Anorexia Nervosa has the highest mortality rate of any mental illness, claiming 5.34% of sufferers. What is it about eating disorders that makes them such an insidious and deadly sickness?

ABOVE: Me, photographed in my first year of University [credit: Kyle Jones]

PLEASE READ THIS DISCLAIMER IN FULL:

This article contains potentially triggering discussions of disordered eating and EDNOS (eating disorder not otherwise specified). Viewer discretion is advised. While I do discuss my eating disorder in this article, I have tried not to go into any detail that could be productive to someone else’s illness— there are no ‘before and after’ photos or detailed descriptions of any ‘techniques’ I have used. There are some references to restrictive eating. If you are reading this to try to trigger yourself or look for ‘tips’ and ‘tricks’ on how to further contribute to your own eating disorder, I implore you follow these links to get help. You deserve to get better. Mind.org: About Eating Problems / Beat Eating Disorders / NHS.uk: Supporting Someone With an Eating Disorder / Enhanced Cognitive Behavioural Therapy

Food has been a consistent anxiety in my life since I was thirteen. My school years were spent hating my young body for not looking how I wanted it to. All of my friends were tall, slim, beautiful people, and I was a chubby, round-faced little thing. During college, I didn’t know how to deal with my instinct to comfort eat, so I would binge, only to have absolute shame wash over me, at which point I would punish myself, in a horrific cycle. Moving away from home created a whole new set of obstacles, as I was completely independent for the first time in my life. I gained weight in my first year, and when this was (negatively) pointed out, I descended into absolute self-hatred. Now, at twenty two years old, I have good days and bad days. On good days, I can make the effort to be healthy. Though the disordered thoughts never go away completely, I have found ways to manage that make it easier for me to eat regularly.

On bad days, I am worrying about food. From the moment I wake up until the moment I go to sleep, I worry about breakfast, and about lunch, and about dinner. I worry about planning meals. When I go to meet a friend for coffee, I worry that they’ll ask me to grab lunch with them, and I won’t have planned for it, and then my feeling of control will fall apart. I worry about people watching me eat, and what they think of me. I worry about how I look. I worry about being rejected for being too big. I worry about how much weight I ‘need’ to lose. I worry about what I should eat, and about what I have eaten, and about what I will eat. I am utterly obsessed with food in the worst way possible, and the most insidious part is that I’m so used to it by now that it has become my second nature. My life is spent at the crossroads of Eat! or Starve!, but both paths make me feel, frankly, shit.

So, when my friend Ant recommended me The Fuck It Diet by Caroline Dooner, I was positive. It’s a book about how most of the truths we have been fed about health and size are completely false. I looked forward to learning more about our culture’s obsession with weight loss so that I— get this— could be a better support to my friends. Instead, I managed to get through thirty-two pages of it. Dooner was explaining how recovery from disordered eating is completely possible, but there are certain things that must be accepted first. One of these things was, “You will gain weight during this recovery, as you should.”

I have never before been hit with such an intense wave of anxiety. The idea of having to gain weight in order to get better was debilitatingly terrifying. It went completely against the grain I’d been living. I am still embarrassed to admit how much it affected me, because it’s a ridiculous things to be affected by, but it was genuinely so distressing that I ended up nursing a nasty panic attack. This was, in part, because of the realisation creeping up on me: this is not a normal reaction. If reading the words ‘you will gain weight’ could reduce me to tears, then something in my brain was very, very, very wrong.

I want to stress that, like many people, the standards I have placed on myself have absolutely no relation to the standards I have of other people. Gaining weight is not a bad thing, and I am fully active in the fight against the notion that skinniness should be anyone’s final goal. But, commonly, the kindness I happily administer to others is not so easily applied to myself. 

Following what felt like a religious epiphany, I decided to ask for the wisdom of Rebecca Park— Associate Professor in Eating Disorders Psychiatry and Honorary Consultant Psychiatrist at Oxford University. I was confused, and I’ve always processed things by asking questions and developing an understanding of them.

