I think one good thing is early intervention. I think as soon as I think this is more kind of at GP level, primary care, I think as soon as you kind of get into child and adolescent services they’re sort of, they know a lot more about it. And I know it’s hard for GPs cos, obviously, their job, they’re not mental health professionals but I think early intervention is the key cos both times I think the thing that made the difference between time one and time two for me, was that time two I was just about able to not fall totally victim to anorexia because I was able to get into some very good therapy before my weight got too low. I think if people are allowed to kind of pootle along at home without too much in help I think that things just spiral out of control and I mean the research says that all the lower the longer you are at a low weight, the less good the outcome is. So I think if someone presents to a sort of GP with possible anorexia it needs to be treated quickly, seriously, like even if they’re not that underweight, it won’t be long before they are and that’s when they’re really underweight, that’s when it’s harder to get back up. So I think early intervention is the key.

And yeah, I’d I don’t think I think if it gets to the point where an adolescent has to be hospitalised, I think something’s gone wrong in terms of, if it’s their first time round, I think things can be done withoutBut I think things should be done to prevent them getting into hospital because I don’t think any, I think if you can get in there early it will be better. I think by the time you’ve gone through the hospital thing and seen anorexia, the real face of anorexia, I think it’s a lot harder to get back out and the longer it gets ingrained. So really early intervention, yeah.

I mean undergraduate level, I worked very, very hard. Especially, I mean of course everyone works hard and especially in the final year, but in the final year, again, the work really got too much to the point where I was not sleeping. You know, I would be up the crack of dawn, go into the library, stay there till evening. You know, come back at sort of ten o’clock, try and go to bed, not be able to sleep and it got too much. And in the end, I was almost it was it was there was a lot of concern and it was almost to the point where I wasn’t allowed to sit my final exams.

Just cos I was just totally overwhelmed by the work and then when you’re not sleeping I was, you know, my mood was all over the place and it just got ridiculous. Apart from that, I think though, I was always I worked harder than the average, average student. I was always, if I did go out, I would always, you know, get up. I would never lay in bed like so I, yeah, and all my friends knew very quickly, I sort of got this reputation for being this very conscientious, hard working person, which is not necessarily a bad thing, but just at points it did get, take over.

And, actually, now I’m here doing a post graduate degree things, they’re still, they’re not great in terms, well, no, they’re fine but I do still have this reputation for working very hard. Not giving myself a break very often but it’s hard in this environment, because a lot of people don’t and, actually, compared to a lot of people I’m actually pretty good. And I’ve really worked over the last year and a half to try and incorporate other things into my life and more, and sort of trying to shift the balance away from work. Work’s still very important to me but I sort of figure if I do a good day’s work, nine to five thirty, I then don’t have to work in the evening.

And at weekends, I usually do a bit but it’s quite relaxed and so I’ve really I really feel like I’ve sort of turned a corner over the last, especially the last sort of year. And so that’s good but I certainly, it is something that I’m much aware of now but if it, I could easily fall into the same traps again where I was just, I’d just work all the time.

I think a lot of education in sort of mental health issues more generally would be of benefit for GPs, especially ones who, I guess, are slightly sort of more old school. I don’t think they appreciate the severity of mental health problems. And I think especially with eating disorders, something that’s is a problem is not only being underweight but kind of the other side, so binge eating, bulimia, that side of things. I think because the individual is not underweight physically they may not be that unwell, I think that’s not to say that, you know, they’re not very unwell like psychologically they are. And I think GPs probably struggle to recognise that side of eating disorders even more than the anorexic side. And yeah, I think they could do with some sort of education on the sort of similar processes that are going on in both of them.

You know, my poor parents, it was everything became a battle. They couldn’t leave me. If they left me literally, to go to the loo or to pick up, if the phone rung I would be off, you know. They had to lock, keep the doors locked and just, yeah, it was like having a toddler around.

And then there were times I quite often, if I sat at the table, I would line my, I would always be adamant that I had to wear my dressing gown at the table. They thought it was sort of a body image thing but I’d line my pockets and I was putting things in my pockets and hiding them. I think my mum and dad have had, they could see what I was doing. I wasn’t that sly. I mean I was trying to be sly but they got to the point where they just they didn’t know what to do. They’d, we’d done the screaming and shouting. We’d done the chasing. They’d taken everything off the bathroom so I couldn’t lock myself away and they were just like at wit’s end. They didn’t know anymore what they could do to help.

