Adult with ED - can treatment be forced?

[SoMauveMonty]

My GP thinks i'm heading towards a eating disorder - she picked up on the weight loss (which she described as "concerning", but i think is fine) during a routine appointment for something else. I feel physically well, though am very stressed/down due to unexpected long term relationship breakdown earlier this year, and it caused my appetite to vanish. But I've found restricting my food intake makes me feel calm and clear headed - and with everything else going on, i really need that. I have absolutely zero desire to eat.

GP said she wants me to avoid any more weight loss - will check me again in about a month - & gave me ideas to encourage me to eat more, but i really don't want to. When she said "eat at least 2 meals a day" i felt quite panicked.

If i do continue to lose weight/can't get my eating back to 'normal', what is likely to happen? I've had a quick look online but much is aimed (rightly) at teens/young adults and mentions anti depressants, inpatient treatment etc - but surely an adult can't be forced into anything? (i'm 48) How much autonomy do i/will i have? I feel fit and well but am anxious i might be strongarmed onto a treatment path i don't want to take.

I'm sorry if these are stupid questions - i've never had an issue with my weight/body image before (it's very much not about body image now) - i heard the words 'cusp of an eating disorder' and just thought 'what??'

Ultimately anybody who is a danger to themselves or to others can be detained in a mental health or standard hospital for treatment. This is called “being sectioned”, as it’s a power the hospital has under a section of mental health law.

In general they only section people for eating disorders if their weight is dangerously low: my sister has been sectioned multiple times for anorexia but only when her BMI has been so low that her heart and other internal organs were in danger.

So it’s not something that would happen unless you were really very ill.

I get it OP, I've been there. I don't know the answer to the forced treatment question but I just want to say this - if 'Zero desire to eat' results in zero eating, do you understand that this cannot be healthy and indeed left untreated could actually kill you? Sorry to be so blunt. Wishing you well.

I will just add that it’s common for anorexics to feel calm and clear headed when they don’t eat. That’s a biological reaction. For my sister that was how it all started.

You are on a dangerous pathway at the moment, and the GP is right to monitor you.

Thank you both
@AlittlebitofMonica i'm sorry to hear your sister has been so unwell - i'd always thought a section only happened if you were considered a danger to others.

@heldinadream blunt is fine :) i can cope with that. Yes, i do understand that but it seems so far removed from how i feel at the moment. Despite lack of desire to eat i do eat quite routine, small amounts and thinking about that stops me thinking about all the other crap going on and tbh is keeping me sane right now.

Restricting your eating will give you a temporary feeling of calm when the rest of your life feels less under control. And that's extremely powerful, so it feels difficult to return to more normal eating patterns. That's the danger of an ED, they give you something to focus on and then your attention shifts more and more onto the coping mechanism it's easier.

It might be keeping you sane right now, but once disordered eating is firmly established, it is extremely hard to leave it behind you.

They can put you under a "section" if they deem you at risk or unsafe yes. You may not be at this point yet but it's a real slippery slope, I hope this doesn't come off rude or nasty but they will force treatment on you if they think you need it and it is lawful. Hope you are okay OP and get the help you need x

@SoMauveMonty I'm recovered from an eating disorder, and my heart went out to you reading your post, because I recognise what you describe so well. I even felt a pang of regret and envy when I read "Restricting food intake makes me feel calm and clear-headed", because I'm going through a stressful time myself at the moment and I miss having that quick way to feel calmer. I feel like it's important to publicly acknowledge this aspect of eating disorders, because when everyone is telling you how dangerous they are it's very easy to start thinking, "But I feel the best I've felt in ages! This is nothing like what they're describing. Some people obviously have an illness but I'm not one of them. This can't be an ED." But if the ED behaviours didn't bring us at least some short-term benefit, we'd never get drawn into them in the first place.

