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James

Age at interview: 21
Age at diagnosis: 20
Brief Outline: James developed anorexia nervosa at the age of 20, having always been very sporty and interested in nutrition. With the help and support of an eating disorders unit and through his own commitment and determination he is now gradually recovering.
Background: James is 21 and lives at home with his parents, attending an eating disorders unit a few times a week. Mixed Race British.

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In the time leading up to James developing an eating disorder, he remembers becoming isolated and feeling ‘hollow’. His family had always been weight conscious and James remembers a turning point after new scales appeared at home. James was surprised to find that he had lost weight and became intrigued to see how much more he could loose. James became “obsessed” with reducing food intake and increasing walking, which he measured with a pedometer. James had always been sporty and interested in nutrition so he knew exactly what to do to lose weight.
 
James lost weight very rapidly. He compares anorexia to being on drugs; he was spaced out, vacant and didn’t care about anything expect food. His family became very worried but James ignored this. Looking back James says he is amazed how he managed to keep his job. James reluctantly saw a GP but nothing followed from the appointment.
 
James deteriorated, becoming severely underweight, with no energy to do simple tasks. James was seen by an emergency GP who sent him straight to hospital. He describes this as “horrible”; he felt frightened, undignified and lost all his freedom. He was confined to strict bed rest and all his possessions were taken away. At first James would take any chance to avoid eating but when he realised his condition made it difficult to take his blood and to even find his organs on an ultrasound, he realised it was not what he wanted at the age of 21.
 
After a month in hospital, James was transferred to a specialist eating disorder unit. There, seeing other patients unwell and recognising similarities in their behaviour to his, was a real ‘eye-opener’. This helped him to change his perspective and make the decision to try to get better. James is the only male and the youngest in the unit, and although he has made friends, often feels like ‘an outsider’.  James explains that the unit has really helped him to get better and is soon going to be discharged to become an outpatient.
 
Currently, James lives at home, but visits the unit 4 days a week. Living back in the environment where he developed anorexia reminds him of how he used to feel. James is aware of his vulnerabilities and feels prepared and determined to overcome them. He describes how now he is better he can think clearer and plan for the future. He realises that he can only rely on himself to get through anorexia and is very determined to do so.
 
 

James felt that his anorexia nervosa was so severe that the only thing that could stop his eating...

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I mean I would have, like I said before I wouldn’t have stopped for anybody, until somebody actually forced me into hospital, and even when I was in the hospital the first day when the doctor seen me, and he, I was, I actually told him, “You know, you’ve got better patients to look after because I’m, you know I’m, I should be out on the weekend.” [Laughs] You know and I actually still believed that when I first came into hospital. The first day I was there I thought I was going to be let out on the weekend and, and you know that’s, that’s it. But that weekend never came and I was in hospital for the, for the duration of this time so it’s, it’s been quite eye opening.
 
But just coming up to that point of when I was like, I just showed every sign of anorexia basically and coming from that, and I told you I was doing the exercising regimes, I wasn’t eating, or what food I was taking in was pretty much non-existent. I was isolating myself even more, well loads basically, and my, it was causing so many arguments around where I lived, my family, my friends, I just didn’t care anymore and when I actually did come into hospital and I was stuck on like strict bed rest and I felt like I was being punished and you know the toilet doors are locked. 
 
 

James felt like he was being punished when he was on constant observation. He felt his “dignity”...

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And I wasn’t allowed, I was on constant obs. I was stuck next to a nurse station. It did, and it did feel like I was being punished for what I’d, what I sort of did at that time. But obviously I was really ill but I felt like I was just doing this to make myself happy. 
 
