"I am so self-conscious that I cannot even look someone in the eye. I am extremely lonely and feel as if no one wants to be my friend. When people talk to me I never know what to say to them. I feel so insecure and immature."

Tiffany despised herself and felt clumsy, her brother described her as someone who loved selflessly, never asked for anything in return and was always there for other people.

Eating disorders affect not just adults, but young children - both female and male. Even if the symptoms do not manifest until teens or adulthood many of the causes still begin in childhood. It is important for carers to have an understanding of some of the signs of eating disorders and the underlying issues.

Mastery over self

The anorexic carefully controls what she eats. There are "acceptable" and "unacceptable" foods. She feels triumphant in not giving in to the sensation of hunger; when she does give in she is filled with self-disgust at her weakness. When the anorexic sets out on cuffing back on eating she seems no different from anyone else who is dieting, but there is a subtle difference. For the dieter who is not heading in the direction of anorexia, dieting is one part of her life and she diets to achieve physical attractiveness. For the anorexic, dieting is her whole life and she diets to achieve mastery over self. With children there may not be the same emphasis on dieting, but other warning signs. These can include repeated complaints of feeling full, feeling sick, having tummy ache or experiencing difficulty in swallowing.

Dieting itself is not the cause of anorexia. Certain factors will already have put the person in the position of making her susceptible, such as; personality, family background, desire for perfection and suppression of feelings. As she diets she discovers that it gives her a sense of achievement.

Most anorexics have a fear of weighing more than a certain weight (which is below average for her age and height). Sometimes anorexics believe in "magical" weight at which they consider that everything will be OK. When they achieve this weight and discover that nothing has changed, they set another "goal". The pattern continues in an ever downward spiral. Though painfully thin, when she looks in the mirror a huge flabby figure stares back at her. Hating what she sees, she develops frantic exercise programmes pushing her body to physical extremes. She becomes obsessive, can't allow herself to enjoy life and feels guilty when she does.

Why would a person push her body to this extreme? Even to the point of death? Anorexia is not really the problem, but rather a way of coping with a whole series of problems. For various reasons the potential anorexic feels unsafe, and she discovers that through, not eating and pursuing thinness she is in a better position to handle her world. Life is seen as frightening, full of situations, experiences and responsibilities with which she feels she can't cope. For the child who has been fostered, adopted or who is "in care" it is understandable that there are things with which she is trying to cope and may not know how to deal with.
The behaviour patterns of the anorexic distract her from confronting her true feelings. She feels that anger and conflict cannot be openly directed at anyone. She may be hurt, disappointed or angry with those close to her. However, because she does not know how to resolve conflict, facing these feelings is too dangerous and she can only direct them at herself. Without realising, the anger and conflict are pushed inside and turned into shame and guilt. Soon she believes that everything about her is flawed.

Identity struggles

The sufferer finds herself in inner turmoil over who she is and where she fits in with friends. The issue over identity often has a connection with the way her family have related: expecting her to be a part of the way they see and do things rather than someone able to form her own opinions.

Along with the confusion over identity is a crisis over independence due to other people defining how the potential sufferer should be. Lack of individuality leads to over-submissiveness, non-assertiveness and difficulty in making decisions and forming opinions.
Although the child who becomes anorexic wants to conform she also wants her independence. In controlling her food and weight she is making a statement about independence. Yet, in regressing to a childlike state physically she is showing that she cannot cope with independence.

Desiring perfection

The meeting of ordinary needs, such as hunger and comfort, can be seen by the anorexic as a sight of weakness. Anything which falls below the anorexic's standard is considered as "bad". Her striving for perfection becomes concentrated on the body, but in reality it relates to the whole of her life. She is desperately trying to get rid of a sense of bad within by getting rid of bad in terms of flesh. However low her weight is it is not low enough because she can still feel the "ugliness". She needs to be helped to look at what is going on inside (emotionally) rather than what she is doing on the outside (physically).

Keeping control

The main purpose behind anorexia is control. Anorexia gives a sense of power in a life that has known the struggle of powerlessness. The sufferer's low self-esteem and her acute sensitivity have resulted in her being vulnerable to the control of other people. Feeling the dis-ease of this, her answer is to take control for herself. If she can't control her circumstances, she controls herself within her circumstances. Her greatest fear is of losing control. Not just losing control over food and weight, but over every area of her life.

The anorexic cannot get better until she understands the reasons for her need to be in control and until she has been helped to find ways other than not eating as a means of feeling in control.

Bingeing because you're bad

Bulima is slightly different from anorexia. Whilst the anorexic will mainly use starvation and weight loss as a form of control, the bulimic will appear to lead a more normal life but with episodes of binge eating and vomiting. Sometimes her craving to binge and vomit is so great that she doesn't care what she eats. The amount of food consumed in one binge can be equal to what most people would eat in ten days. After she has eaten she feels heavy and her stomach distended as though ready to burst. She forces herself to vomit and feels tired and numb. Some nights she goes on to repeat the pattern several times.

The bulimic's needs to both binge and vomit actually symbolises what is going on in her emotional life. She is trying hard to take control, but is also in a great deal of conflict. She wants to present herself as strong and yet inside she feels needy and emotionally hungry. She feels ashamed on the non coping part of herself which she tries to keep shut away from others, and deal with through her eating.

The bulimic pattern can also be a way of physically releasing tension brought about through inner conflict, family problems, loneliness, stress, anxiety and depression.

Shifting relating

Underneath the bulimic's facade there exists a need to be cared for. But she is scared to allow people to touch the part of her which longs to be treasured and so she pushes people away. To be loved by others is to risk destroying herself by letting the other person see the "ugly" part of her.

Splitting feelings

The "bad" part of the sufferer is seen as that which contains "bad" feelings. These are feelings and experiences she has been brought up to believe are not acceptable or must be kept hidden from other people. The way in which some people deal with these feelings is to split them off and not allow them to be part of the person. For the bulimic they are split off and dealt with through her bingeing and vomiting.

Everyone has needs which they long to have met, but when the need is intense this usually stems from the person having been deprived in some way as a child. If needs are not met or they are seen as bad, weak, childish or selfish, then the person can be left with an empty void. The bulimic finds it easier than the anorexic to admit to having needs, but the thought of being needy frightens her and she feels compelled to return to a state of emptiness. Often she looks to adult relationships for what she failed to find in childhood relationships and so is continuously disappointed and "hungry for love".

Whilst a bulimic's illness helps her to cope with pain and distress, her means of coping brings added problems - addiction and self-hatred. As she is helped to see how her eating pattern is a mirror image of her emotional world and she is encouraged to find other ways of handling conflict and emotions she can find release from the condition.

For further information on Kainos (seminars, resources, support) write to:

Kainos Advisory Service, FlaxleyHouse, Broadwater Road, Holme-next-the-Sea, Nr Hunstanton, Norfolk PE36 6LQ

In addition to Helena's books, readers might like to be aware of Eating Disorders-Guidance for Teachers, published by the Family Reading Centre; available from CCPAS. Although written for teachers, this booklet presents a great deal of useful information in note form - see CCPAS's resource list.

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