To ask someone to explain to me a little more about anorexia?

[weetus]

I'm just watching a documentary on Amazon prime called 'Emma wants to live'. It's a documentary about a young girl with anorexia that sadly dies. She films parts herself and states that she knows the documentary will end in one of two ways - her recovery or her death.

I am watching it a little bit gobsmacked - one picture shown of her really, really shocked me.

So I may be being ignorant here but I have to ask why wouldn’t they put a tube down her throat and hold her in a psychiatric treatment unit undergoing intense psychological treatment. I still don’t get why they can’t do that? Like if I went to the hospital and claimed I was going to kill myself I would be held until I was deemed safe to leave. So these poor people with anorexia are just committing suicide slowly. Don’t understand why more can’t be done.

In this documentary it seems to me as if they had explored all avenues of treatment and she could not be saved, however, surely she could have been saved had she been tube fed? I imagine that would be a horrible experience for anyone suffering from anorexia but if the alternative is death then surely it is necessary?

I hope I don't cause offence but I genuinely just wanted to know why this is the case as I am sure there is more to it.

@weetus realistically how do you think that would work? Sit on your child while they trash for their life, you might be able to force a bit of food into their mouth but then what? How do you make them swallow? How do you do that for their full calorie requirement? Do you sit on them all day long so they don’t purge it? Every parent I’ve heard of who tried to force feed regretted it and it didn’t help anyone. It’s interesting the research into genetics and physically factors in EDs and yet our treatment of it is still so outdated and worst still only given once they are truly in the depths of an eating disorder. There’s some parents on this program

Anorexia is a scary, scary thing. I had a brush with it as a teenager and they were the worst months of my life.

I was fortunate, if you can call it that, that I cycled through different forms of self harming behaviour, including severely limiting eating, so didn't go too dangerously far with any of them. It was nightmarish though, it's so seductive, and goes from being hard not to eat to so, so hard to eat, each mouthful feeling like it will choke you.

I think things are changing, but here it used to be that your couldn't be referred to EDS until your BMI got a certain point. So rather than getting help earlier on, people were told they weren't ill enough. One person I know remarked that they essentially gave her a target for weight loss.

@mynameiscalypso I appreciate the point about cognitive impairment due to malnutrition when they first arrived on the ward, but some were with us for weeks, and were getting the nutrition and calories they required at that stage, but the noise/distraction was always there. I don't know how the noise manifested itself to them, fear, denial, anger, definitely distrust I would imagine ?. You can probably tell I have very limited mental health training and my description is very clunky.
I always found it unsettling, rationally it was the right thing to do, but it did feel like you were removing their comfort blanket by treating the physical symptoms.

I have taught a number of girls with anorexia. It is a devestating illness that appears to rebound often. I dont know the ins and outs of it but I think our fat shaming society and congratulatory attitude towards the very thin doesnt help one bit.
My dd is not a teen yet but I worry that food would one day become an issue for her as it seems to affect so many. I don't know what I would do.

[quote frumpety]@mynameiscalypso I appreciate the point about cognitive impairment due to malnutrition when they first arrived on the ward, but some were with us for weeks, and were getting the nutrition and calories they required at that stage, but the noise/distraction was always there. I don't know how the noise manifested itself to them, fear, denial, anger, definitely distrust I would imagine ?. You can probably tell I have very limited mental health training and my description is very clunky.
I always found it unsettling, rationally it was the right thing to do, but it did feel like you were removing their comfort blanket by treating the physical symptoms.[/quote]
I think you're describing it very well. To me, anorexia gives me something to think about constantly. It's always there and your always thinking about calories and food and exercise and your body because it's 'safer' to think about those things than it is to think about anything real. I used to describe it like a protective bubble around me.

The medicine for anorexia is nutrition. The problem is health care teams set weight targets far too low so the patient never actually achieves true weight restoration and is therefore stuck in limbo and a constant cycle of relapse and inadequate weight gain. The psychiatric symptoms (fear of food, irrational & obsessive behaviour etc etc) are all due to the brain being malnourished. The brain is 60% fat and actually shrinks in anorexic patients. If you don’t achieve weight restoration the body and brain never gets the chance to heal and that’s why psychological therapies don’t appear to work....the brain is not functioning enough for those therapies to be of use. You need proper weight restoration, brain healing and then psychological therapies followed by life long weight maintenance. I’m talking a BMI of at least 22 for weight restoration.....for kids they should be returned to their original growth curve.....whatever it was prior to getting ill....and kept on that curve i.e. continued gains as they get older. But too many physicians allow too low a weight and leave their patients floundering for years.

