I want to say that anorexia doesn’t last for ever. I want to believe what I’ve said to so many fellow sufferers, that full recovery is possible. But these days I’m not so sure.
Following the death of Nikki Grahame, the former Big Brother contestant, on Friday after a decades-long battle with anorexia, I’ve heard from many people who have been living with an eating disorder for years. Mostly their condition isn’t life-threatening — often it’s not even visible.
Grahame was only 38. Too old to fit the traditional teenage anorexic stereotype, but far too young to die. She falls into that category, like me, like so many, whose disordered eating started in their teens and who never fully recovered. Anorexia is not only the most deadly of all mental illnesses — it’s estimated that about 20 per cent of sufferers will die — but eating disorders in general are very resistant to treatment. Even if you can access the limited psychological NHS provision on offer (usually talking therapies, such as CBT) success rates are low. The longer an eating disorder lasts, the harder it is to recover.
We have a generation of women in their thirties and forties for whom dieting, frantically exercising, skipping meals or avoiding carbs or fat is a way of life. Worrying about their weight and disliking their bodies is completely normal. They grew up in the heyday of the Atkins diet and the gym boom: you wouldn’t consider them ill, but they are very careful about their eating. They may not be starving to the extent of severe anorexia, but they are always hungry.
It’s exhausting living like this. Monitoring every morsel that passes your lips, never missing a day’s workout, weighing yourself every morning and scrutinising your body through the ups and downs of pregnancy, menopause, all the other life changes. The relentless discipline and self-criticism takes its toll. It’s inside, in your head, and it’s outside, on your body.
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Eating disorders aren’t just lifestyle habits about what you eat or don’t eat: they’re addictions. However, unlike other addictions — alcohol, drugs, or gambling, say — you can’t avoid food altogether. Even anorexics have to eat and with an eating disorder you have to face your demons every day. Whether it’s restricting, bingeing, purging or a combination of all three, every meal is a battle. The compulsion to starve or to gorge yourself to the point of sickness or to vomit after eating is like a war going on inside your head.
That mental battle, those warring voices, are vicious and so loud. I have been calmly sitting at work lunches, family picnics, dinner with friends, looking relaxed on the outside, but on the inside I’m in pieces. That potato salad has way too much mayonnaise; that couscous is drowning in oil; that sandwich is loaded with butter; that cheese is definitely high in fat — these anxious thoughts are on a constant mental loop. Daily life becomes fraught with stress.
How can we begin to tackle eating disorders (which are on the increase among men and women, with admissions up by 32 per cent in two years, according to NHS England) when they are so poorly understood? It’s hard to explain the toxic mix of physical addiction, mental illness and emotional trauma involved. For most of us a condition like anorexia is not about the physical weight loss (although it usually starts off as a diet), but it is an intensely physical process. Getting thin to the point of emaciation, living in a skeletal, sharp-boned, freezing-cold body was the most frightening experience of my life.
And when life gets challenging, anorexia is still a risk. Even though I am “weight restored” I still have some of the same thoughts. During periods of extreme stress, anxiety, excitement — or just when I’m busy — I cannot skip meals. I can never afford to lose weight. Anorexia is in the background, but I know how quickly it can take hold again. I’ll have to be careful all my life.
There are triggers all around us. Even if you ignore the widespread obsession with weight loss, there are triggers in the most innocent places. Last week a close friend announced she was “done with bread”. She said her bread consumption was so uncontrollable that she has decided to stop eating it. Despite the fact that I don’t need, or want, to lose weight, I found this remark troubling. Of course I understood what she meant — carbs are moreish, they make us satiated and happy. We know that once you start (baguette, bagels or bread fresh from the oven) it’s hard to stop. But her words stayed with me, sparking that tiny, niggling anorexic voice at the back of my brain, those whisperings of guilt and self-discipline, and whether it might be better to cut out bread.
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This is what it means to live with an eating disorder, no matter what you weigh or how long you have been recovered. The niggling voice gets quieter, the behaviours become more manageable, but they never disappear completely. I understand all too well how Grahame battled anorexia for nearly three decades and why in the end it became too much for her.
