In this episode:
Venessa: There's a common belief that eating disorders are all about wanting to be thin, but for many people, it goes much deeper than that. Fi, when you're ready, please can you tell us your journey with eating disorders?
Fi: So I was diagnosed with anorexia when I was 14, but to understand why I developed anorexia, we're going to go back.
When I was a young child, I was very happy. I was quite quirky. I loved learning, I loved to laugh, I loved pasta, and I didn't really feel any pressures.
But as I got older, I started noticing that I was feeling different. I just couldn't explain it, I just felt different.
And as I got older, those differences became more apparent, and I started feeling like I couldn't work out how to be in the world. I felt those differences as me being wrong.
I used to look around at other people, especially starting school, and how they socialised and made friends and just got on with things, and I just used to think, "I don't understand how to do all of this. I don't feel right in this world."
And I started hating myself. I used to look at other people and think, "How is everyone just managing to do all of this seemingly so naturally?"
And I was coming home from school every day absolutely exhausted, and I didn't know why. Everyone around me thought I was fine. Like I said, I was a high-achieving student. I turned up every day. I always looked presentable.
But when you feel so chronically broken for who you are, unsurprisingly, my mental health was not in a good place.
And then I reached my GCSE years, which is another big change, and something in me just broke.
And at that point, I'd say before then, I actually really wanted some help. I knew something wasn't right. I knew the way I was feeling about myself and the thoughts I was getting. I knew they were not good, but I didn't know who to talk to, and I had absolutely no idea what to say.
And when I started having panic attacks, my mum actually took me to the doctors, and they recommended that I started maybe doing some running to try and control my breathing.
And I started running, and in that process, somewhere in there, the exercise kind of became the thing that I had to do.
And it was like something in my head just switched, and I started eating less.
And anorexia just came on so suddenly and so drastically, as I was healthy in the summer of that year, and by October, I'd been removed from school, put under crisis intervention, and I was in and out of hospital.
And the anorexia actually felt like a way of coping. It felt like this thing that came in, and in many ways, it felt like it saved me. It created these routines and rituals that if I completed them, it was happy.
Venessa: So on that then, what are some of the main drivers behind eating disorders?
Peter: It's a very complicated disorder because it has input from all different aspects of life and biology that affect people.
We know that it's got a much stronger genetic component than you'd think. Obviously not completely at all, but it's stronger than you'd think.
We know about adverse child circumstances, ways of thinking which can overlap with autism in terms of perfectionism and black-and-white thinking.
We've got society, as we all know, screaming disordered thinking about body size and weight, and it's obviously not just for women, it's for men as well.
So it's probably an interaction of all of those aspects that you end up with someone who's suffering with it all, and it is partly why it's not an easy disorder to treat because there are so many elements.
Venessa: So Fi, when people think about eating disorders, what do you think they usually get wrong?
Fi: That they're all about food and weight and wanting to be thin.
I often think that it's more of a symptom of a really complex thing that someone's going through, and generally, eating disorders are about low self-esteem and not feeling able to cope, and overwhelming emotions and anxiety, and coping with trauma and difficult events.
And don't get me wrong, eating and food are important in recovery, but so is rebuilding your life, so is understanding yourself, so is learning about your emotions.
Venessa: And you mentioned before about being a high achiever, and from the outside, everyone would be like, "She's fine." So did you ever feel like you weren't ill enough to deserve help?
Fi: I don't think I was ever in a complete denial phase. I knew something wasn't quite right, but I don't think I realised that it was as wrong as it was. I don't think I realised I was as ill as I was.
And I felt that almost intellectually I could say, "Well, yes, I know something's not quite right," but I always felt in control of it. Like, I can turn this around when I'm ready to. I'm just not ready to yet.
And it was only when I tried to recover that I realised how ill I was, because I couldn't. I realised how out of control I was.
Venessa: So why is weight not always a reliable indicator of severity?
Peter: With the biological markers, the first thing we're going to note is their weight, because that in itself can be dangerous. But we also need to do a full physical review, because the heart can have problems at a low weight.
You might need to do an ECG to see if there are any rhythm problems with it.
Some of the eating disorder behaviours can cause very worrying biochemical changes, such as with potassium, which again can be very dangerous for the heart.
And the other aspects are a bit more medium-term, which is you can get strong muscle wasting, which can affect people's mobility. It can damage the kidneys because muscle is breaking down.
So there's the biochemical side of things, and then finally, in the longer term, you have an absence of some hormones which affect the laying down of bone and also the breakdown of bone and that sort of process, and you can get very severe osteoporosis, sometimes quite early on.
Dehydration is one of the most urgent situations. If someone hasn't drunk anything for three days, it becomes life-threatening, and you'll be picking it up with fainting or dizziness, heart problems, kidney problems, et cetera.
So that's one of the major priorities when you're doing a very medical approach to assessing someone.
And then the other aspects of the assessment are much more psychiatric.
Fi: I think it's really important to remember that eating disorders are psychiatric illnesses and that weight can be a symptom for some people, but you can't look at someone and know how much they're struggling with a psychiatric illness.
They might be struggling significantly with eating disorder thoughts and be at a, quote unquote, "healthy" or normal weight, so it's just not a reliable indicator at all.
Weight changes are a symptom that affects some people, not everyone.
Venessa: So on that then, Fi, what do you wish more people understood about eating disorders?
Fi: That they're not about weight and shape, that they are generally about these really ingrained core beliefs around self-esteem, around self-punishment, trying to control when you feel so out of control in your life, trying to find a way of coping.
And I think that the more people focus on the weight and how someone looks, you're missing how much someone is struggling with something that's really not about their body.
The body is often the battleground, but where the battle is, is in the mind.