I think it’s also important to sort of just highlight the fact that you know, even when people, you know, myself and other people talk have spoken to you who’ve had eating disorders, friends of mine. Since coming to university I’ve met several people, that even when the anorexia’s gone there are other things you have to look out for like depression, self-harm, all this kind of thing.

So other ways to deal with the same problem and that’s something that’s a slight problem for me, not too bad. But, you know, I did have periods of low, very low mood and I know other people who’ve had, who’ve used self-harm to kind of help manage. And I think it’s, yeah, just important just to be, you know, even if you think, Good. Eating’s gone Just keep an eye cos it’s all, you know the same similar sort of underlying things that’ll cause you to do all these different things. So yeah, be aware. Yeah, and for other people to be aware, relatives that just, you know, just because you’re eating well again it doesn’t mean that everything’s okay.

I think my relationship with my parents, I have a very good relationship with both my mum and dad and very, since I think both since both episodes it’s made me much more open and I think, in a way, it’s strengthened our relationship. Like I will say to my mum even now, you know, if we go out shopping, I will explain to her and she knows that it’s not easy for me and that I do have a tendency to buy clothes that are too big and she’s very good at, whilst she doesn’t want me to buy clothes that are really tight and are going to make me feel uncomfortable, she tries not to allow me to buy, well, not allow me, but she supports, she she’ll say, Oh, that looks a bit big, I would get the next size down But she realised why I want to get the bigger size. So we’re very open.

Yeah, we have a very open relationship and I can tell her what I’m feeling and I’ll tell her when things aren’t so good and when I’m feeling that I can’t wear jeans at the moment or whatever. So that’s good and so and with my dad. I mean I think some things like that, maybe less so with my dad just because…

Sure.

The relationship between a mum and a daughter is slightly different. My dad, you know, the second time round when I had that slight sort of relapse or dodgy period a while back, he was very good. He’s much more, and I think it’s maybe the dad role, very practical and, you know, If there’s anything I can do, if you want to be picked up in the evenings, come home for dinner and drop you back, that’s fine, not a problem So I think, in a way, it’s really, it’s really helped, it’s really strengthened our relationship.

I mean my sister, I think had a really tough time in that, obviously, all the attention was on me because I was unwell and I think she found that quite difficult, quite understandably really because my parents were very, very concerned about me but she obviously, had things that she was worried about, not, you know, normal teenage things.

And she was, yeah, my parents were trying to, you know, trying to do their best and give her lots of attention and give me all the all the attention I needed but it just, it was tough for her and I can remember her getting very angry with me often and she refused to, after a while, she refused to eat with me, eat in the family, with the family because it was just, she couldn’t she didn’t want to be involved in it at all.

And I think she got quite resentful of me and quite angry. Understand, totally understandably because I was tearing the family apart, basically. And all the attention was on me, every mealtime was a battle. Mum and dad were in tears, not sleeping, you know, stressed and for someone who hasn’t had an eating disorder and don’t have much insight into it, it does seem, you know, I’m doing it to myself. I accept for her, it probably looked quite selfish. I was, yeah, doing it for attention. All the sort of, yeah and so it was very difficult for her. And we did have a couple of sessions of family therapy but I wasn’t really into it at all because I think I was just past the point. So yeah, I think it was just I think she found it very, very difficult.

How did your relationship then change over the years?

With my sister.

With your sister.

So I think, to be honest, the worst part of our relationship was that period when before I went into hospital, when I was hell in our house. My sis-it wasn’t something that’s really I don’t feel, affected our relationship long term.

Since I started getting well, things started going back to normal. She I think she was quite relieved when I went into hospital and I don’t, I think it’s interesting, because I don’t think she ever, at the time, really expressed how worried and upset she was.

Like I thought she’d just she’d removed herself from the family meals. I thought she didn’t care but actually, it turned out that it was actually, quite difficult for her, you know, understandably I guess, to see her sister in this state. And just like in a in a mental health hospital.

I have done a MBCT course in mindfulness based cognitive therapy, which is kind of targeting more depression which I initiated myself. There was a course running and I qualified for it.

What was that like?

Interesting. Very difficult for someone like me who’s very driven and like to be doing and busy all the time and to then suddenly have to meditate for forty minutes it was quite different and trying to incorporate, as part of it you have to practice a lot, trying to incorporate practices into my daily routine, which involves a lot of work and, you know, socialising and things, it’s quite difficult. But it was it was interesting and it’s given me another sort of tool that is useful and, you know, when I did it I was fine, you know, quite well. So if ever I do feel my mood going down it might be something that I pick up on again.

