My advice to anyone who has a loved one suffering with anorexia is to try to remain calm as much as possible. Anorexia is a very frustrating illness and most carers at some point or other try to force the anorexic to eat more than they can cope with. This can lead to hostility, fear and anger developing. It is important that the carer allows the sufferer to take things at their own pace. So long as there is progress forward, it doesn't matter how slow that progress is.

Confronting an anorexic can be very important if the sufferer is totally in denial although this has to be done very gently and carefully. It is quite likely that the sufferer will become upset and angry, denying that they have a problem. At times carers are likely to feel anger towards the sufferer. It is important at times like this that they try to remain calm, in order to help the anorexic. Sufferers usually feel a strong hatred for themselves and if the carer shouts at them, this will only reinforce their negative feelings. Kindness, understanding and support are vital if you are to help your loved one.

2) I want to start to change my anorexic behaviour. How do I do this?

Unfortunately, many people do not understand the illness anorexia nervosa, which can cause both sufferers and their families great distress. For most people, food is an enjoyable part of the day and they cannot understand why it would induce total fear in someone else. Often when carers try to force an anorexic to eat, this causes tension. The anorexia causes the sufferer to become angry and even more determined not to eat. For this reason, it is important not to push an anorexic to eat. If you are trying for recovery, take it at your own pace. See if you can make a little bit of progress each day, even if that progress is just holding steady on the amount you are eating.

You will need to stop cutting out different foods from your diet. If you decide to try and eat two meals a day, see if you can manage this for two days running. If you can manage this, then try to maintain this for a full week. Very gradually, start to add small portions of new and different foods to your diet without cutting out anything that you’re already managing. Try to remember to always take baby steps forwards. If you make changes that are too large or attempt to change your diet too quickly, you are more likely to feel scared and want to scurry back to your eating disorder.

3) I think about food all the time. Will this ever end?

When your body is starving hungry, your mind will become obsessed with food. This is your body’s natural response. Many anorexics are so preoccupied with thoughts of food that they will watch every cookery programme on television and often make scrapbooks of recipes cut out from magazines. As you start to recover from your eating disorder, the obsessional thinking does greatly diminish. In fact, I don't ever think about food any more except when I am deciding on what to have for a meal or if I get hungry. It will take time for your body to readjust to accepting food and you need to maintain a reasonable calorie intake if food is not going to preoccupy your mind all the time. If your blood sugar level is stable, then the cravings and obsessing will start to end.

4) I find myself bingeing some of the time. How do I stop this?

Many sufferers feel unable to try and stop their bingeing behaviour because the solution seems too frightening to them. Bingeing usually takes place when the sufferer’s blood sugar level has dropped too low as a result of long periods without food. To prevent yourself from bingeing, you need to keep your blood sugar level stable. If you go long periods of time without food, you are likely to eventually reach the stage where your body can no longer cope and this may lead to bingeing. Small, regular meals which contain carbohydrates will maintain your blood sugar level and reduce the urge to binge. Many eating disorder sufferers who binge are of a normal weight and because of this, they feel afraid to eat regular meals in case they gain weight. However, many sufferers find that they actually lose some weight when they begin eating regular meals because this allows their metabolism to speed up.

5) Are laxatives dangerous?

Laxatives are very dangerous medications. Many anorexics and bulimics take them in the mistaken belief that they aid weight loss. I myself took them for about a year, overdosing at least once or twice a week. Laxatives are very addictive and, as the sufferer’s body becomes dependent on them, it can no longer carry out its natural functions unaided. Laxatives do not actually cause weight loss because they work on the bowels and once food has reached that point, all the calories have been removed. However, they do cause dehydration, removing all the vital salts and electrolytes like potassium that regulate your heart function. If you continue to take laxatives on a regular basis, you do risk completely losing your bowel.

6) I am addicted to laxatives. Is it possible to give them up?

You can give up laxatives in a number of different ways, either by cutting down on them slowly or stopping them in one go. Unfortunately, giving up addictive drugs such as laxatives is never easy. It took my body quite a while to train itself to work without them again.

