In this episode:
Venessa: Realising that you need help with an eating disorder isn't always a clear or an immediate moment. Fi, what was it like when you finally realised you needed help, and what happened when you did?
Fi: I was terrified when I realised I needed help. I think when I realised that I was unwell and that I needed help, I felt paralysed. I felt stuck and terrified of the idea that if I got better, it would mean going back to the person I was before, which was so painful that I developed an eating disorder. But then if I didn't get better, I was going to be stuck in the eating disorder, which was also a living hell.
I was lucky in a sense because I was in treatment quite quickly, which isn't the norm, unfortunately, these days. But I remember saying to the psychologist, "I think I've got an eating disorder." And she, who'd been treating me for quite a while at this point, going, "Yes." And I was scared because I didn't really know what that meant, but I was also scared because getting better terrified me because the anorexia had felt like a way of coping, and I didn't know what taking that away would mean.
Venessa: So Fi, you speak about things retrospectively, which is wonderful because it means you've passed through that. What did it feel like in the moment?
Fi: Terrifying. It just felt terrifying. I felt trapped. I felt utterly trapped, and I ended up trying to do things to please other people. But I had absolutely no idea and no hope, and it got to the point that I genuinely didn't want to be alive anymore.
Venessa: Thank you. Peter, what are the key warning signs that someone may need urgent support for an eating disorder?
Peter: I think one of the very painful things about an eating disorder is every psychiatric illness at the severe end is torment, just as we've been hearing. So there's risk on the physical side and the psychiatric side at relatively high rates compared to other mental health problems. And so that's why we need to do a very thorough review of the person.
Plus, once you start treatment with someone who's very malnourished, it brings its own risks as well in that the body goes into shock if you're not careful. So you have to balance out how much to give, not too little, not too much, to get through that first week or two, and then you can just calm down a bit. Hopefully, they're either in hospital or with very frequent monitoring in the community. And once you've got through the highest risk time, which is those first two weeks, you can then move forward with that.
Venessa: And those elements that you just described, what kind of time period does that go over? I know it'll vary, but.
Peter: All of the acute stuff, the stuff that's sort of life-saving, the assessment would be a couple of hours, but then you'd have all the tests and the ECG, working out where to treat them, and then the very careful reintroduction, systematically, of food.
Venessa: So Fi, what were the barriers that stopped you from seeking support earlier?
Fi: I think initially an element of denial. I felt like I knew something wasn't quite right, but I thought when I was ready, I would be able to choose to change things, and the reality was just so far from that. I thought I was in control, and I was so out of control, but I only realised that when I started trying to get better.
And so much guilt and shame. I think any mental health condition, frustratingly, carries shame with it. And so a barrier to getting help was I was going to be all the things I was scared of. I was going to be taking up someone's time, or I was going to be asking for help, asking to be visible, and that scared me.
Venessa: It's a massive paradox, isn't it? Because you were wanting to get away from this life before, but then where you escaped to was not great, a living hell, you described it as, so you were just in the middle. Were you ever aware of feeling in the middle?
Fi: Yeah. What I found really difficult was I wanted just to be left alone, and I think that that, for me, was I had no hope, and I wanted everyone, the number of times I must have screamed, "Just leave me." And I think what I was saying in that was, "Just leave me to die," because I thought I was completely broken.
Venessa: Peter, when is hospitalisation necessary in eating disorder treatment?
Peter: Generally, it's used for managing urgent life-threatening situations. And biologically, you would break it down to how they are the moment you see them, and then how are they going to be as you introduce foods and treat them. So in the immediate sense, it could be at any weight, but most typically very low. But it could be any weight that someone is losing over a kilo a week through eating so little.
There's dehydration, which is sometimes the most important. And then in the next two weeks, you have to be very careful with the rate of reintroduction of food because the body can go into shock and become very dangerous.
So we have to carefully monitor, on a daily basis, various biochemical changes, weight, et cetera, and slowly increase the food. So those would be the acuter ones.
And then you do get cases where you're going to need to treat someone in a hospital because they can't hold it in the community at all, and they would lead to longer admissions. But that's less of the urgent side. And nowadays, it's more focused on the urgent than the prolonged treatment.
Venessa: Thanks, Peter. So we were speaking then about hospitalisation, Fi. Have you had that experience, and what was it like?
Fi: Unfortunately, yes. And I've had medical hospitalisations for my eating disorder because of physical risk, and I've also had longer inpatient stays where I've been sent to specialist units.
And I had one really bad relapse with the eating disorder that led to me being sent 400 miles away from home to a specialist eating disorder unit in Scotland. Whilst being sent to hospital was very scary in every possible sense, I do recognise that it saved my life. And with hindsight, I can see that what happened needed to happen.
And actually, the hospital that I ended up in not only saved my life from a medical standpoint, but psychologically. They gave me the therapy and the time I needed to work out what was going on in my head. I got the therapy I needed. I got the support I needed that I couldn't get at home. I needed 24/7 support, and that's what hospital gave me. And so I got therapy, I got support, and I attribute that to me still being here today.
Venessa: So Fi, if someone was questioning whether they need help, what would you say to them?
Fi: I'd say if you're at the point you're questioning whether you need help, you probably do. I spent a lot of time, too much time, thinking that I was in control, and I could turn it around when I wanted to and when I felt ready, and that never came.
I think with recovery, it is the bravest decision you will ever make. And I'd say be brave. Make it as soon as possible. Don't wait till tomorrow. Make it today. Be bold, be brave, and know that you don't have to go to the life you were living before because there was a reason you became unwell. But give yourself the chance to create a life that you can live in, and that is recovery. So that's why it's not about the food. It's about creating a life that you feel that you want to wake up for.