When she picks up my Zoom call, Rebecca is in the garden of her family home in Oxford. She smiles, greets me, and carries her iPad into a small office slash shed. Once the door is closed, the sounds of the outside world are promptly quietened. With the external shut out, it becomes an oddly intimate space. There is a soft sunlight coming through a window to her left, and the books scattered along the shelves behind Rebecca seem to be a visual representation of her immense knowledge. Rebecca worked in the NHS for fifteen years before she decided to focus her studies on clinical research studies, and she describes her team as “[striving] to reduce stigma, promote recovery, and reduce the cost on individuals, their families, and health services.”

Our conversation settles into a strange limbo between an interview and a therapy session. Rebecca’s speciality is the treatment of anorexia, but we speak about many different forms of eating disorders. The first thing I asked her about was how common but undiagnosed eating disorders seem to be. I know a concerning amount of people who struggle, in some way or another, with eating, weight, and body image, but who, if asked whether they have EDNOS, would dismiss the idea entirely. Rebecca says, “There’s still a lot of stigma and shame attached, and that this should be something one can control— people who develop eating disorders are often quite perfectionistic. People are quite private about it. People who get into binging are often deeply ashamed about it, because it’s associated with this notion of ‘greed’ and ‘laziness’. Obviously, if your daughter is losing weight very quickly it’s clear that she’s going into anorexia, but that’s the tip of the iceberg: there’s masses and masses of people that struggle outside of that type of disorder.”

“People who develop eating disorders are often quite perfectionistic.”

Rebecca Park

Rebecca explained that the beating heart of most eating disorders is the reward system— “Some people’s reward systems, especially when they’re in a depressive episode, are particularly liable to not pump out enough reward. People who have that vulnerability [to develop an eating disorder] are more likely to have that craving for something that’s going to give them that ‘hit’. That’s why people are more likely to overeat when they’re in a low mood, because that’s their ‘hit’. It’s not even to do with liking something, it’s to do with that wanting [of comfort] as an attempt to regulate mood.”

I tell her that I completely understand this mood-regulatory aspect of food, as comfort eating was a huge issue for me in the past. Rebecca nods, explaining, “Teenage-hood is a particular time where the reward system is very open, so people try drugs, they develop anorexia, they get into all sorts of things, because the reward system is so sensitive. Behaviours you get at that time are then linked [to reward] in the memory.”

I tell Rebecca that part of what I find fascinating about the psychology of eating disorders is that they often develop at such a young age. She replies, “One idea about anorexia is that [in teenage-hood] people have felt that they’re out of control, or felt a bit rubbish about themselves, and so they’ve gotten into a bit of dieting. That person has then got a lot of social reward from that: others say “you look fantastic” and they feel better about themselves. So the under-eating gets linked with reward, and the effect of that is the more people under-eat, the more their reward system fires up, so in a perverse way, the under-eating has become the addictive, compulsive component. That’s when it takes off.”

Anyone who has ever been ill for an extended period of time, only to be told they “look great” once they return to normal life, will understand how confusing it is to be exposed to such a contradictory logic. Our bodies are seemingly most praised when they are at their weakest. Rebecca distills my feelings about this: “Society has done this thing— idealising thinness and emaciation to a perverse degree, and demonising people who are rounder. But Nature did not mean for you to be a BMI of nineteen, Maja— fuck that.”

The romanticisation of thin bodies doesn’t just impact people’s self esteem. Rebecca tells me that in brain scans, the lower the body weight goes, the more out of sync the ‘body-state’ part of the brain becomes. This is the bit that intuits and is aware of the body, and it gets cut off when the body weighs too little. “I see scenarios where people think they’re fatter when they’ve become underweight because there is so much de-sync going on.”

“Nature did not mean for you to be a BMI of nineteen, Maja— fuck that.”

Rebecca Park

This ‘de-sync’ is something Ant writes about in his fantastic essay (which you should absolutely read), Posting photos of myself without a top on Instagram: “It’s only recently that I’ve realised how much I’d been running on fumes and dissociation. Not caring about whether my legs bruise, or I burn my fingers on the oven, grabbing parts of my body and hyper-analysing them, separating myself from them and eventually seeing my body as something separate to my mind. Body pain and mental pain; mutually exclusive. Starting to see something that wasn’t. Not wanting to exist in this or any other body.”

