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Nil by mouth: Starving for body perfection Jun 13, 2018

Fistfuls of laxatives, running on empty, along with constant pain and shame. This is one woman’s struggle with an eating disorder.

I wake at 3am (the usual). Cramps in my stomach wake me. It’s like something’s ripping me apart from the inside.

The toilet’s right beside where Dave sleeps. I tip-toe to the door, peek to see if there’s light from his laptop. No visible signs he’s awake, the coast’s clear. I quickly fill the kettle — if he wakes, the noise of the it will drown the noise of the laxatives.

I leave the bathroom feeling like a million euro, feeling empty. I love it. I watch one episode of MasterChef while having my morning Americano. Time to get moving. It’s safe to go for a run now. Dave will be none the wiser. I grab my running gear, stashed in the drawer under the bed sheets — he doesn’t know they’re there.

My handbag’s hidden behind the couch in case Dave got up during the night and went rummaging for tobacco. I take my routine 20 laxatives, 15 fat metabolisers, 10 peppermints capsules and 10 colon cleansers. I fling three pieces of chewing gum into my mouth. I’m out the door.

I love running. There’s no one around, the stillness of the night consumes me. My feet are sore today, it feels like they’re bleeding. I tried to counteract the pain by layering up with three pairs of socks, it’s no use. The pain’s strong, like the pains in my knees and hips.

I struggle. I tell myself if I just keep running the intensity of the pain will subside. My legs won’t carry me as fast as I’d like, so I opt for distance over speed. I run the same route every morning — it maximises the effort needed, while also avoiding any chance of running into people.

 

The silence of the night suits me, I can’t listen to music and run at the same time anymore, I have to focus on my breathing to keep going. I have privacy here, no witnesses to my blatant struggle. Giving up simply isn’t an option. I’m nearly finished. I might as well give it one last burst of energy — go hard or go home.

I get in the door, after a five-minute battle to get my hands to work properly to get the key in the keyhole.

I feel weak, dizzy, my legs feel funny but I feel better now I have it done. I could have gone faster though, I will tomorrow.

I go into the bathroom and just sit. How long I’m there escapes me, time and all sense of reality eludes me. I can’t move — nothing works. I make a coffee and start my exercises, always the same set. I grab my pillow from the couch, my spine sticks into the floor otherwise, preventing me from doing them properly. All the while I tell myself: “This will make you feel better for the day, it’ll put you in a better mood. If you feel better, you’ll be able to be intimate with Dave later.” This spurs me on for the next hour.

Another coffee, more chewing gum. Dave will be up soon, I take off my running gear, stash it in my hiding place. I’ll wash it when Dave’s not around, he’ll only ask questions otherwise.

I jump in the shower, not turning on the main light, only lighting a candle, I can’t see myself properly in this light, which I prefer. My movements are slow, staring at the shampoo bottle for a significant amount of time before the action follows to lift it.

After the shower, I have another coffee. It’s 8.30am. I’ll be gone by 9am. Dave wants to have a movie day. I promised him days ago I would, but I can’t. I can’t sit around all day, he’ll torment me trying to put his arms around me, kiss and cuddle me. I recoil at the thought. Touching me isn’t an option, he’d only be doing it because he’s a man. There’s no way he could genuinely want to do that while I’m all bloated and swollen. I’ll get out and about for the day and tonight, maybe I might. I can surely pretend for one night.

I gather my swimming gear, my peaky cap and long puffy coat and I’m off again. I need the cap — the lady in reception at the gym looks at me funny without it. I leave Dave a note saying I’m gone swimming and into town, I’ll be back later. He’ll be grand — he’ll find something else to do.

In the gym I change in the cubicle, its 10am. The laxatives will kick in about 12. I’ll be out of the pool by then. I do constant lengths of the pool. Again, my body fails me and won’t carry me as quickly as I’d like, so I opt for distance rather than speed. It’s hard to control my breathing — too often I have to stop mid-length.

