elasticated trousers, specially selected so as to make it less easy to measure weight gain, I tried for the millionth time to focus my attention on the benefits of recovery. Not living in a psychiatric ward for one. Being herself, going for dinner, laughing with friends, taking responsibility, walking on the beach, fresh air, feeling awake, being able to run, accepting challenges, having energy. And chips. And wine. And cheese. It wouldn’t be that bad surely. If only things were as simple as a decision. But for too long I had been punishing herself and perpetuating the illness from an anger towards being ill and a fear of what else is out there. I had had enough.

The difficult part was this feeling of stasis. The thrill of the permission to eat had gone and the excitement for a new start in life waned. But I was no longer in the dizzy arms of my eating disorder. It was like going back was no longer an option, but neither was there any clear sight of a life without the anorexia. It was just a constant cycle of eating and reading and sleeping and starting again. Most of the time it was ok, but I had to tread carefully because at any moment a trigger may send me plunging into freefall. But equally, I was no longer ill enough to be a worry, have constant vigilant carers. I felt like I was suspended in a boring space that would never end.

But the task of creating oneself loomed insurmountable. I never wanted to go back. I didn’t want to stay here. But the thought of where I was headed remained as daunting as ever. Writing and rewriting the past was no longer serving her, but there was a real sense of stasis.

I was being kept on the ward for ‘extra support.’ My weight chart, originally ascending at a perfect 45 degree angle has now flattened out. So they were keeping me here, on the ward, to help.

I spent my days surrounded by people who have no intention of ever recovering. They were not even aware they are ill. Sometimes I envied them. To be so embroiled in the illness and detached from reality that they don’t even know what they are doing.

I felt greedy. I was the only one eating solid food. They sat and swap stories about the first units they were in thirty years ago, or their favourite flavours of Ensure. I felt different. It made me feel guilty – and arrogant. Who the hell was I to think I am different, or could have a better life than this people? I might think I am unique, but I too was in thrall to an emaciating and debilitating disease. My life had been reduced to being a tormented bony creature perched on a weighing scale. I’m pathetic.

Breakfast time. The bell rang. Just like Pavlov’s dogs, I came out for my food. I was handed a tray with a coffee, some juice – and an empty bowl. I can only assume there was the assumption that I will get my own cereal from the cupboard in the unsupervised dining room. I wet into the room and think about this. I had been given an empty bowl and told to go and sit in a room on my own for half an hour. If I were struggling, which my weight would suggest I were, and if this is support, which I was told it is, it seemed slightly bizarre. I sat for a bit, staring at the white ceramic. The perfect opportunity to restrict. No one would ever know. I’d just swirl the milk around in the bowl and be done with it.

But where would that get me? Another weekend here. Feeling not unlike Oliver, I carried my bowl to the kitchen.

‘Please, can I have some food?’

The anorexic voice was beating me, welling up inside, anger coursing up like shards of metal in my throat.

What are you doing you greedy bitch?

As I sat eating my breakfast, I try to remember that I am getting my life back.

Eating Disorders

A healthy relationship with food is absolutely necessary for mental and physical health. It seems so natural and simple. A baby is born and Nature provides the mother with milk that’s complete nourishment for the beginning months of life. Or if the mother can’t, or prefers not to, breastfeed the baby, there are excellent prepared ‘formulas’ that keep the infant well-nourished. Then comes “baby food” and the gradual addition of a variety of foods to provide balanced, healthy nourishment for the growing child.

But human beings are complex creatures and this basic requirement for nourishment sometimes becomes psychologically complicated, troublesome and occasionally damaging to physical health and emotional well-being.

When does a negative relationship with food begin?  For each person who develops an eating disorder, the problem begins at a personally vulnerable time with a unique set of circumstances that may cause the troublesome perspective on food to worsen as months and years go by.

An eating disorder is a persistent disturbance of eating or eating-related behavior that results in the consumption of food that is not typical or not suitable for the person’s age, circumstances and nutritional needs.  An eating disorder is diagnosed when that disturbance impairs physical health or psychological or social functioning.

The most common eating disorders are anorexia, bulimia, binge-eating and avoidant or restrictive food intake disorder.

About 25 million Americans are currently affected by eating disorders and about 25 percent of those are men. Eating disorders affect people of all ages, races and socio-economic levels.

The confusing thing about eating disorders is that they are not actually based on food, but are brought on by biological, psychological and social factors.

Abundance and Mixed Messages

Societies in the developed world are fortunate to have, in most communities, a wide variety of fruits, vegetables, meats, cheeses and breads that are often available year-round, thanks to transportation and refrigeration. But within that abundance, the U.S. and other Western countries have, for complex reasons, valued “thinness” to an extreme, even casually repeating the phrase, “You can never be too rich or too thin.” Well, that’s frighteningly incorrect and dangerous.

Being too thin, as in the case of anorexia, can cause serious health problems and in extreme cases, even death. Concerned health professionals, educators and parents are making efforts to increase awareness that the extreme thinness of fashion models sets a twisted and dangerous ideal of beauty.

A survey of 1,000 adults conducted for the National Eating Disorders Association found that 70 percent believe encouraging the media and advertisers to use more average sized people in their advertising campaigns would reduce or prevent eating disorders.

Scientific research on a wide range of illnesses has prompted society as a whole to understand the health benefits of fresh, pure foods.

