They laughed, and so did I. They laughed a lot more when we entered the indoor swimming pool. The five-year-old had a large water pistol and proceeded to shoot me. The only thing was, he was laughing so much he could not see straight and luckily missed his target much of the time. The two year old, resplendent in her pink ‘Tinkerbelle’ bathers, took to the water like the plastic yellow duck and three baby ducks that her mum had given her to play with and I was busy keeping up. (Mum is expecting baby number three in three weeks and was looking on from the pool side – she was laughing too).

For an hour we frolicked in the indoor pool like seals in the sea. Happy, happy, happy. Why was this simple event so important to me?
Because I let it happen! When my daughter was aged five years, she gallantly swam 50 metres in the ‘big pool’ as a junior member of the local swimming club in the town where we lived. I made sure she and her brothers had lots of opportunities – swimming, ballet, brownies, cubs, tennis, horse riding lessons and more. But I never once got in the pool and played with my daughter or her brothers. Or went to a rehearsal, or went to a gymkhana, or went camping with them. Not once. The rigidity of thought imposed by decades of eating disorders prevented me doing many things that I knew I would have enjoyed, and wanted to do, but could not allow myself to do.

Before we went to the pool this afternoon, I accompanied my daughter and grand daughter to the primary school where my eldest grandson began his formal education two weeks ago. We waited in the quadrangle with other Preparatory Class parents and grandparents, for him to emerge from his class. Standing there, and thinking back 30 years, to when I was aged 31, and my daughter was aged five, I felt momentarily overwhelmed by grief. Grief for lost moments with each of my four children.

I had never gone to their school to greet them after class – I was always at work when school was out for the day. Doctors, rightly, had encouraged me to work – work was essential as the only small part of my life not negotiable with ‘Ed’ and Ed was raging when my children were young. If I had not worked, I would have had no self-esteem at all and most likely would not be here to write this. I was afraid to be a parent. As afraid as I was to eat three meals a day. So, I was reminded of this, briefly, today.
Briefly, because I have learnt to shove such thoughts aside, and focus on the moment. Damned if I will lose any more of my life to ED! So, with a minute or two before my grandson appeared, I swept up the two-year-old and watched as she climbed in the school playground and caught her as she flew down the slide, shrieking in glee.
Back to the swimming pool – my grandson was so impressed at having my company in the pool, that when I suggested maybe it was not such a good idea to shoot Grandma in the eyes with that water pistol (because I needed to keep an eye on his little sister, proper little fish that she was), that he took off his goggles and said: ‘Here Grandma, put these on’. To be offered goggles by a young grandson is very special indeed.
I loved swimming as a child. Growing up by a river in rural Australia, I swam several times a day during the summer holidays – together with the snakes, goannas, platypus, salamanders, bearded dragons, eels and whatever else had made its home in the river. I love water. Full stop. I love to look at it, hear the sounds (of rain, waves, rapids) and most of all, being in it. If only my grand children knew, what great medicine they are for me.

It is a little more difficult to go swimming now, with a titanium rod in my cervical spine (A Girl Called Tim) but the helpful young staff at the swimming pool have assured me that a snorkel will be a perfect solution, enabling me to breathe underwater as I swim. Oh, what joy! My daughter is as happy as me. I am even going to try an aqua aerobic class on Thursday of this week.

Life. This is living. Shake off ED and that lingering rigidity. Allow yourself to do what you know you will enjoy, too. Never too late to make a splash!

Recovery means no longer hiding in 'Ed' when faced with obstacles on our life path.

Picking up the pieces of life after an eating disorder recovery can be challenging. Years, decades, may have passed. Relationships tested, scarred, and lost. Decisions made that cannot be un-made.
So it was for me. For more than 40 years many of my thoughts and behaviours were at the behest of my eating disorder. My parents and sister did not know that; they simply saw June misbehaving badly. Now that I was able to think and behave with a free will, I had to face the aftermath. There was much joy but also much pain. Hiding in my eating disorder to deal with the pain was no longer an option. I had to learn new coping skills. I had to learn acceptance, and to live in the moment. In 2005, I was on the verge of recovery. I had slogged against ‘Ed’ for years, and the summit of freedom was in sight. But re-emerging into the light after a long time in the dark was fraught – debilitating and discouraging obstacles seemed intent on popping up to block my pathway. How I dealt with these challenges would determine if I slipped down into the eating disorder, or continued the upward climb. On August 10, I described one such major trial in a letter to my therapist:

I am really battling depression this week. Luckily I am seeing you today.