I keep an eye on the time, 11.15am and the cramps in my stomach are coming hard and fast. I quickly make my way out of the pool, careful to keep tensed, if I relax my body now the result would definitely not be pleasant. There are lots of women in the changing rooms, panic consumes me — they’ll hear me. I scurry to the showers and switch them all on — they’ll drown me out.

When I’m finished I feel better, the swelling in my legs feels less. It’s easier to get around, I’m not as heavy, but I’m tired. I take another dose of all my tablets from this morning, a larger quantity this time. I need to get more.

I do my rounds of the chemists, answering the same questions every time:

“Have you ever used this before?”

“Yes.”

“They’re not intended for long-term use – abuse could result in lasting bowel problems.”

“Oh really, thanks.”

It’s nearing 3.30pm. I need to get to the supermarket, fast. The cramps are bad, the pain almost inexplicable. The shop’s busy but I cannot care, control is non-existent.

I leave yet again with a sense of release, a feeling of euphoria, not before taking another dose of all my tablets. They’ll kick in when I get home but I’ll go for a shower to hide it. It’s also an excuse not to have to sit around Dave. I can’t be dealing with the effort of it. I spend the next hours walking around Lidl, Tesco, Dunnes, mindlessly pondering and glaring at all the food. Stuck in a world of ‘Will I, won’t I? Yes. No. Nah, don’t need it. No, you won’t let Dave near you then, imagine the feeling tomorrow, you’ll have to do more’.

A constant fight, mostly only ever leaving the shop with a jar of coffee, Coke Zero, chewing gum or bran sticks.

8.30pm. I make my way home. I’m exhausted. The bus isn’t an option. God gave me legs for a reason. I get home and Dave’s watching something on the laptop. I’m quiet, cold, distant. I say “Hi”. The more strained the conversation, the less likely he’ll want to stay around me and he’ll just leave me alone. I’m too exhausted for him. I’ll make it up to him tomorrow.

As I’m pottering around, Dave makes me coffee. He put milk in it. Oh Lord was he born without a brain? That’s all it takes and my mood’s satanic. I throw it down the sink, snapping that he knows I don’t take milk. He immediately cowers, apologising profusely, attempting to give me a kiss and cuddle in the process. I turn my head, pull away: ‘Just get away from me!’ I scream in my head.

I huff around the apartment, nit-picking at fictional faults: “Did you not do the washing, did you not clean the bathroom, why is there a towel on the floor?” Eventually, he succumbs and retreats to the bedroom for the rest of the night. Mission accomplished. I wait until I hear the laptop come on, grab my running gear and toss it into the washing machine — the noise will cloak the noise of the bathroom.

I catch a glimpse of myself in the mirror. The enormity I feel is reflected back. I repulse myself. All I see is bloat, my stomach, face, legs, ugh. I spot a note stuck to the corner of the mirror: ‘You’re the most beautiful girl I’ve ever met. What you see is not real, I love you more than the moon and stars, Dave xxx .’

A pang rips through me, sure God love him, but I automatically think ‘lies’.

The pain in my stomach pulls my thoughts away, back to the matter at hand: bathroom. I light my candle, flick on the shower. I notice soil marks on my pants. Oh God, not again, how long have they been there? I don’t allow myself to delve into the thought due to pure shame, I was wearing a long coat, no one would have known.

When I finish in the bathroom it’s as if the weight on my shoulders and mind has diminished. I feel light. My mind’s empty, unable to put a cognitive thought process together. Nothingness consumes me.

I grab a handful of bran sticks. Will I treat myself to a Rich Tea light biscuit? I decide against the fleeting notion. No need — it’ll only keep me awake.

I lie on the couch in a zombie-like state. Today was a good day. I take my nightly concoction of tablets, more than throughout the day.

I’ll be able to run faster in the morning if I feel lighter if my body isn’t working to digest whatever’s in my stomach.

I flick on MasterChef, fling a duvet around me. I begin to drift, my last thought: ‘Same again tomorrow?’

