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Barriers to getting treatment and support for Anorexia Nervosa

By Sophia Greaves

CN: detailed discussion of ED

Anorexia Nervosa has the highest mortality rate of any mental health disorder, with many deaths occurring from suicide. 

Misconceptions about this illness prevent:

  • Sufferers of Anorexia reaching out for personal and professional support.
  • An Anorexia diagnosis being taken seriously by the sufferer’s family and friends.
  • Early detection and treatment, which improves recovery speed and chances of long-term recovery, and reduces symptoms and the risk of relapse after recovery.

Myth 1: Only thin people suffer from Anorexia

Truth:  Anorexia affects people at all weights, shapes, and sizes. 

Anorexia is characterised by an intense fear of gaining weight, not by the sufferer’s size. Firstly, those at a “normal” weight, “overweight”, or “underweight” can equally suffer from Anorexia. In fact, less than 6% of people with Eating Disorders are medically diagnosed as “underweight”. Secondly, the body heals long before the mind. Brain recovery can only occur after weight restoration, when the brain is being nutritionally rehabilitated and can process challenges to the Eating Disorder. Although a sufferer might look physically healthy, their brain could be equally as ill as someone dangerously underweight. You cannot tell if someone has Anorexia or how severe their illness is by looking at them. 

Myth 2: Treatment is only available for those at ‘death’s doorstep’

Truth: Treatment is available to sufferers at any stage of Anorexia, including early onset, partial remission, and those requiring hospitalisation. Every man and woman seeking help is taken equally as seriously irrespective of their weight, or the severity and duration of their illness. 

Believing that treatment is only available for those who are emaciated was a barrier to me seeking help early on. At 15 years old I acknowledged my Eating Disorder but believed I did not look ‘sick enough’ and would therefore not be taken seriously by friends, family, and medical professionals. Over the next seven years I became sicker and sicker. My weight plummeted to hospitalisation levels. I increasingly isolated myself by withdrawing from friends and social events because I considered myself too fat to be seen. I was constantly exhausted and dizzy, and felt freezing even with the heating on and wearing three jumpers. I was so terrified of gaining weight and so hungry that I could not sleep properly most nights. The backs of my hands were callused from forcing myself to vomit up “fear foods” I could not avoid, such as my Brother’s birthday cake. I could not digest food properly and developed IBS symptoms. When looking in a mirror immediately after eating anything, even an apple, it always appeared that I had gained 10kg, and I panicked so much at my “overweight reflection” that I caused myself severe pain. If I had reached out at 15, I would have saved myself years of struggling alone.  

Myth 3: Anorexia is a choice

Friends, partners, and family trying to be supportive can mistakenly believe their loved ones need to ‘snap out of it’ and ‘just eat’. 

Truth: Anorexia is a complex psychiatrist illness that people do not choose. Those with Anorexia are not ‘attention seeking’. In fact, sufferers go to great lengths to hide Eating Disorder behaviours and frequently are unaware, or in denial, of their illness.

Some individuals are genetically more susceptible to developing Eating Disorders when faced with environmental stresses, and are therefore no more at fault of developing Anorexia than of developing type 1 Diabetes, Asthma, or Epilepsy.

Compulsively restricting, over-exercising, purging (i.e.: self-induced vomiting, and laxative and diuretic abuse) often starts as a coping mechanism for controlling painful emotions or aspects of ones’ life, including:

  • Bullying or teasing (often about weight)
  • History of physical or sexual abuse – which can trigger guilt, fear, and shame
  • Depression, low self-esteem, loneliness, anxiety, and/or high stress
  • Perfectionism, especially perfectionism involving setting unrealistically high expectations for yourself
  • Stressful life transitions e.g.: starting University, studying abroad for a year, losing a loved one, parents divorcing, and pregnancy 

Myth 4: Anorexia only affects Caucasian middle-class females, particularly adolescents 

Truth: Individuals from all genders, backgrounds, ages, social classes, and ethnicities are at risk of developing Anorexia

 Women are certainly at particularly high risk. Other high-risk groups include people:

  • Under high levels of stress
  • Participating in ballet, athletics, long distance running, modelling, and gymnastics
  • With co-existing physical illnesses e.g.: endometriosis, diabetes, and polycystic ovarian syndrome
  • With co-existing mental illness e.g.: depression, anxiety, OCD, and social anxiety

Awareness of high-risk groups should not distract from recognising Anorexia in all areas of our community. Men make up 25% of those with Anorexia, and yet are under diagnosed by medical professionals due to a low index of suspicion. The highest risk period is 12 to 25 years old, with 85% of individuals developing Eating Disorders between 13 to 18 years old. Nevertheless, onset can occur in children under 11 years old, and those in their 50s and 60s. In the UK, Eating Disorder Treatment is accessed through your GP. If your GP is not aware that someone of your gender, age group or ethnicity can develop an Eating Disorder and does not take your concerns seriously, seek another GP to access support. 

Resources

Online Support Groups for Sufferers and Caregivers

https://www.beateatingdisorders.org.uk/support-services/online-groups

Approaching your GP for access to Treatment

https://www.beateatingdisorders.org.uk/recovery-information/going-to-the-doctor

Advice for recovering as an Adult

https://tabithafarrar.com/

“Life Without ED” by Jenni Schaefer – this book provides advice for Adults with Eating Disorders and allows loved ones to fully understand the Eating Disorder

Supporting someone with an Eating Disorder during Covid-19

https://www.beateatingdisorders.org.uk/coronavirus/supporting-someone

F.E.A.S.T First 30 Days Programme – FREE short daily videos for Caregivers about Eating Disorders and how to provide support. This programme is also a useful resource for Adults with Eating Disorders wishing to understand their illness. 

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