Stigma: Anorexia Vs Bulimia and Binge Eating Disorder

Every mental health problem has a troubling mist of stigma surrounding it, but recently I have noticed that not all stigmas are created equally, and often the level of judgement varies depending on what condition that judgment is focused on. 

It isn’t even as simple to organise as “personality disorders get this level of stigma and mood disorders get this level”, because the amount of stigma can vary even between conditions of the same category, especially, I have noticed, when it comes to eating disorders, more specifically, anorexia, bulimia and binge eating disorders. 

I am sure there are exceptions out there but as a broad overall in my experience, I have found that the stigma surrounding bulimia and binge eating disorder (henceforth referenced by its acronym BED), is a lot worse than that existing around anorexia, and considering they are both so similar in being considered under the umbrella category of eating disorders, it makes me wonder why that is. 

I hate to say it but the level of judgement isn’t even exclusive to people who don’t know anything about mental health, and I have found it is incredibly prominent in the world of eating disorder sufferers themselves. 

For example, over the years in various groups and hospitals, I’ve met a lot of people with anorexia and I have found that many of those people actually had the fear of becoming bulimic or having BED as one of their reasons to fear recovery from their anorexia. I even remember one particular incident in treatment where a new patient asked another patient if their eating disorder was bulimia and the insinuation that that could be the case was taken as extremely offensive. Obviously it isn’t exactly polite to go wandering around introducing yourself by asking people intrusive questions about their mental health, but that wasn’t the part of the question that was taken as offensive, it was the bulimia part, and I know for a fact that had the question been “do you have anorexia?” the reaction would have been more “yes I do but blimey that is a bit outright as a question, we haven’t even had a cup of tea together yet” rather than “how very dare you accuse me of such a thing”.

I suppose in life it is common to fear the unknown, so it is more likely you will fear something that you haven’t experienced as opposed to something you live with everyday. 

For example I used to be terrified of blood tests but now I have them every few weeks and am not scared of them at all. Indeed I am quite the professional and can now have blood taken whilst remaining perfectly relaxed and without so much as a shudder (as long as that blood is being taken by a professional using one of those syringe things…I don’t mean I am cool with having people stop me in the street and attack me with a chainsaw…I imagine that would result in quite a lot of shuddering so please do not do that to test my statement because I will certainly shudder and you will certainly get arrested).  

Still, as much as that would make sense for people who don’t already have eating disorders, it seems a bit odd for someone who is familiar with the life of living with an eating disorder that is trying to kill you, being so scared of basically an eating disorder trying to kill you with a different name. It’s a bit like the experience of having a tabby cat, living with a tabby cat, yet still fearing ginger cats when really it is the exact same thing only with a slightly more tangerine-esque glow. 

I actually don’t think the fear of the unknown is really a part of the increased stigma around bulimia or BED versus anorexia at all though, rather I think it has to do with the fact that so many traits and behaviours that are associated with anorexia are praised in society.

Despite the fact that not all people with anorexia are underweight and, contrary to popular belief, people with anorexia DO eat, as a general consensus, people associate being anorexic with losing weight, being thin and never letting a morsel pass your lips, three things that are seen as good by most people. 

Think about it, when it comes to all of those diet clubs out there like Slimming World and Weight Watchers, you get things like certificates and “I lost half a stone” keyring prizes for losing weight and I am pretty sure they only hand out certificates in life for things that you are supposed to be proud of. When I was learning to swim as a child at least, they certainly didn’t hand out prizes for the person who was drowning in the bottom of the pool (which is understandable as that is not exactly the aim of a swimming lesson but still a bit sad as it is the person who was drowning at the bottom of the pool who could use a bit of cheering up with a certificate, as opposed to the person who managed to swim a perfect ten lengths of front crawl…what do they need cheering up for? Isn’t it enough not to have water up your nose? Kids today are so ungrateful!). 

Similarly, as I have mentioned before, in society we have this weird obsession with associating refusing a piece of cake at a birthday party as “being good”, while those of us with icing on our chins are doing something “naughty”, so the idea that anorexic people don’t eat unhealthy foods is similarly admired, rather than feared as a sign that someone is potentially starving themselves to death. 