In February this year my daughter ‘A’ announced she would marry this September. Some months later, my sister’s daughter announced her engagement and set her wedding date for one week prior to that of my daughter. I thought the timing – just one week apart – a little strange.

When the wedding invitations to my niece’s wedding were sent out, the situation became more strange. I did not know invitations had been sent until three weeks later, when my children mentioned they had received invites. I did not receive one. I kept looking in the mail each day for the next two weeks, but an invitation did not come.

Last weekend, my daughter phoned her cousin to ask her directly ‘what is going on?’, and was told that my sister had asked for me not to get an invitation.

Old feelings of rejection hit me all over again. I also felt distressed at my sister for putting my daughter in an awkward position in the lead up to her wedding.

My daughter was now in the difficult position of re-assessing her own wedding list. She asked me what I would like her to do, and I told her that I could not tell her what to do, who to invite, because it was her special day.  I said that because someone hurts you doesn’t mean you treat them in the same way. On the other hand there is a fine line between that and guarding oneself against further hurt.

With depression deepening and tears flowing, I phoned my second son, who is a rock for me, and he managed to calm me and put things in a manageable perception.

He emphasised: “Mum, you seem so happy at Leongatha (where I had moved the year before), you are going to Rotary, you like your newspaper job, you are getting to know people. Go down to nearby Inverloch and walk along the beach and think about all the good things. Your life is at Leongatha now. Forget everything in your childhood valley. We, your children, are your family.”

I wailed and said: “I know, I know what you say is true, it is just that I have made the big effort to get my own Patch and be part of a new community and beat my eating disorder and start a new chapter in life and my sister doesn’t see this – I am in distress, and worse, your sister ‘A’ is also in distress.” But my unflappable, ever-calm son responded: “‘A’ will only be distressed if you are distressed, so you must try and be strong and focus on ‘what is now’.

I hear my son but don’t know what to do. Don’t feel strong enough to talk to my sister. Afraid of further rejection. I mean, if she wanted me to attend the wedding, she would have invited me, her only sister, right? Is it my eating disorder or something else that has allowed my parents to split their family down the middle? I don’t know.

Years ago, when I realised I needed counselling, I had encouraged my sister to seek some, too. She said ‘you go, I’m fine’. Well, I didn’t think things were fine then and certainly not now, but what can I do?

This is dragging me down. I am trying to do my best and adapt to Leongatha, I do enjoy my work and the people are friendly, but oh, tis a struggle to develop a sense of belonging with others when feeling so alienated from one’s family of origin.

But I am lucky. I have friends and my children are supportive; I would be totally lost without them.

I am depressed. It is like a cloud sitting on my shoulders. I am trying to kick it off, but it keeps coming back. My moods are see-sawing. Can you tell?

I talked with George, my children’s dad. He is always a rock when the chips are down. We agreed that my sister should be invited to our daughter’s wedding. George said: “Two wrongs don’t make a right, but she will have a lot of … if she accepts.”

I had tears rolling fast down my face by this time (I am an emotional wreck) and was fiercely trying to stop them escaping from my eyes. I had this panic feeling that oh, it may be too painful to attend my own daughter’s wedding…. George held on to the phone while I caught my breath.

Now that I know my sister will be at my daughter’s wedding – I have no doubt that she will accept the invitation – I need to prepare myself emotionally.

Like, I have to practise detachment of a supreme level to pretend I am not hurting. Even though I have moved well away from my childhood valley, and made a big effort to start belonging to a new community, where I have known absolutely nobody, the past is playing havoc with my present. I wish I could look forward to my daughter’s wedding without the fear of seeing my sister. I can see that my sister will feel validated, having not invited me to her daughter’s wedding, but yet receiving an invite to my daughter’s wedding. I am the bad one, the ‘one with problems’ in the family’; I did not deserve an invite, but my sister is the good one, and so she has received an invitation. I am rejected and she is accepted.