If you decide to just stop all of the laxatives you are taking, you will need to readjust your diet or else you are likely to suffer from constipation. If you have been taking laxatives for a number of months, your stomach and bowels will be unused to dealing with food unaided. You do need to increase the fibre in your diet but it is important to do this in a safe way. Don’t suddenly eat lots of food containing wheatbran because this can have a very negative effect on your body. Wheatbran passes unchanged through your body but as it does, it can leech out vital nutrients such as calcium. Try starting very gently with peeled fruit and vegetables and gradually build up to raw fruit and vegetables, cereals containing oatbran and other higher fibre foods, such as potatoes, rice and bread.

If you decide to cut down slowly, which is the gentler option, then draw up a plan. Work out exactly how many laxatives you take each day and slowly cut down on this number. By drawing up a plan, you are setting yourself targets and are giving yourself a goal to aim for. Unfortunately, giving up laxatives may feel very uncomfortable to start with and if you are having too difficult a time, it would be very wise to see your doctor and ask for some extra help.

7) I’ve started vomiting. Is this dangerous?

You are endangering your life every time you vomit. Vomiting frequently damages your teeth since the stomach acid erodes the enamel and before long, they are rotten. You also risk losing your hair. In addition, you are constantly risking internal bleeds and most seriously of all, heart attacks. Vomiting affects the electrolyte balance in your body and this affects your heart rhythm, which can result in serious heart problems.

Even though many people start vomiting as a way to lose weight, it is not actually effective for this. Our bodies adapt very well and you will find that your body soon discovers different ways of absorbing calories. Once you have been vomiting for a while, the salivary glands in your cheeks adapt and start to absorb calories as you chew food, even before it enters your stomach.

8) I want to try and stop vomiting. How can I do this?

There are a number of different ways that it is possible to give up vomiting. Changing any form of eating disordered behaviour is difficult and it is very important to persevere, even if some days that feels impossible. If you are vomiting regularly, it is going to feel very difficult to initially keep food down. Work out how long you usually leave between eating and vomiting. Your aim is to slowly extend this time period. If, for example, you usually vomit after 5 minutes, try to extend this to 10. If this feels impossible, make the time changes smaller and increase them at a more gradual rate.

Eating will feel uncomfortable for a while because your stomach needs to adjust to digesting food again. See if you can work out a number of activities that you could occupy yourself with to prevent yourself from vomiting. Can you sit with someone after your meal, so that you can’t vomit? Alternatively, you may want to plan a trip out after your meal so that you don’t have an opportunity to make yourself sick. Try to plan special treats for yourself, such as watching a movie or phoning a friend, instead of vomiting. Changing this kind of behaviour is very difficult, so take it slowly and don’t be too hard on yourself if you have the odd setback.

9) Do I need to discover why my eating disorder started in the first place?

I personally feel that it is very important to learn why your eating disorder started. If you can work out why you developed your illness, then you can start to face the problems that caused you to start dieting in the first place. There are many reasons why people develop eating disorders.

One possible reason is that traumatic events in the past caused them to develop the disorder. When the eating disorder begins, the sufferer finds that their mind is so preoccupied with thoughts of food and weight loss that their other feelings and difficult memories are pushed aside. In my case I was badly abused as a child by my Grandmother and when I was finally able to talk about these experiences with my partner Simon, I began my recovery from the eating disorder. I no longer needed my illness to be a shield that protected me against the difficult feelings from the past. My Grandmother had convinced me that I was a terrible person and I had reached a point where I didn’t even feel I deserved to have food like other people. Simon started to show me that I was not the bad person I believed myself to be and very gradually, I realised that I didn’t have to punish myself by starvation all the time.

Another reason may be that the sufferer feels very afraid of the responsibilities and pressures of the adult world. They are certain that they will not be successful in anything that they do and as their eating disorder develops, it offers a means of escape.

The family situation can also be a contributing factor, especially when sufferers feels unable to express themselves openly and honestly. It is often very helpful, both for sufferers and their families, to attend family therapy sessions.

Often sufferers find it very difficult to work out exactly why their eating disorder started and therapy can help to isolate the causes in each individual case. Examples of reasons why eating disorders begin include abuse of any kind, the death of a loved one, parental divorce or separation and life changing events (such as moving school or puberty).

10) My metabolism is very slow. Will it always be like this?