Anorexia is often seen as a sign of strong self control, whereas bulimia and BED on the other hand is associated with things like a lack of control and even more infuriatingly, greed/gluttony. These two things are so opposite to being admired that they are two of the seven deadly sins for goodness sake, and it drives me up the wall, back down round Tottenham and up the wall all over again because neither bulimia nor BED are anything to do with greed or gluttony. I am seriously considering getting that as a bumper sticker so that at least whilst I am doing all this being driven mad I am educating people along the way, although I would really rather not drive at all because I do not have a license and petrol is incredibly expensive. 

If a person with bulimia or BED goes around a supermarket and buys a lot of unhealthy food to binge on or eats excessive amounts to the point that they are compelled to purge (or not), it is not out of personal want or greed, it is because they have an eating disorder in their head that drives and compels them to do so. It is not the person with the disorder in control thinking “ah this will be a lovely way to spend an evening, I thoroughly enjoy a few hours weeping into a toilet with a throat as raw as sandpaper”, it is the disorder that is at the steering wheel, and when people are attempting recovery it is more about learning to steal that control back from the disorder rather than trying to control their personal desires. 

Similarly, anorexia is nothing about self control and I would even argue shows an extreme lack of control. You can praise people for not dunking a hob nob in their morning cuppa all you like, but how in the hell is it a sign of good self control to be incapable of eating and starving yourself to death? Who would give a certificate out for that? (I realise this may sound hypocritical considering I was arguing that we should give prizes to people drowning in a swimming pool five minutes ago but let’s just set that example aside for the time being…). Much like the person with bulimia, when I struggle to eat I do not feel in control of the situation and I do not look forward to an evening crying over a bowl of cereal, excitedly clapping my hands at the prospect of a few hours staring at a Weetabix. 

Bulimia, BED and anorexia then are, despite the varying stigma, very much the same and very similar in that they are about wrestling with a deadly eating disorder. That’s it. It doesn’t matter that two of the disorders are known for expressing themselves via binging and possibly purging, whereas the other has its name up there as a sign of a lot of lettuce and weight loss. Aside from the treatment required, the expression of the disorder has nothing to do with it just as the colour of a ginger cat means nothing next to the tabby, THEY ARE BOTH JUST CATS AND BULIMIA/BED/ANOREXIA ARE ALL EATING DISORDERS. Both bulimia and BED are as much about greed as anorexia is about self control, aka they have nothing to do with it, and I really think we need to spread that message to stop the level of shame surrounding such disorders. 

Admitting you have an eating disorder is hard and embarrassing, but it is even harder and even more embarrassing when you have extra stigma piled on top just because of the name of your condition. If bulimia and BED are portrayed as about greed and shame, people are far less likely to admit to having a problem and seek help which is incredibly dangerous as both disorders are serious, they are deadly and can be fatal with complications caused by things like electrolyte imbalances, heart attacks and other consequences of recurrent purging, so seeking support for these conditions is as important as seeking help for any restrictive disorders. We need to stop the judgement and discrepancies between different names for eating disorders and need to see them back under the same deadly umbrella, they are ALL serious, ALL dangerous, and ALL are worthy of the help and support needed to get better. 

Take care everyone x 

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How It Feels To Be Recalled To Hospital Under A Community Treatment Order

If someone had asked me what it feels like to be recalled on a Community Treatment Order (part of the Mental Health Act), before it had ever happened to me, I am not sure what I would have said. Possible guess answers that I might have offered would have probably included things like “scary”, “shocking” or “dramatic”. Probably one of the last answers I would have given, would have been “it feels like having your car stolen by a band of incredibly apologetic thieves who are very sorry for your loss”. However, as it turns out, that is exactly what it feels like…

As you will all know from the fabulous explanation of the Mental Health Act that I posted last year and linked to again last week (hint…it is right here: Demystifying The Mental Health Act…With Penguins), when you have a CTO, you have a list of conditions hovering over your head which must be adhered to if you want to avoid being legally recalled to hospital. Rather than conditions hovering like ominous wasps at a picnic who like a look at your jam sandwiches though, I like to think of them as “things that hold you accountable” or “reasons to do things”.
Every time I was scared to challenge my eating disorder and follow my meal plan I had an argument I could use, that being, “you have to do this because otherwise you will lose weight and go back to hospital”. It was a system that worked but admittedly I felt really trapped by it.
Every day I would wake up and force myself to eat a number of calories that made me feel depressed, knowing that it would keep me at my CTO weight which felt equally depressing.