Now, I am on edge again, wondering if she really will accept the invitation or not. I look in the letter box every day for two reasons – a) hoping (silly, I know) for a late invite to my niece’s wedding and b) dreading seeing my sister’s handwriting on an acceptance card.

I feel dreadfully ALONE and CUT OFF from my family tree. I feel I can’t talk to my parents or my sister and I have no brothers or other sisters.  Each time I have tried to talk to my parents, they have turned on me and refused to give assurance or answer any questions.

My children are my family. They and George keep reminding me of this. But my sister’s decision not to invite me to her daughter’s wedding has made the lead up to my daughter’s big day, just one week later, very stressful.

HOW WILL I COPE? WHAT CAN I DO?

I have to fight the urge to sink deeper and deeper into a black hole.

My therapist gave good advice. She became my coach. My sister and her family, including the new bride and groom, attended my daughter’s wedding. How I coped, the skills I practised, defined my recovery. ‘The wedding’ was to become the last big test in my divorce  from ‘Ed’, the last hurdle between me and freedom.

Anne-Sophie and fellow bloggers are fighting anorexia big time during February.

Regaining one’s life from a long-time eating disorder is an amazing feat. Imagine an unwelcome, extremely bossy person living in your home for 10 years or more; well, it’s a thousand times worse when the equivalent lives in your brain, and you just can’t get a moment’s peace. Regaining one’s true self, and pushing that horrid illness-cum-bossy-boots out of our lives leaves us feeling like we have had two lives – one with the eating disorder and now, one where we are free to be. The experience of escaping from an eating disorder makes our new life all the more special. Nothing is taken for granted. Joys never end. And many of us are filled with a desire to help fellow travellers on their journey. Why? Because we know how tough that journey can be. We identify with the isolation, the loneliness, the torment, the pitfalls. We know that no matter how many times one might slip, slide, right to the bottom of the valley, that we can get up, we can climb that mountain and regain our self. We offer friendship and above all, HOPE.  Anne Sophie shares her inspiring story:

THEN
The alarm clock rings. Before I can open my eyes, a flood of thoughts starts to control my mind. What did I eat yesterday? Did I overeat? Lose control? How does my stomach feel? Is it empty? Am I hungry? Starving? Yes. Relief washes over me. This will be a great day. I am strong. Even though I am trembling with weakness, I know I have won the battle against the gnawing hunger once again. I am at peace knowing that my mind won’t have to endure any other thoughts than the oppression of hunger and the fear of exercising today. I am happy because I know I wouldn’t be able to handle all my horrible memories. I will be way too occupied trying not to faint in classes to dwell on the past. Yes, today will be a good day. This is what my life looked like for over a decade. This was my reality.

NOW
Today I am healthy. Today I wake up excited about the day. I open my eyes knowing that nobody will harm me. I rise with tons of ideas in my head of what I will do with my life and my business. Today I know that life is precious and amazing. Today I am truly alive.

There are hardly words to compare the life that I live now to the one I lived for 14 years. During my teens and the first part of my twenties, I walked through life going through the motions.

I didn’t know what joy was, I was constantly terrified, sad, depressed. I put so much pressure on myself that I was repeatedly in danger of collapsing. The world looked bleak, harsh and hopeless.

My eyes looked sad and haunted, my posture showed my insecurity. My thoughts tortured me. I was never at peace. Not once.

However, today everything has changed. Ever single day I leave my eating disorder behind a bit more and I experience a freedom that I never thought was possible. I can now distinguish between the thoughts that are mine and those that belong to my eating disorder.

I can now walk confidently through life not fearing that everybody judges me depending on how much or how little I weigh. I can concentrate, read, write, be creative, laugh, love deeply and enjoy each moment.

Recovery has opened my eyes to a whole new world. I appreciate the beauty of little things. Things that are so very normal for others, but are beyond precious to me.

Having the inner peace to snuggle up to my hubby on the couch is one of my favorite ways to spend a Sunday afternoon and worth more than a million bucks. Being able to watch a movie and concentrate on the plot instead of counting calories in my head is priceless.

Cooking a wonderful meal knowing that I will be able to eat it without feeling guilty has become one of my favorite hobbies. Being able to give my creativity an outlet on my blog again without having to interrupt myself with ridiculous hours of exercise is one of the biggest benefits of leaving a recovered life.