They have discovered a gene for anorexia now. If you have that gene and for whatever reason end up with a consistent energy deficit you become malnourished, your brain is malnourished and that gene is triggered and they fall down the hole.

@LemonMeringueThreePointOneFour

Please could someone who knows clarify something to me? Are images of very slim/thin models or, for example pop stars likely to trigger anorexia? I've always felt that seemed a bit simplistic, but happy to be corrected.

Pictures in the media of very thin models won’t really trigger the illness in someone that’s not predisposed to it, but they won’t be helpful to someone that’s struggling.

The mainstream perception of anorexia sufferers as vacuous middle class white girls who want to look like the pictures in magazines is very far from the reality.

My d was accepted for treatment by the eating disorder team aged 16 with a bmi of about 14. They were not helpful and she was admitted to hospital with a bmi of 12.9. She was discharged back to community care after about 6 months in hospital and was discharged from all services with a bmi just over 18 - so at 5’7” and 52kg she was ‘cured’. Of course we’re now three years down the line, shes a uni student with a bmi of 16 and cant get any help because she’s not suicidal - this is what she was told over the phone by her GP practise.

You don’t ‘make’ someone eat if they just can’t do it. Its really not as simple as that.

Gosh, I remember watching that Rhodes Farm documentary when it was first broadcast. Looking at it now, it just seems such a crazy way of tackling the problem. Forcing those girls to eat piles of chips and custard puddings etc Just plate after plate of stodge. It’d give anyone food issues. I wonder if these treatment clinics have improved? The staff seemed so unfeeling too, especially the woman running the place.

Heartbreaking to see such young girls suffering and missing out on their childhoods because of it.

Ime anorexia is often about control, or rather feeling a lack of control, which triggers it. It’s very little to do with wanting to be thin. I lose my appetite completely when very upset and it takes a long time to come back. Even then, I can feel I’m starving hungry but can actively ignore it for a long time.

Personal responsibility, capacity, human rights.....
Voicing suicidal ideation does not automatically mean you are admitted to hospital. A lot of cases of ‘suicidal ideation’ are not in fact caused by mental illness, they are caused by poor social situations such as drug use, debt, poor coping skills, lack of resilience.

@ApplyWithin I was watching some videos of someone recently in ED treatment, she was sharing all the crazy food rules treatment places had. It included that their once weekly cafe outing they couldn’t order a low calorie item which is understandable but they also were only allowed the small hot chocolate not the large hot chocolate as it had too many calories for their plan! I should add this was anorexia treatment. I don’t have much faith that treatment centres have improved. Rhodes farm got sold to another private company some years back, bet they make a fortune off these kids :(

@Advic3Pl3as3 I don’t have anorexia but have the anorexia gene. I wonder if one day they will be able to target that gene in people who do get anorexia and have the gene

I can’t believe you watched this thinking that you could see a clear solution that nobody else could, and that you could manage it in your own child when others can’t. That’s such deluded, arrogant thinking.

Where is the empathy?

I just looked up Rhodes farm and it’s changed to Rhodes wood, this article came up. The poor kids www.edp24.co.uk/news/health/norfolk-teen-speaks-on-eating-disorder-treatment-1393872

I had an ED for probably 7 or 8 years. I was lucky that I had treatment for it, and have recovered.

The feeding is only a small part of it, and has to be done very gradually as it's actually dangerous for someone really malnourished to eat a huge amount of food. Images and photos hopped images of thin celebrities and models dont cause anorexia but they can warp someones perception of what normal or healthy looks like.i think a lot of celebrities are probably borderline anorexic but keep their weight just above the level that would need medical intervention.

If someone was morbidly obese, the treatment would not be to completely starve them?

I’ve treated two AN patients in ICU. Both young girls. Neither of them made it. When I informed the relatives there was just silence. They didn’t react at all. They just thank me and left.

