Mental health conditions, Children & Adolescents, Stigma

24 July, 2017

#StillJustMe: Stigma and Eating Disorders

Often when we hear of terms like "eating disorder", "anorexia" or "bulimia", we have an associated image in our heads related to those terms.

For those who have not had any personal experience of eating disorders, the conjured image is often an emaciated celebrity who was on the cover of a glossy magazine, with one of these terms as part of the accompanying headline. It is therefore assumed that eating disorders are something to do with how we look

The common belief is that eating disorders must be driven by an over-exuberant pursuit of vanity, or else it is a fad diet that has gone wrong. We think about these conditions with a degree of intentionality and say things like "look what she has done to herself". Our collective response can be to apportion blame and responsibility to the celebrity in question and, like our views of celebrity addiction, empathy and sympathy can be short in supply.

This is also understandable, because the majority of us have fairly diverse relationships with food where we can see food as something comforting and nurturing. This is not surprising, as many of us have associated food with emotion for most of our lives, from our childhood experiences of getting the ice-cream we got when we cut our knees or the selection boxes at Christmas time to family dinners. Traditionally, we have a positive association with food, which influences our attitude to people living with eating disorders to include phrases like "ah, would ya just eat?". The concept that, for some people, eating a delicious chocolate cake could feel like eating a spoonful of crushed glass and drinking a delicious sugary soft drink could be experienced like the ingestion of battery acid is, to many of us, unfathomable. Unfortunately for people with eating disorders this is often the case.

Untangling the myths

In my 20 years of working with young people with eating disorders, I cannot remember one case where the pursuit of vanity was at the core of its origin. In fact, the reality is quite the opposite. There are two aspects of eating disorders that are often confused. These are the concepts of triggers and causes. A trigger might well be seeing a picture of ourselves where we feel we look overweight; it might be a healthy eating class in school which strikes a chord; or it might be a hurtful comment that someone has made in reference to our weight or shape. However, these incidents do not cause eating disorders.

The cause of eating disorders is often a feeling of overwhelming anxiety and a loss of control. This can often arise where a young person feels alone, disconnected and powerless in their lives. They do not have the ability to voice their worries or concerns, and, more often than not, their self-worth is so low that they believe they are not worthy of burdening others with their problems.

The combination of being overwhelmed, voiceless and disconnected leaves the person vulnerable. In this vulnerable position, the eating disorder arrives like the knight in shining armour, with a tempting offer to fix all of the above difficulties. The eating disorder promises emotional control, companionship, an experience of accomplishment, visibility and a way of communicating all of your uncomfortable feelings without ever saying a word. In that vulnerable position, most people would sign up to that contract.

Feeling trapped

 In the beginning, an eating disorder is like a new romantic relationship. It is all-consuming and creates a distance from you and your family and friends. You feel better, in more control, and, soon, you become hooked. However, the romantic relationship between you and the eating disorder soon becomes toxic. The relationship is less about flowers and chocolates and more about severe control, unrealistic expectations and hostility. Like most controlling relationships, the person feels trapped. They are repeatedly told that they will be nothing without the eating disorder and they become victims of the most cruel and persecutory life-coaching that anyone could imagine.

Like our advice to the victims of a controlling relationship, where we flippantly suggest "just leave him", in terms of an eating disorder the equivalent remark is "just eat". The reality is that the relationship with food, weight and shape is a lot more complex than that; finding your way out of that relationship which has left your self-esteem in tatters and your self-belief non-existent is incredibly difficult.

Therefore, the reality of eating disorders is that they could not be more removed from an association with vanity. Most young people with eating disorders feel completely worthless and trapped, and they pursue thinness so fervently not because they want to look good, but rather because, if they don’t, they will be subject to the most vicious psychological assault imaginable. An eating disorder sets out the rules and God love anyone who tries to break them.

Fighting your way out

So, recovering from an eating disorder is more than just eating. It involves conjuring up superhuman bravery, withstanding the most vicious tirades of psychological torment and, most importantly, standing up to the most fearsome of bullies.

Recovering from an eating disorder is a battle that involves leaving something familiar and taking a leap of faith into the unknown, without what you believe is your greatest ally. It takes courage and bravery beyond belief, but it is ultimately very possible.

There will be good days and bad days on that recovery journey, but, ultimately, there is a way out if you are still fighting. Recovery is a journey away from who I have become, with the desired destination of a return to myself. This return need not be to the lonely, overwhelmed and disconnected person of old, but a venture into a new self-believing and self-valuing me - but #stilljustme.

This blog was written by Dr Colman Noctor, child psychotherapist at St Patrick's Mental Health Services.