But scientific knowledge, abundance and choice can be overridden by psychological and emotional imprints that cast a shadow over the natural impulse to eat what the body needs to survive and be healthy.

When Does a Food Choice Become an Eating Disorder?

Let’s say, for instance, a coworker brings in a cake for an office birthday celebration. Some people voice concerns about sugar and calories and refuse a piece of cake, while others voice the same concerns, but eat a piece of cake anyway, thereby setting up an internal contradiction – eating the cake, but at the same time feeling guilty about sugar intake and worried about getting “fat.”

This example of people in a self-contradictory state about something as traditional as birthday cake does not describe an eating disorder. But if you intensify and multiply this or others conflicted behaviors for every meal, and almost every interaction with food, you get an idea of the agonizing daily physical and emotional challenges of a person with an eating disorder. Combined with a distorted view of body image, it sets up an unhealthy relationship with food.

When you take these sometimes casual remarks about food, calories and being fat and repeat them so often in society that children begin to live with confusion and guilt about what they eat, it becomes an environment with the potential to increase eating disorders, which often begin in adolescence, especially among girls. These contradictions and suggestions of “guilt” about food, weight and body image are creating a troublesome, and at times deadly, health crisis.

The Troubling Statistics on Eating Disorders

In the United States, 20 million women and 10 million men suffer from a diagnosable eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or other specified feeding or eating disorders.

Dissatisfaction with their own bodies or weight is increasingly common among young children and teenagers.  Here are some more troubling statistics from the survey done for the National Eating Disorders Association:

  • By the age of 6, many girls start to express concerns about their own weight or shape.
  • 40-to-60 percent of girls ages 6-to-12 are concerned about their weight or becoming too fat.
  • More than one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting or taking laxatives.

Disorders Related to Food and Eating

Anorexia: A diagnosis of Anorexia Nervosa is made when a person has restricted their food intake so much that they have a significantly lower body weight than others in their general range of age, sex and physical development. The person has an intense fear of gaining weight or becoming fat. They may have a distorted view of their own body shape and be unable to recognize the seriousness of their extreme low body weight. Anorexia is 10 times more common in females than males, according to the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. Anorexia often develops in adolescence or young adulthood and is sometimes associated with a stressful life event.

Bulimia: A diagnosis of Bulimia Nervosa is made when binge eating occurs and the person feels unable to stop eating or control how much is eaten. To compensate for this binge eating, the person often takes unhealthy steps to prevent weight gain, such as self-induced vomiting, laxatives, diuretics, fasting or excessive exercise.  The person is overly concerned about body shape and weight. Bulimia is 10 times more common in females than males.

Binge Eating Disorder: Although this has factors in common with bulimia, the person with a binge eating disorder does not take compensatory measures, such as self-induced vomiting or use of diuretics. Those with a binge eating disorder tend to eat very quickly, often eat until they are uncomfortably full, eat large amounts of food when they are not physically hungry and often eat alone because they are embarrassed by how much they eat. They often feel depressed or disgusted with themselves after an episode of binge eating.

Avoidant or Restrictive Food Intake Disorder: In infants or young children, this restricting of foods could result in lower than normal growth and development. This disorder often appears as a lack of interest in eating. In some children the avoidance food could be associated with sensitivity to the appearance, color, smell or texture of the food. This may sometimes occur in individuals with heightened sensory sensitivities associated with autism.

Treatment for Eating Disorders

The main goals in treatment are restoring adequate nutrition, bringing weight to a healthy level, stopping binging and purging, and reducing excessive exercise.

Psychotherapy is an important factor in gaining understanding and skills to develop healthy eating habits and body image. In some cases, where depression or anxiety is a prominent factor in the eating disorder, medication may be prescribed.

Individual, group or family counseling mcetay be a part of the treatment plan and can be a critical factor in creating a support network.

In cases of extreme malnutrition, a person may be hospitalized for a time until the condition is stabilized.

Hope for Those who Suffer from Eating Disorders

Research is continuing on the complex biological, psychological and social factors that combine to create an eating disorder. The most important step is to first acknowledge that there is a problem. Human beings are tremendously capable of growth and improvement in the face of enormous challenges, but until an issue is addressed and acknowledged, work to change cannot begin. Being able to talk about it with a trusted friend can be helpful and can diminish the sense of isolation and shame that is often a significant part of the problem. Being able to seek treatment from a professional therapist can also open a path towards healing and renewal.  Eating disorders often occur in combination with other problems such as depression or anxiety, so developing a path to good health must be designed specifically for each individual. The most promising fact about eating disorders is that with professional, compassionate and consistent treatment, a complete recovery and hope for flourishing is very possible..

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References

American Psychiatric Association, “Feeding and Eating Disorders,” Diagnostic and Statistical Manual of Mental Disorders: DSM-5, Arlington, Va., 2013
http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596

The Alliance for Eating Disorders Awareness, “What are Eating Disorders?”
https://www.allianceforeatingdisorders.com/portal/what-are-eating-disorders

National Eating Disorders Association, “Get the Facts on Eating Disorders,”  New York, 2016
https://www.nationaleatingdisorders.org/get-facts-eating-disorders

National Institute of Mental Health, “Eating Disorders: More Than About Food,” Bethesda, Md., 2014
https://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml

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