Following the tragic news of Nikki Graeme’s death, our Deputy News Editor Lucy shares her own eating disorder experience and discusses what the health service and society need to do better to support sufferers.
Content warning: eating disorders, mental health
For the last five years, I’ve struggled through an eating disorder. I find it hard describing it as such because I’m so painfully aware of the stigma that continues to exist. Stereotypes come to mind that are both haunting and inaccurate, and for whatever reason, the subject remains taboo in many circles. I’ve had experiences where I felt brave enough to open up, for my honesty to be thrown back in my face in the form of a disturbed side glance mid-story, or silenced by an awkward smile and hasty conversation change. The truth is that eating disorders aren’t yet accepted in the way that they should be by society, and this prevents sufferers from accepting their own condition and getting the help they need.
Mine started in my sixth year of school. I’d seen so many friends and family affected in one way or another, but I, as an avid lover of bagels and all things pastry, didn’t understand, in any translation, the language of starvation. I’d just finished a book about how a journalist went undercover to infiltrate Islamic State and it had inspired me to take on a similar project of my own. But I was 17, so instead of taking on an international terrorism organisation, I took on a less alarming, yet more lethal, threat: to see if I could better understand the silent illness that plagued those closest to me. Yet what I foolishly embarked on as a 30-day project at the start of 2016 took half a decade from my life.
Five years on, and as much as I’ve recovered in many ways, there’s been both a physical and mental price to pay. I don’t know if my body will ever fully recover from what I put it through: I had palpitations, amenorrhoea, and concerning vitamin deficiencies. And even now mentally, when I think there are no more hurdles to push through, another materialises. Just the other day, I couldn’t finish a drink after a friend jokingly threw its alleged calorie content into conversation. I felt like I was betraying all the progress I’d made, but the fear momentarily took hold. Every time I think I’m “cured”, something jumps back in to unbalance me, making me doubt whether I truly ever will be.
All those years ago, I thought I’d seen enough in the people around me to safeguard myself, but the addiction to the process came as readily as thirst to a runner. Just as a subconscious instinct takes over when you’re glugging the bottle to quench your thirst, there was no chance I could rip myself clean away. No matter your intelligence, background or social set-up: eating disorders don’t discriminate.
It had started restrictively, and with weight loss going a bit too well, it felt impossible to stop. In the world of eating disorders as I knew it, anorexia was the pinnacle – one I was unfortunately fast approaching. But eating disorders aren’t as simple as just a diagnosis. With both physical and mental changes occurring far too fast to be healthy, my hormones and hunger signals fell out of kilter and this, combined with a move to university and a near unlimited supply of alcohol, caused a weight gain I hadn’t anticipated. That’s when the “binge-purge” behaviours crept in.
Like before, I wasn’t aware of it immediately, but I can pinpoint the day the guilt and anxiety at this weight gain – not even enough to shift me up a dress size, by the way – wracked through me, one of the medic balls only a few days away. The perfectionist, restrictive part of the ED within me berated me for slacking off those past few months, letting the “greed” win. By this point I was having intense cravings, to the extent food was all I thought about, and I became caught in this to-ing and fro-ing between giving into temptation or avoiding the inevitable guilt that would follow. I went to the University GP twice during this period, citing my anxieties: not at my eating disorder, because I still wasn’t aware that’s what I had, but at this “irreversible” weight gain. One doctor didn’t have time for me and advised me to watch the calories in my salad cream if I was worrying about gaining weight. Another gave me a list of websites to look at. I recently found that same list in the pocket of the jacket I’d worn to the appointment four years ago, untouched.
In second year, I discovered veganism was an ideal way to channel my restrictive habits more covertly, and it also provided me with the perfect excuse to refuse foods. As I got on top of the binging, I started heading back towards the other end of the spectrum; this time falling further than before. But, dangerously skinny as I was, I saw something entirely different in the mirror. Not only was I eating less, I’d discovered tablets that would, I thought, aid the process. Whatever their effects on weight, they also caused me sleepless nights and abnormal heart rhythms, as well as a perpetually near-empty bank account. Again, I went to my doctor, but again it wasn’t directly because of an eating disorder: I was still in denial. I wanted to be diagnosed with hypothyroidism because I knew the meds for this increased metabolism and accelerated weight loss. When blood tests came back normal, me, in my delusional state of mind, told them something must be wrong, begging them for repeats. Again, they sent me on my way, likely perplexed at my response but not pushing further.
In third year, the bingeing had returned, and like with the restrictiveness, when the beast reared its head again, it was more powerful than before. Still skinny as ever, but increasingly anxious, I went to a therapist for a while. Good intentions aplenty, he put his foot in it several times over. Once, he told me “tricks” that other clients had used in order to restrict further, which I think was done to goad me into expanding more on myself, but only added to my own mental list of tips. Another time he told me I looked “swamped” by my jumper, “tiny” comparatively, and I simply took this as a compliment, my warped mindset seeing this as fuel to continue eating less.
Thankfully, I would describe myself as fully recovered now, though the road to where I am is one filled with potholes and U-turns. And I doubt, to many, my story will seem alien. Eating disorders are incredibly prevalent in all shapes and sizes. Anorexia nervosa is the poster-girl, but bulimia, binge-eating, EDNOS and orthorexia exist, and their crossover isn’t uncommon: it’s never as clear-cut as you’d think.
They’re mental illnesses; they may manifest physically, but they warp the mind past the point of reason. That’s why it’s not as simple as telling someone to “just eat more”: there are forces at play that I cannot confess to understand even as a sufferer myself. I look back at the last five years, essentially my entire time at university, and whilst optimistic, I’m not unaware of all the time wasted: curled over MyFitnessPal, planning spreadsheets of diet plans or obsessing, on sometimes a bi-daily basis, over the scales. I couldn’t focus on anything else and it took a lot more from me than just weight: concentration, confidence, happiness.
What do I think should be changed? I think we need better education in schools about eating and exercise, for people to have an understanding of how food and weight are interlinked, instead of gathering information from “Pro-Ana” corners of the internet. I think there should be less taboo and more talking, to create safer spaces for people to come forward if they’re concerned they have a problem. I think that GPs, being the front-line of the health service, should be on high alert for sufferers being unreliable narrators, and for eating disorders to present in all kinds of different ways. And I think, as a medical student myself, more work needs to be done within the curriculum to teach doctors how to deal with those with eating disorders more effectively.
Professional support is helpful, and I’ve seen that first hand with a very close family member. As much as the health service can get a bad reputation, there are doctors out there who are amazing in what they do. But in saying that, we desperately need more support available to deal with EDs sooner. The recent tragic news of Nikki Graeme is so sadly one of many, and the lack of resources fail those who relapse. It’s hard to get immediate help unless you’re in a life-threatening state, and that shouldn’t be the case. The sooner these issues are dealt with, the less likely they are to create habitual, life-long problems.
I’ve come to conclude, from the time I’ve spent looking into eating disorders, that there tend to be three main stimuli: a desire to lose weight, the need for control, and finally, trauma. It can be hard to separate out the causative factor, too. So my advice to family and friends of sufferers would be: be gentle with friends that are suffering or who you suspect to be. Remember that anyone can have disordered eating behaviour, no matter their size or apparent attitude towards food. However, whilst there’s more than meets the eye, try not to scrutinise either. Be open and receptive, non-judgmental and non-prescriptive. Let them know you’re there to listen, and try and provide them with a stable pillar of support in a world that they may see as otherwise frighteningly chaotic.
To anyone struggling out there, I would say: trust the process. Recovery is worth it. Life is so much better when you’re not always trying to lose.