But it’s not something you kind of at the moment, incorporate in your routine?

Not really.

it’s more sort of…

It should be cos it is something you’re meant to keep up.

Rather than when things
Yeah, exactly. Yeah, but I have as part of it though, you sort of done some yoga practices since doing it I then, I now do regular yoga so that’s still a part of it and but it’s just another way just to have a bit of sort of time where you’re just, you’re not doing anything for any reason. it’s just like an hour of kind of, I don’t know, being in the moment or whatever. You know, not actually doing anything so it’s good for me and I think that has come through that sort of mindfulness path where I first experienced a bit of yoga and that sort of therapy, yeah.

I can remember I kept being asked to drink Ensure drinks, which are like high calorie drinks. And there was one evening where I again hadn’t eaten anything and I think I probably hadn’t drunk much either and I was sat down with one of the medical doctors and he sort of said, Look. You’re a sixteen-year-old girl, you’ve got a life ahead of you. You need to do this And I was still, I was in tears. I was not gonna drink this Ensure drink and he actually, got the cup and sort of forced me to drink it or some of it and I was, after that, I was very I was distraught. I was I felt totally out of control. I felt, you know, it was just. I felt, oh, it was horrible and I know, subsequently, I didn’t realise this til sometime later on, that because what this is not strictly what you should do apparently, they’d have to call my they had to call my parents in and tell them what had happened that I’d, basically, been forced to drink this thing. And my parents were, apparently, just like, That’s fine. That’s fine, you know. If that’s what it takes, that’s what it take [laughs]. And strangely enough, after that, I mean nothing, it wasn’t easy, but I was able to start having a tiny amount of food at each mealtime.

So just like I remember like the next morning I was asked to have half a Weetabix with a bit of milk and I was able to, you know, it took about three hours probably but I was able to eat it. And it built on from there until it got to the point where I was eating what everyone else was eating, meals, snacks. And so, in a way, that was kind of good that happened. But, at the time, obviously, it felt awful.

So did something sort of change in your head?

Well, I think it felt, it was, yeah, I mean I think it felt it was okay if you do it nothing, you’re not suddenly going to feel out of control. it’s, yeah.

It just felt like it had been so long and I’d not eaten anything and it just, I, in my mind, in my disordered mind, I thought, As soon as I start eating I’m going to worry that I’m not gonna be able to stop or I’m gonna put on lots of weight very quickly And I realised, actually, having this small amount of Ensure drink made no difference. I didn’t, you know, I felt no different. I didn’t feel better. I didn’t feel worse. It just, it was fine and I was still, you know, all my friends were very good and coming in and seeing me and I still had this incentive, this huge incentive, to get better because I wanted a normal life. So I was able to gradually start increasing my intake.

I think I am very driven in everything I do. When I say everything I do, I mean I don’t actually do a lot other than work. Work is a large part of my life and it always has been and always will be I think. And I’ve always felt the need to push myself to the extreme. Not necessarily because I want to be the best, but just cos there’s always this kind of underlying, I’m not good enough If I worked, if I didn’t work as hard as I did I just wouldn’t be able to do this. So there’s all this kind of need, I guess it’s the perfectionism thing.

And so I’m, yeah, very driven. I also like to feel in control of whatever it is whether its work, whether it’s my body weight, I always need to feel in control. And so as soon as I think something goes, feels out of control in my life, nothing to do with food and weight. I’ve got this kind of safety blanket of, Well, I can control my food and weight quite well. I’ve done it before. I can And so I always fall to that and I also have got sort of I think I’m sort of quite an anxious person. So I think all these things kind of don’t help. Yeah.

Would you say your worry about things? And what do you mean about anxious? How does it sort of manifest?

Yeah, I mean I think I do. I worry about not performing or not being good enough a lot. And it is all related to work and that sort of thing. it’s not anything to do with worry about my body or how I look. it’s all to do with not being good enough, people not thinking that I’m good enough, yeah.

When you that you want to work hard to feel good enough, would you say that this is linked to self-esteem? Is that sort of part of your identity, work?

I think it is. I mean I think I sort of value myself pretty much wholly on my ability to perform and do well in my work. And I don’t have I mean I realise this now, I don’t sort of have a lot else that’s important to me and I don’t value myself for much other than my performance academically. And so if that goes or I feel like I’m not up to scratch, it really feel very uncomfortable and I need to, you know, do something else like starting to control my weight or whatever.