- This is edited from a patient’s treatment diary written at Renewal, a part of Tabor Group

Heavy burden

 

There can be a crossover from substance addiction to eating disorders which are often more difficult to treat, writes Helen O’Callaghan.

“I’m an alcoholic and an anorexic. It was my alcoholism that drove me into treatment. More than one treatment actually, but I try not to focus on the number.” Caroline* was treated at Renewal Extended Treatment Centre for Women, part of the Tabor Group. According to the group’s report, launched this week, 100% of clients cite alcohol as a drug of choice, but addiction to alcohol alone is rarely seen — large numbers report combined issues with ecstasy, cannabis, cocaine, heroin and prescribed medication. Like Caroline, food and/or eating disorders also affect three in 10 of these women.

Bodywhys training and development manager at Bodywhys Harriet Parsons sees similarities between eating disorders and addictions. “They’re often very alike. There’s the preoccupation — with not eating for the person with anorexia and with drinking for the alcoholic. There’s progression [in the behaviour] and negative consequences — the person suffers for what they’re doing.”

Parsons has done a lot of training with addiction treatment centres and sees connections between certain eating disorders and addiction. “People with binge-eating disorder or bulimia are sometimes likely to engage in binge-drinking or to have a volatile relationship with a substance. And I’ve heard anecdotally from centres that when people give up the drug, an existing eating disorder flares up, it gets stronger.” Which makes sense because eating disorders and substance addiction are ways of managing feelings of anxiety in the body.

Eileen Crosbie is treatment manager at Renewal, where women with deeper issues or requiring further work come for 12 weeks after treatment at Tabor Lodge.

Crosbie typically takes a group of nine women at a time. Until this year, one or two women in the group would have an eating disorder — in her current group, she has six women with eating disorder. “There’s an epidemic of eating disorders in Ireland at the moment. Normally we’d put nine to a dozen through each year — this year, half-way through, I’ve already passed that number,” reports Crosbie, who believes eating disorders are tougher to treat than addiction.

“Take regular addicts, over-eaters and people with anorexia. After a few weeks the first two get better — they’re taking more care of their appearance, they’re physically getting better, they have more interest. The eating disorder gets worse before it gets better — it’s like ‘you can take my alcohol, my drug, but keep your hands off my eating disorder.”

With an eating disorder, there’s plenty of potential for cross-over into addiction. Someone with bulimia could take up to 40 laxatives a day for example. Crosbie points to the relentless 24/7 presence of the ‘eating disorder voice’. “Sleep’s very uncomfortable for someone with anorexia. You’re talking about skin and bone against mattress. They wake up a lot and the eating disorder voice in the middle of the night is more frightening. If you have a vodka, you’ll pass out, whether you’re sore or not.”

In Ireland, just under 200,000 people experience eating disorder at some point in their life, a proportion on par with elsewhere in Europe and the US. Approximately 1,757 new eating disorder cases develop annually in the 10-49 year age group. Everybody with eating disorder is different, says Parsons, but certain personality traits are common: tendency towards anxiety/perfectionism, to black and white thinking and extreme sensitivity to how they/others are feeling.

Dr Mary Mullane, senior clinical psychologist on St John of God’s Hospital Eating Disorder Programme, says people with anorexia can be very driven, very conscientious — they have high expectations of themselves. “They’re people with lots of promise but with very strong self-criticism while being very warm to others. There’s a lot of shame about having an eating disorder, which is a barrier to seeking treatment.”

Crosbie too sees a deep self-hatred in people with eating disorder.

“It’s like ‘I can’t fix what’s on the inside, but I can change the outside’.” The new Model of Care for Ireland’s Eating Disorder Services launched in January. It’s based on a hub and spoke model — five major hubs and three minor ones for Child and Adolescent Mental Health Services (CAMHS) and four major hubs plus four minor ones for adult patients.

“Over the next five years, these hubs will have expert eating disorder teams for both children and adults,” says Parsons, who welcomes that this is a national plan with consistency and expertise at its core. Already a training programme has started.