All I wanted to do was give up, give in and lose weight but I felt I couldn’t because that would only involve being recalled to hospital which was simply not an option. My CTO weight was the border to a war zone and I was not taking a single step into no man’s land.
Then however, the recent hospital surgery medical drama, naturally led me to lose weight and I crossed that barrier without even intending to. Before, that CTO number had held a power over me, every digit had felt significant, like a law from the gods that I would probably find carved into one of those massive rocks at Stonehenge if I visited and looked close enough (a lot of people have theories as to why those mysterious stones are there including “for religious reasons” and “rituals”…My theory is that they were simply put there by some cheeky prankster who wanted to leave a pile of stones lying around so that future generations would ask “why the hell are those stones there?”)

When I went under the weight however, the power of that number and the spell was broken. I had thought that one step over the border would have resulted in guns and tanks sending bullets and bombs flying all over the place…but nothing happened. Of course it would have had the weight loss been “my” fault, but I had an excuse, my appendix did it not me, so it was almost allowed. Obviously the CTO weight still mattered and I had to get back to it, but with this medical “it isn’t my fault” get out of jail free card, I knew that I could take advantage and lose more weight without getting into trouble.

Thus it was that, as you know, I ventured further into no man’s land, and it was a sudden surprise when after all this “oooh this feels quite safe and allowed” turned into the previously expected “guns and tanks and swords and back to hospital for you”. Unsurprisingly, it was pretty distressing and traumatic, so a lot of people have been very sympathetic which has been lovely. I really appreciated comments from people online who were not directly involved in the situation because they felt genuine, but it is when we get to the words of the people closest to me that we get to this whole “I feel like I have had my car stolen”.

To use another analogy, I suppose you could view my body as a car that the garage have been keeping very strict rules on. I may have owned the car but there were restrictions as to what I could do with it, what colour I could paint it and how far I could drive. Then, when the CTO barrier was broken, I suddenly regained control over that car, so I grabbed that wheel, painted it purple and zoomed off into the distance (I suppose if we are combining this with the other analogy I zoomed it off into former no man’s land…just like people did with BMWs in World War Two…I may need to retake GCSE history).
With the car all to myself I set my speed limit, I pumped the tyres to a level that I wanted and I filled every seat with penguins because that is what I wanted to do. I could chose…until I was ambushed by bandits who seized the car and stole it, meaning that it didn’t belong to me anymore. Suddenly they would decide how much petrol went in, how plump the tyres were and how many miles it could run and my opinion was irrelevant (the bandits in this analogy being all the doctors and psychiatrists who recalled me to hospital).
Naturally, having just had my car stolen, I was not best pleased. Thing is, when you ACTUALLY have your car stolen you never tend to see the thieves who are the new owners enjoying a trip around the block in what used to be your very own automobile, and they are unlikely to be very apologetic.

Being in hospital though, I am not only seeing the “thieves” every day, I am living with them, and watching them abuse my car. The doctors and therapists decide what I eat now, when I sit down, where I can go and it is all very hard so I try to talk and work through it with them. I say how scared I am to eat, how scared I am to gain weight, how scared I am of everything and like many people online said last week, they say things like “I am so sorry you are in this position”, “this must be very hard and scary for you” but unlike when people online say it, it makes me angry, and all I can think is “WELL YOU CAN’T BE THAT DAMN SORRY BECAUSE YOU ARE THE ONE DOING ALL THIS. YOU STOLE MY CAR, I AM UPSET ABOUT IT AND CRYING AND NOW YOU ARE SAYING HOW SORRY YOU ARE ABOUT THE SITUATION BUT YOU ARE THE THIEVING, HYPOCRITICAL VAGABOND! VAGABOND I SAY!”

