York and District Mind

We all need food to live; it is an essential part of our daily lives, regulated by appetite and the clock. In times of stress however, our 'normal' eating patterns often change. We may develop cravings for certain foods, lose our appetite or eat more for comfort. This is a natural response experienced by many people, particularly women, but it usually resolves once the problem is overcome.

However for some people life may become centred around food. Whether denying it to themselves, eating, or thinking about it, food becomes like an addiction and starts dominating their whole existence. Yet we all have to eat or we die.

As a person who has had direct personal experience of the vicious cycle of denial/abuse that is a characteristic of eating distress, l also know that during those nightmarish years, denying myself was the only thing that kept me alive.

Eating distress is viewed on the one hand as a serious psychological problem needing psychiatric treatment, whilst on the other, the media simply define it as 'slimmers disease'. The material in this leaflet offers alternative approaches to this complex subject - exploring the causes as well as the effects.

There are no easy recipes for curing eating distress - everyone's experience is individual, but we hope that through reading this you will gain a deeper understanding of its powerful statement, so that both those affected as well as close friends and relatives feel there is a way out.

It is an expression of deep emotional conflict which results in the individual experiencing a distressed relationship with food. Eating itself may provoke feelings of fear, anxiety, guilt and self-hatred. The individual may feel unable to eat with others, and become socially isolated. Depression, disordered sleep patterns, restlessness and disturbance of bodily functions are some of the effects. It is important to remember that these problems are symptoms - the effects of underlying distress which are often deeply linked to the person's need to be valued, respected and acknowledged as an individual. They are not the cause itself.

'My whole life became one governed by fear. I felt trapped, controlled... so I sought to control the one area of my life I could... that of food - yet soon that too consumed me...'

'Compulsive eating', 'bulimia' and 'anorexia' are the more common medical 'labels' given to the varying symptoms of eating distress. However in practice there is no clear boundary between them, as all, in their own ways, severely damage the individual.

Compulsive Eating

Such individuals can be, but are not necessarily, overweight. It is neither greed nor hunger that drives them to eat constantly. They may feel unable either to regulate or make decisions regarding their dietary intake. They feel the powerless victims of food and yet are constantly trying to gain control.

Compulsive eating usually occurs when the individual is feeling distressed, anxious or angry. At these times any type of food and any amount may be consumed regardless of appetite, taste or time of day. A specific food can act as a 'trigger' -chocolate or high sugar items - but this is not always the case; the urgency is the desperate need to get something into the mouth.

Compulsive eating may be accompanied by self-induced vomiting. In between the more difficult times - before the next uncontrollable impulse occurs - are often periods of strict dieting and rigid food control.

Bulimia

Unlike anorexia - the distress experienced by an individual suffering with bulimia may go unnoticed. The person may be any weight or size and not look ill. They may appear to be in control of their external lives, coping fairly successfully on a day to day basis. Yet they are tormented by an unpredictable cycle of chaotic eating. This may range from periods of total starvation to eating thousands of calories at one time - generally alone - and is accompanied by self-induced vomiting. Abuse of laxatives and diuretics (drugs which induce greater bowel movements and urination) are other methods of self-harm resorted to in desperate attempts to 'gain control'. All these forms of abuse can occur regardless of how much actual food is consumed and the consequences - both physical and mental - can be severe.

Anorexia

This does not necessarily imply a 'loss of appetite' as is often assumed. Anorexia is more about denial. The individual may experience severe hunger and long to allow themselves to eat. But denying themselves the right to eat may be the only means available to them of controlling their lives. 'Giving in' is seen as reinforcing all the conflicts they are trying so hard to survive, even if survival, paradoxically may result in death.

Food and fluid intake is restricted to low calorie items, and often carefully measured. Eating with others may become a nightmare as others may attempt to 'force-feed', and a ritual of secret and isolated eating often occurs. The individual may also embark upon vigorous exercise regimes and weigh themselves several times a day. Life becomes centred around food, weight and body size.