“Somebody from each CAMHS and from each adult service have trained in the eating disorder therapies with very strong evidence base. No matter where you are in Ireland, you have access to trained clinicians with experience and expertise in treating people with eating disorder.” And for those unwell enough to need hospital admission, Parsons says there’s joined-up thinking.

“The system follows the person — there won’t be a situation where a person’s discharged from hospital and there’s no [community] service for them.” Many parts of the country have community services for eating disorder — the plan is to make this consistent nationally.

When somebody arrives for treatment, the origins of the eating disorder in the person’s life — what caused it to happen — are long gone, says Mullane. “We don’t look at causative factors but at what’s keeping it going right now. The person might desperately want to get well and recover their functioning but they’re locked in a vicious cycle of behaviours.”

CBT-E (CBT for Eating Disorders) has a strong evidence basis and Mullane says behaviour change is the lead factor in recovery. “The person assumes even a small amount of food will lead to disproportionate weight gain. There’s an assumption weight gain will be uncontrollable and unstoppable. CBT-E is about exposing people to that fear.”

But no one therapy suits everybody. Mullane points to the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) — it motivates the person around nutrition, symptom management and behaviour change. She also highlights Compassion Focused Therapy, developed by Paul Gilbert, professor of clinical psychology at the University of Derby. It targets shame and self-criticism and has been modified for treating eating disorders. “It addresses the biological, psychological and social challenges of recovering from an eating disorder.” Preliminary evidence for its effectiveness is encouraging.

Renewal runs the only 12 step Minnesota Model Extended Treatment Care programme for women in Ireland, which includes eating disorders. Crosbie trained is one of the few qualified eating disorder therapists working in an Irish treatment centre. In 2017, a new Eating Disorder Support Group was set up at Renewal. “With eating disorder patients, you have to work with their heads so their heads can take care of their bodies. You’ve got to get their cognitive voice louder than their eating disorder voice,” says Crosbie.

The NICE Guidelines, updated last year, recommend out-patient treatment as the first-line approach. But when someone’s very physically unwell, they need to be monitored medically and require residential care, says Parsons. This may also be necessary as a break for family when things are very fraught at home and “there are power struggles all over the place. You take the person with the eating disorder out of the situation to allow everyone regroup.”

Generally speaking though, residential treatment’s more about safety than recovery. “The best place for a person to recover is in their life, in their home, when they’re going to college, working, with their family, so the focus isn’t on more beds but on more services in the community,” says Parsons.

It’s “absolutely possible” to recover from eating disorder, says Parsons, who understands that one-third of people recover fully, another one-third recover to the point where they’re able to live a normal life though still with some distortion around eating/food/control. The final one-third don’t recover. “Recovery always means different things to different people.”

Caroline had to be willing to go to any lengths to recover. “That meant facing my eating disorder head-on and letting go of it. I’d developed anorexia nearly 20 years ago. When it comes to addiction, it was my first love. The alcoholism came later and as much as I loved drink, I loved my anorexia more.

“I wasn’t going to give it up without a fight. I didn’t want to give it up, I had to. I’d been told time and again that I’d have no recovery from alcoholism if I didn’t deal with my anorexia. One of my biggest turning points was when I started to separate myself from my anorexia. I used to think we were one, that I was my anorexia and my anorexia was me.

“Once I began to separate myself from it, I began to recognise how it presents itself to me in many guises and speaks to me in many ways. It mostly tells me the less I eat, the better I’ll feel. That if I maintain rigid control over the food that goes into my mouth, it means I’m in control of my life. Now I know that really I’m not in control at all, but anorexia can be very convincing.

“[Today], I mainly have an amazing and amazingly simple life, which is what’s recommended. I have a job and friends and a solid network around me at all times. I am more than OK.” 

* Caroline’s story features in the 2018 Tabor Group report. Her name has been changed.

https://www.irishexaminer.com/breakingnews/lifestyle/healthandlife/nil-by-mouth-starving-for-body-perfection-847525.html

 

- www.bodywhys.ie