Why do you think it (bulimia) was worse for you or made you feel worse than anorexia or restricting?

I think because when you arewell, I think several reasons. Because my whole my whole thing is about control, you know. It still is and it probably always will be. I like to be in control and this was not in control. This was disgusting, out of control. I, even though my whole anorexia thing wasn’t about being thin, the fact that I started to feel very disgusting and actually, started to feel a lot worse about my body. And also, I think it was hard, inside I was really sort of crumbling and quite distressed and quite like psychologically still having a lot of issues. But everyone else thought, Oh, she’s done so well. She beat anorexia. Gosh, she’s, you know, this case casebook, you know. She’s done such a great job with the anorexia And they didn’t realise what was going on behind the scenes as it were.

And I really and it wasn’t and because it sort of, it felt quite disgusting and quite greedy. It wasn’t something I wanted I felt comfortable talking about, whereas anorexia, you know, you’re not eating. it’s not good but it’s not you’re not sort of over indulging and, yeah.

The first thing that I can really remember in terms of eating going a bit wrong was I’d just finished my GCSE exams, so this was when I was sixteen, and shortly after that well, after finishing we had a very long summer holiday, longer than I’d ever had before because the exams ended and until sixth form started there was quite a long break. And during that time, I was well, looking back I can see it now but at the time I wasn’t really aware, that I sort of starting engaging in a lot more exercise than I would usually do.

And also I started cutting back on what I was eating and I think it was it was because I felt like I’d put on maybe a bit of weight over the exam period, which I don’t know whether I had or not. I mean probably had because I was just sitting revising. And over the summer months it sort of that sort of pattern increased so I was gradually doing more and more exercises and eating less and less.

And by the time I started six form in the following September I had lost a substantial amount of weight and I think when I got to six form it was a very different structure to what I was used to. There was no, well, not many lessons. There was a lot of sort of study periods and I think that sort of made me feel perhaps out of control and so, because of that, I started, you know, I was really started increasing the exercise even more, restrict, controlling what I was eating even more to kind of make up for the lack of control I felt I had over my sort of school work.

And at the time I had a boyfriend, who noted that things weren’t right. I’d lost a lot of weight. I was obviously, he could tell I wasn’t eating and I was engaged in quite a lot of exercise and I was not myself. I was very miserable, I felt I was quite tearful. I was really focusing very much more even more than usual on my studies. So really just studying the whole time.

So eating disorder was really taking over and I was getting weaker and weaker and less and less like myself. I was still going to school and really focussing on my studying and my parents didn’t know what to do.

I think it was kind of him [her boyfriend] who actually first sort of really realised that something wasn’t right and it suddenly, because we spent quite a lot of time together, it was him who realised it was obviously, something to do with eating and it was affecting my mood hugely.

I can remember he [her boyfriend] produced something off the internet. You know, he printed me out a sort of anorexia you know, check list or something. And I was quite shocked because I did meet all the, you know, all the requirements. And I it was for some, I mean it seems ridiculous now, but I didn’t even really know about anorexia. I didn’t, I mean I knew, I’d seen occasionally, on news programmes like parents whose daughters had almost died from anorexia and you think, you know, That’s such a rare thing I didn’t know anyone who’d had anorexia. Or an eating disorder. And so when I saw this piece of paper that I sort of met all the criteria, I thought, Oh, okay. Yeah, something is not right And then I think it got, it started, I realised, you know, that it was more than, I wasn’t so concerned about what I was doing and the fact that I was losing weight but I was more concerned about the impact it was having on my relationship with my friends and my boyfriend. I thought, Okay. I need to sort this out I mean I didn’t want to, I wanted to sort it out without having to eat or change any of the things I was doing. But I realised, Okay. Something has to happen So that’s when I agreed to go to the GP first time, yeah.

I now do regular yoga so that’s still a part of it and but it’s just another way just to have a bit of sort of time where you’re just, you’re not doing anything for any reason. it’s just like an hour of kind of, I don’t know, being in the moment or whatever. You know, not actually doing anything so it’s good for me and I think that has come through that sort of mindfulness path where I first experienced a bit of yoga and that sort of therapy, yeah.

I was the youngest and in a way, it was quite nice because all of the other patients were quite kind of mummy-ish over me. They sort of cared for me and they were and they were sad to see this young thing, cos this was then twenty years ago.