I don't give in to the urge because I know from experience that the relief is temporary. Restriction stops feeling like a release and becomes a prison, because to get the same soothing effect, you need to eat less and less. You might wake up a bit constipated (a physical consequence of EDs) and the number on the scale is the same as yesterday or worse, higher - and all you can focus on is how to bring that number back down. No room for work, friends, family, hobbies, even just appreciating the sunshine and how nice that tree over there is looking as you pass by: all that fades into the background like a badly tuned radio and all you can think about is how to lose weight, and what a shitty failure you are for not managing it. It sounds like your GP's comments have already alerted you to the feeling of dread that will become a 24/7 companion if your ED progresses and you don't take steps to help yourself.

If you're going through a tough time after the breakup and you have things you'd maybe prefer not to think about, it's possible that even this sounds attractive. Eating disorders can be a distraction from other problems that feel more painful and difficult. But the ED can't take those problems away, it can only numb them to a certain degree, and eventually it will make things worse. Imagine if you broke your leg - relying on an ED as your coping mechanism is like dosing yourself up on morphine to the point where you feel no pain and then continuing to walk around with a broken bone. That's basically what you're doing now.

The good news is that it isn't a choice between having an ED and continuing to live in exactly the same way you were before. There are healthier ways to cope that might not be obvious to you in your current situation, but there are people out there who will help you to find them. It sounds like your GP will be one of those people. EDs are very isolating illnesses and it's easy to start feeling like you're the only person in the universe who is feeling this particular way, so how could anyone possibly know what you should be doing? If you notice yourself experiencing those thoughts, remember that your GP will have seen other people in your situation, struggling with similar things, which is why she's recognised what's going on for you and why she'll know how to support you. She doesn't want to take your coping strategy away, she wants to help you find better strategies that will enrich your life instead of narrowing it down and leaving you stuck with a lot of pain. I hope you can accept help from her even if you feel anxious or sceptical about it at first. Sending you lots of love and luck.

Treatment is unlikely to be forced upon you unless you lose mental capacity or become very physically unwell.

That said, if you slip into the grips of an ED, things can go downhill very quickly. Or (more likely) you'll live under it's control and be miserable until you feel ready to either help yourself or engage with professional help.

Your GP sounds wise and wants to help you.
My ED started as something I could control during a very, very difficult time. I knew it was not healthy, but I let it be - it was enabling me to get through each day. It then became something that controlled me - like an addiction.
I sought help because I was scared. Help from the NHS ED team was excellent. I was under their care for a few years (and then again for a shorter period a couple of years later).
I am not entirely recovered and I do feel myself slip into unhealthy behaviours fairly frequently, and I know my mind is not free of it, BUT I now have many (more healthy) ways to stop the cycle starting again. It would be very easy to get into that cycle again, but VERY hard to then get out of it.

There is lots of support out there, but you need to want to engage with it.

I wish you all the best

Thanks @ketzeleh and @CharlotteBog for posting, it's really interesting hearing about your experiences.
I've realised i'm in the 'that's definitely not going to happen to me' camp, while actually being quite a text book case 🤦‍♀️ Life has been bloody awful the past few months, and the clear headed control thing feels like the only thing keeping me sane. It wasn't about food in the beginning - beyond loss of appetite due to stress/upset - but it's become all about food now. @ketzeleh your comment about not losing weight despite restricting - yes, i've experienced that and found it baffling and frustrating. I didn't realise it was a 'thing'. Crucially, focussing on maintaining that clear head feeling stops me thinking about anything else. Besides currently divorcing a complete shit, i've a dc with sen, and another with significant mental health problems (not an ED). I feel like i'm being walloped on all sides some days.

I've gained a couple of lbs, but only because my sweet tooth has kicked back in, and I can eat my bodyweight in biscuits no problem. I'm not eating meals, or generally eating well. I realise (obv) that's not good but have no desire to do anything about it. I like the broken bone analogy but equally feel i am managing 'broken' or not, and don't have the time (dcs, home, aging parents, divorce, pets etc ) or inclination to get fixed. I haven't had a holiday in 10 years, i don't have time for treatment.