Although perceptions of body size and self become distorted to a degree in all forms of eating distress, for a person experiencing anorexia, these feelings may be magnified out of all proportion - however thin, they still see themselves as fat.

There may be times however when deep bodily instincts for food become so overwhelming that huge and frightening eating binges result, which only perpetuate the individual's distress. Self-induced vomiting, laxative and sometimes diuretic abuse may be further measures used in order to 'purge the body of poison' however little has been eaten.

Medical consequences

These can apply to the three 'labelled' symptom pictures described above and may' include:

• tooth decay and gastric erosion (especially if there is vomiting)

• blood disturbances and mineral imbalances in the body

• bodily hair growth

• disturbed menstrual functioning

• low blood sugar

• heart, kidney and intestinal damage

• bowel damage

• severe fluctuations in body temperature

• a variety of mental symptoms: anxiety and panic attacks, hallucinations, fainting and dizziness, insomnia and depression.

There is also a greater incidence of self-mutilation, suicide attempts and other forms of self-harm.

A large majority of the population, especially women, at some point in their lives, experience a certain degree of dissatisfaction with their body weight and size. Various dietary regimes and exercise programmes may be tried, and food itself may become categorized into 'good' and 'bad' - the bad being food with greater calorific value. These episodes usually present no particular difficulties and the individual's 'normal' eating habits are generally restored with no lasting effects.

However, eating distress is affecting more and more people (an estimated 60,000 to 200,000 in the UK alone). Though primarily affecting women in their teens and early twenties, in recent years more men and even children younger than ten have been reported as suffering. Recent research results show that one in three nine-year old girls are worried about their weight, and that many are already dieting.

A number of theories have been put forward. These have included difficulties within the family, relationship with mother, sexuality and gender issues, emotional/physical abuse, fear of growing up, reaction to stressful life events etc. Depending upon the individual, some of these issues may play a part along the road to distressed eating, but they are not the whole story. For this, we need to consider the wider context.

Social/Political

'Sexism transcends... class, race and religion. It is a culture in itself.'

'Until now eating disorders have been exclusive to a Western culture obsessed with slender figures but now they are believed to symbolize revolt among young Asian girls trying to straddle two cultures.'
Guardian 5.3.91

'Many men won't speak out about how rigid definitions of sexuality stop them from fulfilling themselves.'

Gender oppression can affect both men and women. We are expected to conform to stereotyped roles regardless of what we feel. Women, for instance, are supposed to be both universal care-giver and ideal sex symbol - to be both mother and lover - within a society largely dominated by masculine values. The work of the feminist movement exposes these conflicts and continues to present a different role of women in an attempt to find ways of redressing the balance. But for many women, and to a lesser extent, men, the struggle between self and societal expectations still creates enormous difficulties and suffering.

To many individuals such conflict becomes internalized - the taking in or denial of food becoming its outward expression.

We are continually given messages through the media as to how we 'should' look, eat, dress and what we 'should' buy. Food and exercise advertisements often portray sylph-like models who use their sexuality to lure people into consuming. The message is of course that 'ideal' looks and physical size equal success and therefore demand. In addition we are presented with conflicting ideas about what is a 'normal' diet, and what foods are 'healthy'.

It can thus be extremely hard to contend with a less than perfect body in a world which puts so much value upon the 'ideal', and can therefore be severely disempowering.

If feelings and conflicts are repressed within the family, it may well be that early emotional needs were ignored. Parents may want to do the best for their children, but in fact can become overprotective and dominating. The growing child's only way to be appreciated then is through living up to parental expectations. They may not feel they are a person in their own right, nor receive acknowledgement of their individuality. Abuse, be it physical, emotional or sexual, may also be a major factor within family dynamics.

Such patterns transcend class and culture and controlling food intake may be the only way the individual can assert control over their life.

Generally those experiencing eating distress are high achievers and perfectionists. Yet they may have very low self-esteem and self-worth. Often sensitive and potentially very creative, they may experience great levels of anxiety but feel emotionally repressed. The triggering event may be a particularly stressful situation, family or relationship crisis, adolescent conflicts, exams, leaving home external pressures which may make them feel so powerless that they attempt to silence their emotional needs through their relationship with food.