So it was really hard because you know we, when I was in hospital I had to get used to getting nurses to watch me going to the toilet which was pretty hard, you know. And it’s, it’s one thing you know taking away your possessions, you know taking away your book or, your, you know your iPod or whatever, but once you take away your dignity and you’re not allowed to even go to the toilet without somebody watching you, or everything, all your food is recorded and you’re constantly watched, it’s, it’s made me who I am today because it’s, it was just so hard at that time. I remember a couple of times I just broke down completely because I couldn’t believe that my life sort of came to this point. Because it was really hard and I couldn’t talk to anybody at that point either because there was nobody as young as me on the ward. I was, there was no TV or anything like that. And I was basically just trapped around myself and I couldn’t even get off the bed basically. So that first month that I was in hospital was really, really hard for me. 
 
 

Restricting used to be a form of punishment for James. He used to love the feeling of hunger pains.

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I loved that sort of feeling of pain I got from it. I’d feel like justified to do it because I, I guess it was, I guess it’s sort of that OCD behaviour coming back but in a different sort of way. And I’m guessing that’s, it really went together with the fact that you know when I wasn’t eating it was coming out in these sort of strange sorts of habits and...
 
But then but with me that’s, that’s how I’d always, I’d always feel justified to punish myself because I never felt like I would deserved anything like, because as I said I have like confidence issues and stuff like that, and it felt right to punish myself because I felt worthless and I felt like, because I felt worthless I should be doing this. And I shouldn’t feel, I should feel pain you know, I like, I enjoyed that feeling of like hunger pangs and stuff like that because it would really, it would hurt. You know? It’s a different sort of hurt feeling that you would get, but it was a, it was a, it was a hurtful feeling that I could control, you know.
 
It’s you know, there’s no coming down from this. You can constantly feel like this, you know, you can stop but you’ve got, you’ve got the power to stop it if you want to, but you can keep going if you, if you dare to go that far. And I always wanted to push it that little bit further.
 
 

James worked in fitness which gave him access to a lot of knowledge of how to lose weight.

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Like I say I was quite active when I was younger and I was in, like the football teams and the rugby teams, so obviously you have to be quite a build for that because it’s really demanding. 
 
But I did like weights when I was like younger as well. And I’ve always, because my dad’s really active, I’ve learned this from him, he’s did a lot of like long runs, well not marathons but like runs and stuff like that, and he was in the army and he was in, he did boxing and did weight lifting and stuff like that. So I’ve learnt everything sort of from him. 
 
But I’ve always, like I said I had that background so once I came to the point where I wanted to start losing weight I had quite a, you know, quite a repertoire of books, and research about how to lose weight, or what’s the best for to, to speed up your metabolism and things like that.
 
But at the point of like last year when I started to want to lose weight it was just a case of me doing more and eating less.
 
 

For James developing anorexia nervosa had nothing to do with his body-image. He thinks it's a...

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When I sort of became full blown with my disorder I never really I didn’t have this sort of image problem I guess. I never looked at magazines and wanted to look like somebody. Because I was always sort of exercising anyway so I knew what I could do. But I really, it’s really hard to see it as a guy now because a lot of people like when they talk to me, when I go home and stuff like that, but a lot of people don’t understand this illness. Quite a lot and they think that ‘Oh, wait a minute, you know you just want to look like so and so in the papers’, and it’s like, it’s completely nothing like that you know. So and so in the papers, and it’s completely nothing like that you know. And it’s, even about anorexia it’s not about food, it’s about feelings. You know and it is true, it’s completely about the way I felt.

 

When James was ill he completely lost his sex drive. He was taken over by eating disordered...

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Oh when I was, at that time when I was really ill I completely lost my whole, what do you call it? Libido, absolutely completely lost that. 
 
Nothing would register in my head. Because I wouldn’t be thinking about that at all. I wouldn’t, I lost it completely. I completely lost all sort of recognition of women and stuff like that. Honestly it was, it was quite strange thinking back at that because, but then again that is a trait of an eating disorder as well. When your body is so starved you just do not think about things like that. And at the time I just, because I was isolating myself so much I wouldn’t think about women or, in that sense at all or, you know, I would try to avoid being or talking about women or stuff like that as much as possible. And that’s what I was like when I was ill. And I was happy like that.
 
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