Anorexia: Where There's Help, There's Hope

Four years ago, Lucia’s alarming weight loss made her the centre of attention at school, and yet the only response from teachers was to exclude her from PE. Lucia never wanted attention, nor did she want to be a supermodel.

Girls are resolute that measuring themselves against media images of stick-thin models isn’t the cause of their eating disorder. Dr Sadia Chaudhry is an NHS consultant psychiatrist working with young people with severe eating disorders in the North East: “Of the hundreds and hundreds of patients I’ve seen, the media has not played a significant contribution. Nor is anorexia restricted to white, middle class girls. It’s a myth.”

What causes a young person to count calories obsessively and develop poor or distorted body image? Christine’s eating disorder started in childhood: “I developed full-blown anorexia when I was 14. However, issues with controlling my weight began much younger. I remember getting up at night to exercise secretly when I was eight.

“I hid my weight-loss well by wearing baggy clothes and keeping covered up so teachers were very slow to notice. At boarding school I would just pick at meals. It went disturbingly unnoticed until it had clearly gone way too far and then they did the best thing anyone can for someone entrenched in an eating disorder – they sent me to my GP to get professional help.

A coping strategy?
Christine agrees the psychology is complex and goes deeper than eating, exercise and body image. For her, avoiding food was a way of coping:

“I felt socially excluded at boarding school, and as my parents’ marriage broke down I found comfort in retreating into a world of my own I could control. One such area was food.”

Medical professionals agree that attempting to identify triggers can be futile as it can be anything from moving school to puberty. Dr Chaudhry says there may be pre-disposing biological, psychological and socio-cultural factors.

“Parents get latched onto one thing, but factors come together. We know that a girl is 11 times more likely to develop anorexia if she has a female relative with the condition. But any genetic determinant is very complex and multi-factorial,” she says.

“There are psychological theories to do with temperamental traits. Perfectionism - especially with academic work - low self-esteem, conforming not rebelling, and internalising feelings might be significant. Often parents express confusion as to why this happened when ‘she’s never given us any trouble’.”

Children as young as four have been reported as anorexic, but Dr Chaudhry states that this is extremely rare. In her opinion, however, ever-younger children are highly sensitive about weight and body image.

Boys get anorexia too
Up to 20 per cent of anorexia patients are boys, and boys are more likely to slip through the net and have an uncertain future. Dr Chaudhry states:

“A girl will have the obvious marker of her periods stopping, but with boys there isn’t a clear sign and anorexia doesn’t initially come to mind for teachers, parents or GPs. Boys tend to over-exercise and become more ill, more difficult to treat, and the outcome can be worse. Anorexia is often considered to be a girl’s condition, so boys and their families struggle to come to terms with it. We should be seeing more boys.”

Parent power
Doctor Kay Callender is specialist at the Altrincham Priory Clinic. In her experience the incidence of anorexia is greater in single-sex schools where students are highly driven.

“Teachers need to be able to identify pupils who are struggling psychologically and they should be doing self-esteem work in the classroom. It’s just not taken seriously enough.

“The decision to admit a young person to the Priory is never a first-line measure. Most in-patients are NHS-funded. It’s crucial to work with the family but uptake of family therapy is low. It’s a long haul and parents are afraid to interfere but my advice is to dive in at the beginning and try to stop it. “

Dr Chaudhry offers similar counsel, adding that there will always be a group who need to be admitted. The key is working collaboratively with parents, giving them the skills to communicate and cope: “Don’t avoid it. The longer the condition goes on, the less likely the child is to respond to treatment. Keep the conversation going, be calm, clear and consistent. Find out about anorexia and share information with them. This is often a relief for the sufferer.”

Training for schools
beat (formerly the Eating Disorders Association) offers support and training to schools and raises awareness nationally. It’s a vital resource for the independent sector where links with the NHS are not formalised as in the state sector. Boarding schools counsellors are there to listen to and support, but is this enough?

Rachel Williams is a nurse at the Royal Grammar School an independent co-ed in Newcastle. She and her colleagues attended a beat event where one of the speakers was a beat young ambassador. Rachel says, “Her talk gave us insight into living with an eating disorder. Since attending we have drawn up a new protocol around eating disorders, although each case is different and our management has to be tailored to the individual. Also, we arranged a talk for all staff from an eating disorders counsellor. We now know what signs to look for that may cause concern.”

Schools have a responsibility, but expert help is required. A report : Under Ten und Under Pressure?, published by Girlguiding UK in partnership with beat, emphasises the importance of building self-esteem in young girls – the group most at risk of anorexia. This is their advice to all of us:

*Listen to children, take their concerns seriously
*Focus on feelings - don’t criticise negative eating habits, find out what’s behind them
*Don’t put emphasis on food or weight
*Be available to talk
*Help girls learn to respect and support each other
*Bring experts into schools

Case study: "The never-ending support from my family really helped"
Annabelle began losing weight around her 15th birthday and was diagnosed at 16. When the illness was at its worst, she lost around a third of her bodyweight.

“I think it was triggered by a combination of a virus, causing a loss of appetite, stress and changes in the family environment. My teachers ignored my rapid weight loss. I think they were unsure how to help, so they left me alone.

“When I was admitted to hospital my digestive system wasn’t functioning and I had to be tube-fed. General paediatric wards aren’t designed for mental health patients and I was there for four months. The nurses knew little about anorexia and some were judgemental. However, most of my treatment team were phenomenal.

“We began family therapy and I saw a psychologist for two years. The never-ending support from my family really helped. They didn’t judge me – when we argued and I was abusive they continued to support and love me. They ate every meal with me in hospital and at home during recovery, and for that I’m very grateful.

“When I was 17, I saw Kay who was a nurse therapist. She was brilliant. She let me be me and talk about my needs but was firm and guided me in the right direction. I also really benefited from my dietician who worked with me to build a healthy, sustainable diet plan.

“Although I occasionally slip into anorexic thoughts and behaviours, especially in times of stress, I’m almost fully recovered, back in full-time education and working in my local pub. I remain very close to my family. Most of my friends treat me like nothing happened which is great, and while I cannot forget, I have learnt and am moving on.”

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