I don’t believe that they can really be sorry because they have what they want, they have the car and are legally allowed to do whatever the hell they want with it. I feel the same way about professionals as I do about close family members like my mum, which I know is terrible and I know I shouldn’t feel that way, yet still as much as I love our visits and I would not be able to get through this place without her, what I get out of them is entertainment, love, company, kindness and knickers (she brings in my clean washing…thanks mum). What I do not want from my mother, is sympathy because in my eyes she is kind of like a thief. Admittedly she did not do the legal act of stealing the car, but she gets something out of it, she now has a say over the car and the thieves will take her views into account. If my mum insists on yellow wheels and the thieves like that idea, those wheels will be the colour of sunshine within 24 hours. She could not have stopped the legal act from taking place but she has more say in it than I think she has used, I am sure if the next of kin kicked up enough of a fuss someone would have to listen, but no fuss has been kicked. On top of that, by me eating and being forced to stay in this hell hole gaining weight, she has benefitted from the thieving.
Again it sounds AWFUL to describe it like that, to compare my mum to someone who is in cahoots with criminals and joyrides around with lemon wheels, when I know she would argue that all she has actually done is not try to stop the people attempting to save the life of her offspring by their actions. She isn’t joyriding (my mum is not a joyful driver…especially if there is a cyclist nearby), she is finally offloading this nightmare she has been living with to professionals who can look after it instead and she can finally sleep rather than stay up into the early hours arguing about sweetcorn. She is benefitting because she gets a break, because as I gain weight she will feel safer and therefore I assume happier yet again, any “I know this is hard and horrible and I am sorry” inspires that same “WELL MAKE THEM GIVE ME THE DAMN CAR BACK AND WHY DID YOU PAINT THE WHEELS YELLOW” rage.

That is why if you were to ask me “how does it feel to have been recalled on your CTO and sectioned back in hospital” I would tell you that it feels like some very apologetic thieves (some of whom are related me), have stolen my car.
Now I am just watching them all make the changes they want, implementing the modifications they have decided, desperate to run out and stop them but with my hands tied. I am just an observer watching people do things to my car, watching things happen to this body that I have had to disconnect from and pretend isn’t mine anymore for my own sanity. I guess a more accurate explanation/analogy then would be to say it is like having your car stolen and then having the thieves force you to be a mechanic carrying out every wish of theirs or risk being whacked on the head by a spanner, but that isn’t how it feels. It feels like things are being done to me, any movements I make are via the puppet strings that they hold, I have no say. When it comes to living with an eating disorder you don’t have much say or control either, but this feels different, this feels more stripped, more naked. This is not my body, it is just a body that I am trapped in, and I am witnessing it be torn to pieces every day. Every meal. Every bite.

CTORecall

“I Wish I Had The Self Control To Be Anorexic”

Several times in my life I have heard the phrase “I wish I had the self control to be anorexic” and, considering I am now writing this blog post about this phrase, you can safely assume that I have a lot to say about it.
You may be thinking “Katie, you already wrote a post about people wanting anorexia and how silly that is, why are you repeating yourself?” (a post you can find at the link here: A Message To All The People Out There Who Are “Pro-Ana”), but please hold that thought as I actually think that the problem with this phrase is not about people wanting eating disorders.
Indeed, unlike people who are “pro-Ana”, in my experience, people who say this are not actually craving the bulging rib cage and hip bone images promoted on “pro-Ana” websites. The mistake these people make is not that of idolising a mental illness, rather it is of completely misunderstanding what an eating disorder actually is and what it is like to suffer from one.

I think when it comes to illnesses such as anorexia, there is a misconception that when people with the illness don’t eat, it is because of their will power or an extreme superhuman ability for self-control. They assume that sufferers feel hungry and want to eat but powerfully override the primal urge to seek food because they are strong, yet in my experience, it is the total opposite, and it is in the times that I am unable to follow this primal urge that I feel the weakest that I have ever felt in my entire life (even weaker than the time I was beaten in an arm wrestle by an rather arrogant and ambitious sloth I met drinking tequila in a bar a few years ago…that was a BAD evening.)

Whenever I miss a meal or don’t eat a free sample handed to me in a supermarket, it isn’t because I implement my ability to make decisions/affect my actions as the word “control” implies. Instead, it is because I am not in control at all, a point I think is easier to explain if we take a trip down memory lane and travel back in time to any birthday I have had over the course of the last decade.