And that was the thing, you know. My parents, I mean it was tough for my parents cos they would come in and see, you know, forty-year-old women who’ve who were had had anorexia all their lives and had their lives ruined by it and they thought this was, this was gonna be me. And I so it was quite a strange environment for someone quite young and quite new to the illness to be in. It was, yeah, I mean we weren’t messing around anymore. This was the real the real side of eating disorders. And I learned a lot about eating disorders whilst being in there about actually, I, you know, I had this awful disorder and I thought, you know, God, I’ve got a really bad eating disorder But it wasn’t until I was in there that I realised, actually, mine was just, you know, another case of anorexia. It was nothing special. It was nothing particularly bad, well, in terms of how far anorexia goes.

Everyone there had had it all their lives. They were, you know, a lot of them were lower weight probably, I mean I don’t, but I remember thinking, I’m not actually that underweight The sort of things that people got worked up about and upset about were, you know, really minor things and I sort of, because I was new to the illness, the people who’ve had it for a lot longer seem to, their whole world was eating, anorexia. Whereas I still had, you know, I still had friends coming in. I still had a boyfriend. I still had school. I was still working when I was in the hospital. I had all my books in there and I was adamant that I would not fall behind. So I was working all the time.

And these other people, they were just anorexia was their life and it was interesting to see that and to see the real anorexia illness, not this kind of snippet I had experienced. So it was a really interesting time for me. For someone who didn’t know anything about anorexia to be in that environment was very, very odd.

Very, I don’t know how to describe it, it was bizarre. You know, I was just a normal, you know, a few a few months ago I was just a normal sixteen-year-old girl sitting my exams and the next thing I know, I’m in this strange environment. But it was I mean the care was brilliant. It really was. I cannot, the care was brilliant.

By that point, I was eating everything on my meal plan and so I thought, Okay. I’m pretty much better now You know, I realised I was still a bit underweight but I could eat again. I sort of thought I realised that I’d been quite silly and that, you know, it was, I I’d sort of seen the light and now I could eat again it was all gonna be fine. And also I was very anxious about school. And I was really worried about getting behind and so I, all these things together, I thought, Well, I’ll, you know, if I can get out, I can just focus on my work. I can, know how to eat again now so I’ll be fine And I was also yeah, I just felt a bit I needed to get out, just, I mean I wasn’t even in there that long but I just, being around people with eating disorders all day every day, it was just too much.

I needed to get out. And, you know, with all my friends coming in and telling me about all the fun things they’d been doing. And because I’d put on some weight and I was eating again, my mood was improving. I wasn’t feeling so hopeless about life. I was feeling ready but I probably, wasn’t actually, but, you know, I wasn’t actually, ready but I thought I was. So yeah, I decided I needed I wanted to leave. Which wasn’t received too well. Only because I’d been so unwell and, thing with me, I hadn’t been ill for that long but I’d sort of gone down very quickly and that’s what the worry was that once I’d get it in my mind and cos I’m so driven, I can just, you know, plummet.

And they thought, you know, She’s only just really started eating everything on the meal plan And usually, people are in there for a significant long, you know, a significant amount of time just kind of consolidating it and working on the psychological side, which, at that point, I was still like, Whatever I was, you know.

I was still very much about it was all about eating and kind of I didn’t really have a great understanding of what had gone wrong, I don’t think. So yeah, I was adamant that I was gonna leave and my, yeah, my sort of therapist and staff there, my parents didn’t think it was a good idea. But I can remember having a CPA meeting, so a sort of care plan meeting, and voicing my desire to leave. And, you know, it was a very long meeting and they decided that if I was adamant I was gonna do it, would give it a try but I’d have to come in, I think initially, I would have to come in every other day to be weighed and to see how it was going and if, like as soon as my weight dropped I would be back in and they kept my bed for quite a long time, well, not that long. You know, a sort of couple of weeks, which in in terms of hospitals that’s quite a long time for NHS, so that was really good of them because they didn’t think it was gonna work but because I wasn’t sectioned and I was so adamant that. I was gonna go they thought, Okay. Give her a chance

My mum, my dad was away on business and my mum really didn’t want me to but I did and I so I did. I left. I can remember coming out of that meeting and telling some of the friends I’d made that I was leaving and they were, you know, their faces just dropped. They, What are they, you know They couldn’t believe that I was allowed to leave. They thought it was ridiculous. Just because they, you know, all these people had had several episodes of severe anorexia and they know how it goes, you know, they, people get a bit better and it’s just like revolving door cases. They just come in go out, come in go out. So yeah, so I left.