An estimated 200,000 people in Ireland are affected by eating disorders and 400 new cases of anorexia nervosa are diagnosed each year.

Harriet Parsons is a psychotherapist and services coordinator with Bodywhys, the national voluntary organisation supporting people affected by eating disorders.

Bodywhys is committed to the belief that people with eating disorders can and do recover.

Taking calls from worried parents is a big part of Bodywhys work.

“Parents have alarm bells ringing in their heads when they call us,” Harriet says.

“They are asking: ‘Am I making a fuss out of nothing’ or ‘do I need to be doing something?’ They are often afraid of doing or saying the wrong thing.”

The average age of onset is 15 to 24, but many are in the 24 to 35 age group.

Not about the food

Developing this eating disorder may be related to the person’s sense of identity suddenly not being as strong as it was.

“On the surface it might be: ‘So and so has broken up with me’ or ‘I’ve suddenly moved from home to college’ or ‘I’m facing into a set of exams that mean a lot to me’ but if you take them all a step further it’s about ‘who am I?’ and about feeling unable to cope with life.

“We always say to parents that it’s not really about the food and the weight. It can be very difficult for the parent to take on this idea,” says Harriet.

“Parents think everything will be all right if they can just get the person to eat, but they have to take in the bigger picture – that this is about their child’s sense of self and their child learning to cope with life in different ways. There’s no quick fix. It’s about finding a long-term solution.”

High achievers

Parents often speak of the children/adults concerned being high achievers.

“We, at Bodywhys, view that as them not necessarily being high achievers but that the high achieving or perfectionist all or nothing thinking is a safety mechanism in itself. It’s a way of them trying to protect themselves. They’re saying: ‘If I give 150% to my exams and if I don’t do well people then can’t come back at me and say I was lazy or didn’t work hard enough or that it’s my fault’.

“The eating disorder is a coping mechanism or comfort blanket. That’s why they won’t give it up easily because without it they feel that they can’t cope, so it can be hard to get through to them,” explains Parsons.

Balancing act

There is no perfect way for parents to handle the situation.

“That’s the first thing parents need to know. Parents need to trust their gut instinct that they have valid concerns.

“The way they act on those concerns can really help in terms of how they can bring their child (teenager or adult child) to get the help that they need,” says Harriet.

It can be a balancing act.

“On the one hand they shouldn’t collude with it to allow it to continue and on the other they can’t make the person give it up or stop until they feel ready to.

“Anorexia is similar to addiction. The more you do, the worse it gets. It slowly takes over your head and your life and has all the medical consequences as well.”

Be aware that anorexia hooks you in

“What’s complicated about eating disorders is that the eating disorder voice/side of their head is working against them all the time,” Harriet Parsons says.

“It’s all the time trying to hook them back into the cycle. For people who food-restrict the seduction of the idea of not eating is very, very strong.”

Recognising they have a problem is crucial

The person themselves recognising that they have a problem is a crucial occurrence.

“With a younger child, parents can bring them to the doctor and can get them into a place where they recognise there is a problem. When you’re dealing with a child over 18 though, you can’t make them do anything.”

Parents should get support themselves

It is vital that family members get counselling support themselves, Harriet believes.

“This gives them the opportunity to talk about their frustration and worry outside the home, which then makes interactions in the house less intense.”

Bodywhys offers support groups for families and friends in Dublin, Carlow and Sligo.

“These are run in the same way as support groups for people with eating disorders, based on the idea of mutual support,” she says.

Bodywhys has a lo-call helpline and also offers email support for those with eating disorders and their families (email alex@bodywhys.ie).

You can fully recover

“In Bodywhys our belief is that people can and do fully recover. Different things work for different people, however, and it can be a case of trial and error. It can take a combination of things,” explains Harriet.

The Bodywhys support meetings have a therapeutic effect but they are not therapy as such.

Counselling and psycho-therapy is a big part of treatment and there are different types, so it would depend on what type a person felt comfortable with. Mostly, good recovery depends on the therapeutic alliance – the alliance you form with a therapist where you feel that they understand you and that you can speak with them.

This is usually what will carry someone through, regardless of what type of therapy they choose.

Bodywhys has a directory of services – just click on the map of Ireland on the website to find therapists who specialise in eating disorders in your area.

“Try several and keep trying until you find the right one. Remember also that relapses can happen but they are part of recovery. You learn from a setback that you don’t want to go back to the disorder. That is valuable learning,” says Parsons.

Cost

For private patients: In-patient treatment can cost in the region of €1,000 to 2,000 per week. A four- or five-week stay can be involved.

Psychotherapy/CBT/counselling costs €60 (approximately) per hour. Long-term counselling is often needed.

Health insurance companies, if you have cover, usually provide some level of cover for treatment of eating disorders.

For public patients – what the HSE says: GPs refer patients with eating disorders to HSE community-based mental health service staff in their area.

If the individual’s psychiatric or medical needs are serious, hospitalisation is offered where necessary.

A treatment programme is put together and family involvement in the person’s care is supported.

Routine waiting time for assessment is approximately six weeks, but it will be faster if a GP requests it, the HSE told Irish Country Living.

As many as 219 referrals for eating disorders were received in 2012 by the HSE Child and Adolescent Mental Health Service.

There is no dedicated child and adolescent eating disorder facility in Ireland. The new Children’s Hospital is expected to have a specialist unit (HSE).

• Bodywhys: www.bodywhys.ie

Call 1890-200 444.

www.stjohnofgodhospital.ie

• For a full list of Irish hospitals and clinics that have eating disorder programmes look up services directory on www.bodywhys.ie

• Overeaters Anonymous is a support organisation for those who undereat, purge or overeat and follows the AA’s 12 steps. For a list of meetings near you see www.overeatersanonymous.ie

More from Dr Terence Larkin of the St John of God eating disorder recovery centre

Q: What happens if the person is not ready for treatment when they are referred to you?

A: “A lot of people that are referred to me are not at the point where they are ready to seek recovery.

“What you can do in that situation is, if the person will agree to talk to someone on a regular basis, is:

  • • Work at their motivation.
  • • Keep helping them to look at what the price has been for this.
  • • Get them to look at what has happened in their life since they’ve got involved with the eating disorder.
  • • Help them face up to their own disillusionment that this did not deliver the promises that they thought it would – that they would be happy in themselves, more successful/more popular and so on. The opposite will actually have happened because physically and mentally they are not fit and they have become more socially isolated.”
  • • An enormous amount of relearning and support will be needed around nutritional balance and working through fear about eating again.
  • Knowing you can't trust what you see in the mirror

    “A key element in recovery is realising that you cannot trust your own perception of your body when you have this disorder,” Dr Larkin says.

    “This skewed perception won’t change until you recover. Mirror work is part of the treatment. This is to help reality test the distortion. Instead, they need to learn to trust the scales for accurate feedback about a healthy weight.”

    People do recover

    Dr Larkin is in no doubt that people can and do recover, but recovery is often divided into four groups, he says – the group that recovers, the one that may relapse at times of stress.

    “Another group would always be slightly restrictive but would manage to keep their weight stable. Another group simply may not be able to let it go,” says Dr Larkin.