It can be very difficult to acknowledge you do need help, as in itself help can appear too threatening. Other people may be all too ready to try and 'help' -often enforcing controlling tactics to get you 'better'.

It can be of value to find someone you trust; it may be a friend, relative, or an independent advocate with whom you can share your concerns and define what sort of help you want. A lot of people do not appreciate the effects food has on your life but may be able to understand some of the emotional and practical difficulties of your situation. This may enable you together to work out the next step.

Eating distress can be an isolating experience. You may feel misunderstood, judged and blamed. You may feel you are the only person with such a problem. It can, therefore be very useful to realize you are not.

The value of local and national self-help groups is that you have the opportunity to meet regularly with others who have similar experiences and who can understand your feelings. The groups tend to be non-professional, and enable you to make contacts, give and receive support.

There are also several helplines which you can call if you desperately need someone to talk to who can understand (see Useful Addresses).

Your GP may be the first person you mention your distress to. If they are sufficiently aware of your needs, alternatives to medicine may be offered, such as referral to a local counsellor or psychotherapist.

However it may be that you are prescribed a tranquillizer such as Largactil or an anti-depressant drug in an attempt to dampen your symptoms without any acknowledgement of your underlying distress. It is important to ask for what you want, and not allow yourself to be given tablets or counselling if this is not your choice. If you feel your GP is unable to help, there are alternatives. However, they may decide to refer you to the psychiatric services.

These vary widely in the degree of awareness of treatment for people experiencing eating distress. Thus any in-patient treatment would depend upon which hospital you were admitted to. Some specialist units offer a high priority to counselling and relative choice regarding food. Others use behavioural techniques; some however still continue to use force-feeding, drugs and ECT.

You may decide upon voluntary hospital admission as a respite if there seems to be no better alternative at the time. Try to gain access to an independent advocate (someone who may speak and act on your behalf) if the treatment is not satisfactory to you.

In certain circumstances, however, your health may deteriorated to such an extent that you are detained in hospital under the Mental Health Act (against your consent). In this case you may apply for a tribunal and be given access to an independent solicitor (see Mind's Rights Guides available from Mind publications).

Some people may benefit, at least in the short-term, from hospital treatment. The majority, however, find the experience both disempowering and profoundly distressing - with physical and emotional symptoms often made far worse.

Counselling: can be very helpful in enabling self-expression and gaining insights into the distress itself. Unlike the medical approach, the focus is not predominantly upon normalizing' the disturbed eating patterns, but upon addressing the cause of your symptoms. particularly beneficial is a therapeutic approach that is non-judgemental, does not offer interpretations but enables you as an individual to feel acknowledged and understood. It is important however, that any counselling contract you enter into is under your control.

Holistic therapies: work from the philosophy that each individual is composed of body, mind, emotions and spirit and any distress whatever the origin or symptoms, is likely to affect every area of life. They thus regard symptoms in the light of personality, past history, likes and dislikes and life situation. You will be treated as an individual - not as a labelled disease - and will be empowered to take responsibility for your health.

All therapists work in different ways and it is important you find a suitably qualified practitioner, whom you feel you can trust (see Useful Addresses).

Creative therapies: such as art, journal writing, music and movement all help in connecting with the creative process within us all and may benefit other areas of your life.

Nutritional advice: may be valuable at some point. No one can give you answers regarding what to eat, but seeing a nutritional therapist who has a sound grounding in holistic principles may help you address any mineral imbalances, addictions or allergies that may be contributing to your disturbed eating pattern and emotional symptoms. However this is more an adjunct than an alternative to emotional support.

Looking after yourself: can be difficult if you are caught in a vicious cycle. But here are some possibilities:

Assertion training is empowering, aids with the expression of emotions, and encourages us to own our right to be angry or upset.

Give yourself time and space to do what you enjoy. It may be drawing, writing, or other activities such as a walk in a park, or listening to music.

