This blog post is another that was inspired by a reader who wrote to me. We had a series of in depth email exchanges and I wanted to use her story as an example of the challenges that face adult sufferers of anorexia. More importantly, what we need to do in order to best serve these people.
Ann, (not her real name) contacted me after reading my book. She thanked me for writing something that made her feel less isolated — neither she nor I had onset of Anorexia in childhood. We were both adult sufferers with adult-age onset, but Ann had spent the vast majority of her adult life without Anorexia, whereas I had an onset age of 17 and spent ten years after that heavily affected.
Ann is currently 62 years old and in recovery — but struggling due to isolation and a lack of ongoing treatment provision.
When I asked Ann what age she thought that she was when her eating disorder began she has trouble remembering exactly:
“I believe my attitude to food during my childhood , teenage years & throughout the 13 years of my marriage was normal …” however she marks 2011 as the year when IBS caused her to have some food intolerance tests done — York Intolerance Tests.
Previous to this, in 1999, Ann had an intolerance test Asyra Pro Bio Energetic Screening that was done at her local health shop. She says it was after this that she went “big” into healthy eating and started to cut out fat. So by the time that she took that York test, she was already far too thin.
Interestingly, Ann didn’t have IBS prior to 1999 — so no IBS before she started to cut calories.
Over the course of two years she had three tests done. These tests told her to avoid certain foods amongst which were: eggs, milk, yeast, salmon, corn, seeds, tuna, almonds, millet, nuts, and grapes. As you can imagine after this amount of restriction Ann lost even more weight, and we think that her ED was triggered in this time.
Her IBS, by the way, only got worse when she cut all these foods out of her diet. When she presented herself after being on a restricted diet with no improvement to her IBS, her doctor went on to suggest that she also reduce carbohydrates. At the time that she was told to do this, Ann had already lost a LOT of weight. My first question here is why a doctor presented with a woman who has lost a drastic amount of weight would not think to explore an eating disorder potential at all, and would instead prescribe further food restriction?
Things had to get a lot worse before treatment was prescribed
Ann continued to lose weight, her IBS continued to get worse, and in the end she was referred to an ED service and a therapist. CBT was used and this helped her get her weight back into a safer place. Her treatment plan and therapist saw her through weight gain, but as usual, after reaching a minimum weight she was abandoned. Well, she has a review in December.
December! That’s months away, and it doesn’t take months to get into a serious state of relapse. I hope that Ann can find some support in the meantime to help her through.
The long term effects of Anorexia for Ann have been osteoporosis and peripheral neuropathy. Without CBT, Ann is struggling not to relapse, and she lives in a remote area in the UK where she has no close family. She has some close friends and a couple of them know about her eating disorder, but she says that only one of her friends will acknowledge it. That friend, unfortunately feels out of her depth in helping Ann which is unsurprising considering just how complicated EDs are. Ann actually gave her a copy of my book in the hope that reading it would help her to understand better. (This really meant a lot to me and it is hard to describe the emotion but rather like relief of all things — relief that my book has been used to help someone I think.)
I’ve never thought that food restriction is the answer to food intolerances and I think food intolerances themselves are massively over diagnosed. In Ann’s case the IBS didn’t change, but restricting foods resulted in her developing a sever eating disorder. Incidentally, now that she is eating more calories and fat and not restricting any foods like the intolerance tests told her to, her IBS has improved.
CBT can be very effective for treating Anorexia in adults, but it’s not a one-stop cure!
The biggest point here is the treatment. It worked, right? The CBT worked. However, once again we are seeing someone thrown out the door as soon as they are not considered a critical risk. Relapse risk is SO high with eating disorders — we know this — so why does this continue to happen to people of all ages? We have to do better to ensure that sufferers are treated long after they reach weight restoration.
Lastly, we need more resources for adult sufferers. Especially those whose generation are even further removed from understanding what illnesses such as Anorexia really are.
Wishing you the best Ann! I am so happy to have connected with you.