The importance of early intervention and prevention of eating disorders is what Trish Shiel, psychotherapist and clinical manager of the Eating Disorder Centre Cork (EDCC), is emphasising as part of Eating Disorder Awareness Week (which continues until March 5th).
“An eating disorder, because of its very nature, is often not caught early,” says Shiel. “Because it’s a coping mechanism for people, they don’t often want to admit that they have an eating disorder. And they don’t see it as a problem. Then, by the time they actually look for help, it’s an entrenched well-established illness.”
Someone in recovery needs to find their own voice again. They have to find out how to say 'no'
There is, says Shiel, a predisposition towards an eating disorder. She describes the internal voice that plagues a sufferer. “It’s not a psychotic thing and that has to be stressed. It’s the person’s own voice being very abusive. The person is fearful of it and needs to follow the rules set down by the voice. The inner voice says very pejorative things like ‘you’re disgusting, you’re fat, you’ll never amount to anything’. In terms of recovery, the person needs to develop a really strong sense of themselves. Recovery is multi-layered because it’s a multi-layered illness.”
Personality
What’s important is recognising the signs of an eating disorder and being aware of the personality type that can be prone to the illness. Shiel describes the typical eating disorder patient as being “very sensitive, maybe somebody who is acutely anxious and a worrier. Even as a child, parents can go back and see that thread.”
The person with an eating disorder will often be creative. “It could be art, singing, music or writing. Nearly always, these people have lovely souls. They’re intelligent and have a perfectionist tendency. They want to excel. They have ‘all or nothing’ thinking. Somebody might have these characteristics and an eating disorder never manifests itself. Often, an eating disorder, coupled with the typical personality traits, can be down to the environment and the culture.”
I began to notice food wrapped up in paper, shoved under her mattress and in the wardrobe. One day she burst into tears. She said 'I hate myself, look at me, I'm enormous.'
What’s important is an environment that allows self-esteem to build and allows the person to have their voice heard. “Someone in recovery needs to find their own voice again. They have to find out how to say ‘no’ because they can be very acquiescent people. They want to care for others but at a huge cost to themselves. Ideally, a person with the traits of an eating disorder will have their self-esteem built up naturally as they go along. Their anxiety will be spotted and well managed.”
It’s all about acknowledging the anxiety, naming it and normalising it so that the young person doesn’t feel there’s something wrong with them. “It’s about helping little ones and older ones to develop skills to manage their anxiety and to become aware of the triggers that cause it.”
Outreach programme
The EDCC, a registered charity, was founded in 2008 by three Cork parents whose children had to travel to Dublin for treatment. It is developing an outreach programme for 12-14 year olds in conjunction with Mount Mercy secondary school in Cork.
“The programme is about recognising what is thought, how thoughts affect our feelings and how feelings affect our behaviour. It’s something that needs to be built in as part of the curriculum, especially today with the pressures of social media. One of the things that can precipitate an eating disorder is the cultural pressure of the thin ideal. Negative body image is huge and so is chronic dieting. Size acceptance is important and being aware of photoshopping.”
Shiel says parents attending weight-loss clubs who have a child trying to recover from an eating disorder is “like offering cocaine to that person. It’s important to be aware of the dangers of dieting. There’s a whole feminist piece in here but having said that, eating disorders do not discriminate and males get them too. There are males who are trying to bulk up in the gym (and follow diets to facilitate this) and we also have boys who have anorexia coming into the centre.”
The EDCC works with families to help open up communication channels. It also offers support for the carers of people with eating disorders.
Mother's view: 'The centre gave Jean back to us'
“I first noticed something was wrong when Jean (not her real name) was 14. She had just started in secondary school. She became withdrawn and had lost a bit of weight. She was having boyfriend trouble too and I was putting it down to that. Then, things were coming to a head. No matter what I said, Jean would shut down completely and she gave up doing sports. She was diagnosed with autism when she was younger. She had early intervention for that which helped a lot. There were instances when I put her behaviour down to autism. With Jean, it’s all or nothing. She gets very intense.
“She was going to her bedroom to eat her meals, but I began to notice food wrapped up in paper, shoved under her mattress and in the wardrobe. One day, I was driving her home. I wouldn’t say we had an argument but it was certainly building up to one. She burst into tears. She said ‘I hate myself, look at me, I’m enormous.’ I was so taken aback. I could not believe that this beautiful child was saying this to me. Eventually, I got Jean to go to the doctor.
“At the time she was self-harming as well. We were referred to a counsellor in another county. That was a disaster with the counsellor making negative comments about Jean’s appearance. Eventually, someone recommended the Eating Disorder Centre Cork. Jean clicked with her therapist. The centre gave Jean back to us. She’s slightly underweight at the moment and is on anti-depressants. Do I think the eating disorder has gone away? Not completely. Jean has her Junior Cert coming up. She finds that hard. Her eating disorder was all about controlling. Food was the one thing she could control. But while she still has her moments, she’s good. I see her eating. She has a healthier attitude towards food.”
Startling statistics Up to 200,000 people in Ireland may be affected by eating disorders.
An estimated 400 new cases emerge each year, representing 80 deaths annually.
12% of all admissions for under-18s to Irish psychiatric units and hospitals had a primary diagnosis of eating disorders.
Females accounted for 87% of all admissions of those affected by eating disorders.
eatingdisordercentrecork.ie Bodywhys helpline: Lo call 1890 200 444. Eating Disorder Awareness Week is from February 27th to March 5th