Most years, when it gets near to my birthday, if I am out shopping in a supermarket with my mum, when we walk past the birthday cake section, she will look at the birthday cakes and sigh. Following this signal, we may have a wander over to look at all the intricately decorated creations topped with thick white icing and pictures of various Disney characters (I don’t look at the plain old boring cakes for “adults” that simply say “Happy Birthday”. Seriously who wants one of those when you can have an sponge shaped like a minion or a giant chocolate caterpillar with a cheeky grin?!), and then after five minutes of eye wandering my mum will turn to me and ask the question “can I get you a birthday cake this year?”.
Now, if I had any degree of “self-control” when it comes to food and my ability to nourish myself, I can honestly say I would turn to my mother in these moments and say something along the lines of:

“Can you buy me a birthday cake? Why of course! There is no question regarding such a matter! It is my birthday in two weeks and I simply cannot celebrate the occasion without a cake! Quick! Let’s go around all the supermarkets and bakeries in the area to try and find the biggest penguin shaped chocolate cake available. I want nothing more than to share such a delight with all of my nearest and dearest friends! Ooh can I please reserve the chocolate beak for me because it is my birthday? I do love a chocolate beak! Hurry mother, let us away to the automobile and get started on this quest immediately!”.
I would probably then insist we head to the candle area to pick the most garish, brightly coloured candles on offer to adorn my perfect penguin centrepiece, poised and ready for the moment when I am ready to blow out the flames and make a wish that Helena Bonham Carter hurries up and marries me already.

That is the response of a Katie who is in control. Unfortunately though, we haven’t seen “In Control Katie” around much lately. That Katie popped out for bread about ten years ago leaving an out of control mess in place, and since then we haven’t heard anything (better be picking up some damn good bread is all I can say…I’m talking a good quality ciabatta or we are going to have issues).
Therefore, with “In Control Katie” otherwise engaged on a mission to find a tasty source of carbohydrates, it is the “out of control” one that turns to Mum year on year with a dejected look and says: “I wish. Maybe next time”, at which point we agree to try again next year before repeating the annual routine in roughly 365 days time.
I know it would mean the world to my mum to buy me a giant penguin birthday cake to share with her/the family, and I desperately want to accept her offer each time mainly because I want to see her reaction. I want to see her face light up with the brightness of a birthday cake candle, filled with hope that for once she can do something that normal mothers do rather than having to come up with some kind of eating disorder friendly replacement for her neurotic offspring (e.g. the act of sticking a candle in a pink lady…the kind of apple I mean…not an unsuspecting blushing female who doesn’t know what’s coming).
When I do not accept the offer of a proper birthday cake then, it is not because I don’t want to, it is because my mind throws up barriers that make me feel that I physically can’t.
It is like a “normal” person standing in front of a bonfire and wanting to put their hand in it to retrieve a particularly nice log. They can look into those flames and want to put their hand in to get the log (this person really likes logs), but no matter what, they can’t. Of course they are physically capable of moving their arm into the vicinity of the fire, but the fear of pain stops them (no matter how much they like logs).
Saying “I wish I had the self-control to be anorexic” then, is basically like saying “I wish I had the self-control not to put my hand on a bonfire”. Of course eating and setting yourself aflame aren’t the same thing, one is vital for life whilst the other is downright ridiculous and not something I advise anyone to try at home or anywhere else for that matter, but the similarity exists in the sense that both the person who doesn’t put their hand in the fire and the person with the eating disorder do not carry out their actions because of self-control, rather it is because they are both scared and fear the pain that could result from their actions.

Whenever you hear yourself or anyone wishing they had the “self-control” and “will power” to eat like someone with an eating disorder then, please know that when it comes to eating disorders, self-control has absolutely nothing to do with any of it. When someone is unable to keep themselves healthy by eating enough, it is because they are not in control, and because the reins of decision are actually being held hostage by an evil dictator in their head who is trying to kill them.
If I had self-control and willpower over my life I could write a list of about a million things I would use it for. The ability to fill my mother’s eyes with disappointment, to refuse sharing a dessert with a friend or turn down the offer of a birthday cake would not be on there.

Take care everyone x

ControllingPea