Give yourself small treats (and big ones!) - flowers, lighting a candle, having a long bath with some aromatherapy oil. All these may help you dispel negative feelings.

There are no miracle cures for eating distress, but much can be done to enhance understanding and insight so that you can help yourself, others in similar situations and those caring and working with you to become aware of the fundamental issues of your problems.

It can be very frustrating and difficult to watch a close friend or relative locked into such a struggle with themselves. You may want to help but anything you do or suggest may be rejected. This can cause feelings of anger, despair and create even more separation between the two of you. Conflicts and arguments may arise that affect not only yourselves but other family members or friends.

It is important not to inflict controlling tactics or attempt to force food or 'help' down their throats. Part of their statement is about finding and keeping control over their lives and their individuality, and anything you attempt that seems to try and take this away from them will appear threatening and make you an 'enemy'.

Respecting them means acknowledging their pain and building up a trusting relationship, where the focus is taken away from food, weight or 'normality' and placed more upon emotional distress, recognizing creative potentials and the individual's strengths as opposed to weaknesses. They need to be fully in control of their own healing, and their views are thus paramount in this respect.

There are carers support and information groups that will enable you to share feelings with others and develop your own support network. This will not only help you understand your own feelings but may throw light upon those of the sufferer.

It is important to remember that eating distress is a symptom not the cause. Any therapeutic approaches thus need to concentrate on holding and caring for the person emotionally - encouraging expression, maximizing choice and developing trust. The following may be useful guidelines:

Measures need to be determined as much as possible by the individual themselves -not focusing solely upon their difficulties with food but aiming to integrate all aspects of their life.

Any imposed judgements or treatment regimes are contradictory and may in fact be damaging.

Be clear and honest and do not promise anything you are unable to deliver, such as confidentiality within your work setting and boundaries.

You may find it difficult, and have your own ethical, professional as well as personal conflicts in working with individuals who have eating distress and it is important to acknowledge you may need support and supervision at work.

It is also important to create an environment which empowers the individual - one that will enable them to recognize both social and political oppression and how that affects their own conflicting struggles for survival. They may need assistance in finding alternative, more productive ways of coping with such stresses in their own individual ways.

Of the essence however, is that the individual is enabled to understand and truly integrate the origins of their distress, into their present awareness. Unless this happens there is the very real danger that both physical and emotional symptoms will either continue as varying degrees of eating distress, or other, often more damaging means of expression will be found.

'To Be Nobody But Yourself In a World Which is Trying.. to Make you everybody Else is the Hardest Battle You Will Ever fight and Keep on fighting...'
E E Cummings

Louise Roxanne Pembroke (ed) Eating Distress Perspectives from Personal Experience. Survivors Speak Out 1992

Naomi Wolf. The Beauty Myth. Vintage 1990

Marilyn Lawrence (ed.). Fed Up and Hungry - Women, Oppression and Food. The Women's Press 1987

Mind's Rights Guides


Useful Names and Addresses

Survivors Speak Out
34 Osnaburgh Street, London NW1 3ND (0171-916 5472)
A self-advocacy organization, offering contact, information and a newsletter.

Women's Therapy Centre
6 Manor Gardens, London N7 6LA (0171-263 6200)
Runs courses and workshops, offers some counselling and referrals.

Eating Disorders Association
Sackville Place, 44~8 Magdalene Street, Norwich, Norfolk NR3 l1D (01603 621414)
Aims to support and advise sufferers of eating distress, their family and friends. Offers a network of self-help groups and contact addresses for individuals and carers, as well as a two-monthly newsletter and a counsellor resources list.

British Association for Counselling
1 Regent Place, Rugby, CV21 2PJ
Has a nationwide directory of counsellors and psychotherapists. Send an A5 SAE for details of those in your area.

Institute for Complementary Medicine
15 Tavern Quay, Plough Way, Surrey Quays, P0 Box 194, London 5E16 1QZ (0171-237 5165)
For details of individual holistic therapies and how to find a practitioner.