By Clare Mellor
The Chronical Herald and
The Mail Star, November 4, 1992
Republished with permission

CRAVING CONTROL: People with eating disorders such as anorexia nervosa and bulimia use food to satisfy their craving for a sense of control. They have an intense fear of being fat and pursue thinness through restrictive dieting, excessive exercise and binge eating and purging.

She was on a high. The more weight she lost, the higher she got. Dieting gave her the sense of control she craved. Her tiny frame, leaning anxiously forward, Susan recalls the day she began starving herself. She and her sister, whom she always believed was "prettier and skinnier," had a contest to see who could lose five pounds first.

"I kept saying, five more pounds, just five more pounds,' but five pounds was never enough." says Susan, who has been battling the eating disorder anorexia nervosa for 10 years.

At 28, Susan, who has frequently been hospitalized, still weighs 65 pounds and suffers permanent kidney damage from the illness. "It used to be nothing else mattered. If I ate a meal and gained weight I would feel like sitting down and dying. That's changing ... (but) I still don't cope very well ... If I eat half a muffin and an apple, I feel very guilty."

Anorexia nervosa and bulimia nervosa are eating disorders seen 90 - 95 per cent of the time in females and usually begin during "periods of adjustment" in early adolescence or late teenage years, says David Pilon of the Victoria General Hospital's Eating Disorder Clinic. Both involve an intense fear of being fat. Anorexics pursue thinness through restrictive dieting and excessive exercise.

"You're feeling all the time like all that matters is that number on the scale and how much you can get away without eating. Constantly, I was thinking, how can I avoid this meal, how can I avoid that meal?' I was so hungry I couldn't sleep. All I could dream about was food," says Susan.

Bulimics are caught in a cycle of dieting and binge eating.

Binges are followed by some form of getting rid of eaten food. Many bulimics vomit, but laxatives, fasting and exercise are also purging methods, says Pilon. Some bulimics will purge 15 - 20 times a day

People with eating disorders may have high energy but eventually develop a host of physical problems such as kidney damage, intestinal problems, loss of menstruation and, in bulimics, loss of tooth enamel.

Causes of eating disorders are complex, and there are numerous contributing factors, says Pilon, such as sociocultural and family pressures. Nearly always, there's low self esteem and concerns with identity, says Pilon.

Susan, who lacked confidence when she was growing up because she had a visual impairment, says that despite being an A student, she didn't feel good at anything until she started dieting.

"My sister didn't last on the diet but the weight just fell off me," she says. "It was such a sense of control."

"As a child, I was upset that I couldn't do what other kids could do but that was never allowed to be expressed. I grow up in a home where they didn't want to see anything but smiles on your face .... Eating was something I had control over .... After that point, I felt I could have control over anything in my life.".

A strong sense of self-worth is vital, especially since females are constantly bombarded by "ideal" images of femininity and thinness in fashion magazines and the media.

"It does influence you. But if you have a strong sense of yourself, you're not going to fall into that," says Susan.

Besides learning not to use food to wage war on themselves, people with eating disorders need counseling to deal with low self-esteem, identity problems, and interpersonal issues, says Pilon, noting the VC clinic sees 60 - 70 new eating disorder referrals each year.

People with eating disorders can recover with treatment, but they will likely always carry sensitivities around the issues of body-image and self-esteem, says Pilon.

Janet Beaton, who has made a slow, painful recovery from bulimia, has spent the last few years helping people with eating disorders and their families.

Beaton, who regularly gives talks at schools, says low self-esteem often isn't recognized early enough by teachers and parents.

Talking to children and finding ways to help them deal with and express feelings is essential, she says.

"You really have to start early with issues such as self-esteem. It's important for a parent to let a child make some decisions for themselves ... If they want to wear stripes with polka dots let them," she says.

One of the theories surrounding anorexia is that at puberty the person has a fear of growing up and wants to remain free of responsibility. "She was afraid of her changing body and would cry about her hips," says Donna. "By dieting, she was dieting the curves away. The curves were gone. She was straight up and down and therefore not subject to anyone's opinion."

Donna, who says her daughter is constantly angry at her, says parents of children with eating disorders must go through their own recovery process.

"When it happened, I was devastated. There is a certain amount of shame attached to it. You think it has to be the parents' fault .... Now ... I realize it's the way my daughter feels about herself."

Beaton says some of the stigma around eating disorders is lifted when children and teens actually see "someone (who had an eating disorder) who is not ashamed of it."

Anorexics and bulimics often develop body distortions, seeing themselves as fat, even through their weight is dangerously low. Those who try to help them are often seen as "the enemy," conspiring to make them obese.

"She would stare at her hands ... and say she was fat," says Donna, a Halifax mother whose 14-year-old daughter is in hospital with anorexia.

"She would look in the mirror ... turn this way and that way and cry about herself and say how fat she was. In actuality, she had an absolutely beautiful shape."