Rebecca’s comments remind me of Ant’s words again, when she says: “We’ve got societal pressures, peer pressures… your generation have got the image pressure. It’s impossible.” Image pressure is probably most vicious on Instagram, where it’s all too easy to become addicted to comparison. I hate to think how many collective hours I’ve spent scrolling mindlessly through a catalogue of thin, white, beautiful women, all while crushing myself under the weight of the worst question we’ve been taught to ask ourselves: “Why don’t I look like that?” I think I have something close to an answer: Because you look like you. They look like them, and you look like you.

Ant explains how he has experienced the problem in reverse. “I took some photos of myself without a top on to post on Instagram. Just me, existing in my body without clothes. Suddenly I’m met with all of these new labels, new assumptions, new comments. ‘Dad bod.’ ‘Your post on Instagram really moved me.’ ‘You make me feel good about my body.’ I wasn’t being radical or making a statement— just existing as a body in an online space. A body with huge amounts of privilege— white, slim, cis. I didn’t know that my body was considered to be a DAD BOD. I didn’t know that my body could be so INSPIRATIONAL. I didn’t know that my body could make people feel better about their own. I’m not even sure what that means and I don’t want to think about the gross connotations it holds. I don’t want my body to be anything other than just what it fucking is. Gaining back the weight I’d aggressively forced myself to lose felt like real physical, emotional and spiritual nourishment. It felt GOOD. Listening to my body and giving it what it wants, like we’re fucking supposed to. Tell me what’s radical about that.”

“I don’t want my body to be anything other than just what it fucking is.”

Ant Lightfoot

This can seem counterintuitive at first, especially in the throes of the body positivity movement, but Ant is completely right: this unsolicited assignment of being ‘amazing’ just because you look a certain way and are proud of it is a bizarre back-handed insult. It’s the equivalent of noticing that your friend isn’t wearing makeup and telling them they’re brave for doing so, which just insinuates that they’re going up against some kind of shame and fear, and that really, they should be wearing makeup, but it’s great that they’re not! Speaking out against body shaming, eating disorders, and body image standards is inspiring. Simply having a body, however, is not inspiring.

I asked Rebecca about this— if it is bad to romanticise thinness but it is also bad to romanticise fatness, then what is the best way of supporting someone with an eating disorder? The answer she gave was brilliantly simple. “Ask that individual who is suffering how they can best be helped.” Eating disorders are complicated. Every person who suffers with one will have different triggers, coping mechanisms, and behaviours. There is no ‘one size fits all’ way of responding.

If you know someone who is fighting their own battle, I can guarantee that the best thing you can do for them is be there, and even if you don’t understand their point of view, listen. I have so many strange behaviours and cognitive reactions that are engrained in me, and it took me a long time to be brave enough to say “Hey, I know you’re saying this because you love me, and want me to be my best, and I understand that exercise is a vital part of a healthy life, but I am working on reversing a lifetime’s worth of negative conditioning and self-hatred, so when you casually ask me if I’ve gone for a run today, it makes my brain explode.” 

It’s a scary thing, to lay out your crazy in front of someone, and hope that they don’t judge you for it. So, I wrote this essay. Part of what has held me back from writing this for so long was that I know I must seem perfectly fine to a lot of people— I’m scared of being thought of as a liar, when in reality, this is actually the first time I’ve told the brutal truth. It took me almost a decade to realise it, but I have an eating disorder, and I have wasted my energy on it for a very long time. It still feels strange to say, because I’ve spent the majority of my life thinking this torturous way of living was what I deserved, but acknowledging that I am ill is, I think, one of the first steps to trying to make it better.

“The essence of living, really, is being at one with oneself, and one’s body.”

Rebecca Park

Sources used include: ‘Why Intervention Is Necessary to Prevent Eating Disorder Deaths’ by Lauren Muhlheim (PsyD), ‘Mortality in eating disorders – results of a large prospective clinical longitudinal study’ by Manfred Maximilian Fichter and Norbert Quadflieg, ‘Posting photos of myself without a top on Instagram’ by Ant Lightfoot.

If you enjoyed this article, please consider tipping me on my Ko-Fi page! ♡