Your metabolism will be affected if you starve yourself or enter a binge/purge/restrict cycle. Our body’s natural survival instinct is to go into starvation mode. This causes the metabolism to slow down dramatically. As the food supply is very limited, the body carries out only vital functions such as breathing and maintaining the heart rate. It is almost as though the body is hibernating.

To kick start your metabolism, you will gradually need to increase your food intake until you are eating a healthy diet which contains all the vital vitamins and minerals your body needs.

11) I try to avoid eating any fat in my diet. Will my health suffer?

Eating foods that contain even a small amount of fat is often very frightening for eating disorder sufferers. However, there are various internal processes in our body which cannot function properly without a certain amount of fat. This means that some fat is essential each day to maintain a healthy body. This fat is immediately utilised by the cells of the body and without it, conditions such as oedema (water retention) can develop.

12) I sometimes feel angry but try to hide this. Is it wrong to feel angry?

Anger is a natural emotion that we all have and expressing it is important. However, eating disorder sufferers often turn the anger they feel onto themselves and will starve, binge/purge or self harm instead. Often the sufferer does not even realise exactly what they are doing because, over the years, they have denied that they even feel anger. Learning how to express anger correctly is an important part of recovery. It is healthy to outwardly express your anger but it needs to be done at the right time, in the right place and with the right person. Often as sufferers start recovering from their eating disorder, they will begin experiencing more feelings of anger and there are ways of dealing with these safely and without turning them on themselves. Hitting a pillow or finding a private place and letting rip with some screams can be very therapeutic for example.

13) I feel like a child and am scared to join the adult world. What should I do?

As I mentioned earlier, often sufferers do feel very afraid of joining the adult world. It may be that their parents are quite frightened people themselves and have passed on their fears to their child. From a personal point of view, I was terrified of being an adult, even at the age of 28. I still lived at home with my parents and only really went out if they went out. I was living the life of a 14-year-old child, pretending to myself that because I ran my own cross-stitch business and drove a car, I was an adult. Looking back now, I can see the reality of the situation. I was terrified of any form of change and lived my life to a strict daily schedule.

The change came for me when I met my partner Simon. With his help, I started to make small changes. These were tiny steps at first - really minor things that others do every day, like making a phone call or returning goods to a shop. Although at first it was very frightening to do these things, the more I did them, the easier they became. Gradually, as my confidence built, I found myself wanting to take greater risks, such as long distance travelling alone to meet Simon. From my own experience, I found that taking baby steps and changing just a little at a time was the way I managed to join the adult world.

14) Can I live with my eating disorder forever or do I need to get treatment?

Eating disorders are dangerous illnesses and although the figures vary, it is estimated that between 15-20% of anorexia sufferers die from their illness. Bulimia is another dangerous condition, from which many sufferers can die and treatment is very important for the majority of sufferers. When you have an eating disorder, it becomes a full time job, occupying your thoughts throughout the day. Friendships and family relationships often suffer, and so does work and leisure time.

To live a happy and healthy life, it is important that your body receives the correct amount of nutrition each day. If you try to live your life following a very disordered eating pattern, you will find that you feel physically ill, your concentration suffers and food and weight become the centre of your life. Treatment can help you to understand why food holds such importance for you and enables you to break free from the destructive cycle of disordered eating.

15) What is the ‘voice’ and how do I fight it?

Many people with eating disorders feel as though they have a ‘voice’ in their head that controls their thinking. Some people feel it is an actual voice that talks to them continually, telling them that food is bad and eating is wrong but starving is good. This ‘voice’ tells them that they are fat and should stop eating. Other people see this ‘voice’ as the negative part of their own thinking. It is much easier to learn how to beat your eating disorder if you can identify this negative thinking as a ‘voice’. I spent many years thinking in an anorexic way but it wasn’t until I talked in hospital with another girl that I identified this thinking as a ‘voice’. Suddenly, I felt more in control because now I had something to fight against. If you can identify all your destructive negative self-talk as a ‘voice’, you can also start to fight back.

When the negative self-talk or ‘voice’ is loud in your head, it is important to learn how to shout back at it. The following are a few statements you could try to get you started:

I am my own person and I can make my own decisions. I do not need to listen to your cruel words.

I have facts and evidence to back up my statements. You are just lying to me.

Feelings and thoughts cannot destroy me unless I let them - I won’t let you win.


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