Where I go from here i'm not sure (am booked in for a follow up with the GP mid July) but thanks everyone for your honesty and support, it's given me a lot to think about.

@SoMauveMonty I'm sorry life has been so very tough for you and continues to be so.
Do you have any real life support? Friends, family?
A couple of things came to mind when I read your latest post.

Not believing it's happening to you - I think this is very common. Even though I asked for help myself, I was shocked and didn't believe how quickly I was moved through the system. Even now I think they must just have had staff available at that time. I often felt like a fraud sitting there thinking I was wasting their time when there were properly ill people out there.

Not having the time for treatment - "Not another fucking thing to add to my to do list....are you having a laugh?". I won't deny it, it did take up quite a lot of time, but way less than if I had become hospitalised. I was able to tell my manager I had a medical appointment and leave it at that. Some of them took a few hours due to the distance.
At one stage I was encouraged to attend the day hospital - that scared me and really shook me into taking better care of myself. I was a lone parent to an 8 year old with a full time job.

@ketzeleh what an incredible post.

My suggestion to you is to please get the doctors to monitor blood, regular ECGs and maybe speak to a counsellor. This is a slippery slope and once you're on it, it's bloody hard to get off. It's possible, but it's hard. There's other ways to help you cope with stresses in life, yes, meds are one, but it's unlikely that they'll impatient you at the moment.

As a sufferer from various EDs from the age of 12 until now, decades on, it's not worth it. I get all what you said and I relate, but now the multitude of impactful health issues I have to deal with, it isn't worth it. I wouldn't say I have an ED anymore, however I don't eat loads, I eat what I need to eat to maintain a normal weight and don't restrict any food group. I've messed up my body so much that now if I don't eat my blood sugar drops so low I have hypos and they're no fun.

@itschemical I'm sorry your ED has taken such a toll on your body.
I wish you all the best.

I was hospitalised for a broken hip and shoulder, and then the MH team were involved for my anorexia. You need to have a bm above 14 to not be in need of hospitalisation. Mine was 12, they kept me till It was 14.5. you'll still probably want outpatient support as well, but if it gets to below 13, as soon as a medic sees it they will say you need inpatient ideally. That is classed as life threatening.

Thanks @BobbyBiscuits My bmi is just teetering on underweight - the GP said she thought it was "concerning" because i hadn't lost a huge amount of weight but quite a bit in relation to my starting weight and height, and was getting into what she considered bad habits.

@itschemical i has bloods done about 2 weeks ago, and all ok (i assume! i haven't heard otherwise)

@CharlotteBog so much of what you say resonates. I honestly thought the GP would say 'you're fine' when i mentioned the weight loss - i wanted confirmation i was ok, and when i didn't get it i was very much oh ffs, i haven't got time for this.

I ate 'well' (ish) yesterday and felt sick and fed up as a result. Very little today. Oldest offspring is causing concern (mental health) and exH is being a twat. I feel like so much is being done to me/around me that i can't control.

On a positive note i do have good family and friends support - for the divorce/child related shenanigans at least, i haven't spoken to anyone about the eating yet and don't really want to at the moment.

Meant to add @BobbyBiscuits 12's an incredibly low bmi. Have you been able to maintain or increase on the 14.5?

@SoMauveMonty yes, thank you. I'm around 15, now and increasing slowly but surely. It takes a while as I've gone up and down, but going up now! 😀

I wanted to add, it's really hard to talk about it, especially if you haven't before. It can feel like you're not having your illness, like oh, others are worse etc. your mind tries to make you keep it secret. Like you feel it's one of your only sources of control.
Can you throw away your scales? I find that helped.
Gently introduce small amounts of foods you like, but won't be too triggering.
Also make sure you take your vitamins. I take forceval multivitamin, folic acid, calcium and D3 for bones, thiamine and B vits. These were prescribed to me personally but you can lack plenty of important stuff if you're underweight.
I wish you all the best x