I had quite a long chat with the duty psychiatrist and still found it difficult to understand.

Upset me quite a bit and I don’t fluster easily.

@Pyewackect

I’ve treated two AN patients in ICU. Both young girls. Neither of them made it. When I informed the relatives there was just silence. They didn’t react at all. They just thank me and left.

I had quite a long chat with the duty psychiatrist and still found it difficult to understand.

Upset me quite a bit and I don’t fluster easily.

Tbh once its takes hold theyre almost not your child any more. Those parents will already have been broken before reaching that point. Many Parents of anorexics experience ptsd type issues afterwards. I freaked out watching ‘sleeping with the enemy’ - watching julia roberts’ tense frightened character around her abusive husband took me back to how it was to live with my daughter at that time.

If it's true that eating disorders act in the same way as addiction in the brain I'm guessing it's much the same reason locking alcoholics in a room with no alcohol wouldn't work. It might buy some more time but you can't watch them for ever. Addiction recovery is only possible with the person's cooperation.

I have recently come to accept that I have an eating disorder.

One of the worst issues I have is people who love me, trying to feed me. It makes me even more aware of why I dont eat properly. I know that everyone is watchig me and that makes me less likely eat, not more. Tube feeding would truly feel like that last bit of control had been forcibly removed and would make me less likely to eat, not more.

I am lucky in a way, although I have an EA I manage to keep just this side of ok. My BMI (thanks to my frame) has me in the normal category so I just about managing. Will I ever eat more than 3 times a week? Unlikely. Will I ever eat carbs again without needing to yack it all up or run it off? Probably not.

Will I engage in recovery? Absolutely not at the moment, I hope I can in future.

The last three years of my life have been a car crash, see MN for details, but basically domestic abuse, ex trying to kill me, work almost doing me in mentally, redundancy and now my teenage son causing a lot of grief.

What I eat and when is the only thing I can control.

@fizbosshoes

I had an ED for probably 7 or 8 years. I was lucky that I had treatment for it, and have recovered.

The feeding is only a small part of it, and has to be done very gradually as it's actually dangerous for someone really malnourished to eat a huge amount of food. Images and photos hopped images of thin celebrities and models dont cause anorexia but they can warp someones perception of what normal or healthy looks like.i think a lot of celebrities are probably borderline anorexic but keep their weight just above the level that would need medical intervention.

If someone was morbidly obese, the treatment would not be to completely starve them?

Sorry but there’s always a more of a concern for a low BMI than a high BMI as it’s a narrow window. I know what your saying but it’s not the same someone being obese... I mean not to sound harsh but if your over weight the majority of the time your expected to control it and cut down your calorie intake. Nobody will force you to have a gastric band your sort of left to your own devices unlike being under weight.

@PyongyangKipperbang I hope one day you’ll be able to eat 3 times a day not just 3 times a week

I agree that you wouldnt simply just starve a morbidly obese person. Not least because massive weight loss in a short space of time has it own health risks.

And forcibly feeding a very underweight person will simply put a sticking plaster over the underlying issue, just as starving a very overweight person would.

It solves the immediate threat but doesnt deal with how and why that person got into that state in the first place. This is why old style "cures" never worked. Poor Karen Carpenter went into clinics, got fed up, got declared well and then went on to follow the same pattern again and died of AN related heart failure at 32.

Anorexia isnt about being thin, it really isnt. The starvation to be thin (or bingeing/purging or overeating or whatever) is a symptom of other MH struggles. As soon as more people realise this then there will be less body shaming and more successful treatments.

[quote DaisyDreaming]@PyongyangKipperbang I hope one day you’ll be able to eat 3 times a day not just 3 times a week [/quote]
Thank you xx

But I have to say that even those words terrify me at the moment.

I think I equate being fat (because I was, nearly 16 stone) with being weak and abused and beaten. When my ex was removed I lost the weight (more due to trauma, like a PP said, I cant eat when I am stressed) got my confidence back and felt so much better. So now I am afraid of getting fat again because I think my brain thinks that if I am then I will get beaten and abused again.

Not quite picked it apart yet, but I will and I do hope that one day I will be able to eat seven times a week. The idea of 3 times a day....not done that since I was a child!