Eating 3 meals a day and 3 snacks (a mantra essential in my recovery) gives me the strength I need to live life to the fullest and engage in all of these wonderful activities.

Obviously, my body has changed a lot. I refer to it as my new body. At first, it was not easy to accept that I would have to gain weight to be healthy. I was terribly scared of this change. Would I ever be able to feel comfortable in my skin? Would I ever be able to love the body that I was given?

It was a difficult journey, but today I am deeply and passionately in love with my body. I have learned to appreciate that looking healthy is something to be proud of.

I love that my body is strong now, I love that I can do Yoga or dance without being scared of fainting, I love that my legs don’t shake anymore and I love that my heartbeat is significantly stronger.

My journey to health was one full of ups and downs. I felt strong, I felt weak. I was excited, I was sad. Especially the beginning of my treatment was challenging. There was hardly a moment I did not cry, curled up on my hospital bed feeling like the world was going to end.

It was all too much and I thought I had made a huge mistake in admitting myself to a treatment facility. Furthermore, being away from my husband was not easy for both of us and it created many arguments and conflicts.

But as the weeks went by, I started to feel more comfortable in my new surroundings and I began to listen to what the team of therapists had to tell me.

Yet, there was still something missing. Instead of talking to therapists who have only learned about eating disorders in theory, I wanted to have a conversation with someone who had actually beat the devil within. In moments of insecurity, I wanted to know that there was hope and that I could completely and fully recover.

Remembering these thoughts when I ended my stay at the treatment center, I decided to be such a figure of hope for others who are starting their fight against their eating disorder.

That is why I created my blog Fighting Anorexia and the accompanying podcast. And it is the reason why I reached out to fellow bloggers in order to make the month of February a month full of inspiration and pro recovery messages.

Since the beginning of this month we have spread blog posts full of hope all over the web and we will continue to do so until the 29th. There is simply nothing more important than encouraging those around us who are still struggling that life can be amazing and that they can be free.

If you would like to participate and share your reasons why recovery is worth it and how life after an eating disorder can look like, I’d be delighted to have you join us. You can find more information by clicking here.

Recovery is hard and it takes a lot of work, but this fight is one of the most rewarding things you will ever do in your life.

I am happy, my eyes sparkle and I am deeply and passionately in love with my life. This can be true for you too!

Stephanie has conquered Anorexia but that's not good enough for the Defence Force.

Overcoming Anorexia Nervosa is a battle. This mighty big, life or death battle requires much courage, resourcefulness and determination. During the ANZAED Conference in Sydney, 2011, I met a remarkable young woman who has conquered her eating disorder with flying colours. She is blossoming with life as she sets about fulfilling her life dreams. But her history of Anorexia has thrown up an obstacle – not within herself, but within bureaucracy. This is a story about a young woman who has won one battle only to find another. And she won’t give up:

My name is Stephanie and if you happened to bump into me on the streets of Sydney today you’d see me as I am; a typical 22 year old university student who loves life and has the world at her feet (… and a particularly awesome pair of red Doc Marten’s ON her feet). I’m ambitious and determined; hard working but happy to have fun and enjoy the lighter moments of life.
Roll back almost five years and you wouldn’t recognise me, in fact you wouldn’t believe I was the same person. Barely 18 years old, I was lying in a hospital bed in Sweden; I had wasted away to an emaciated, emotionless shell.
My five year battle with Anorexia Nervosa began after many years of illness with various viruses and Chronic Fatigue Syndrome. I had started a diet which triggered a predisposition I had no knowledge of; I lost my grip on reality and plummeted down a terrifying, seemingly endless, rabbit hole.
Whilst I was ill, my malnourished brain tormented me; it convinced me that I wasn’t ill and did not deserve to live. I was very resistant to treatment and insisted I was ‘different’ from others; I begged people to understand that I was ‘worthless’ and should be allowed to die.
After three years spent mainly in hospital, and with no noticeable improvement, my parents made the decision to send me to the Mandometer clinic in Sweden’s capital, Stockholm. After years of tube feeding, and existing on liquids, I slowly began to learn how to eat again. It was an excruciatingly painful process; one that took everything I had and more. My fears were intense to the point where I couldn’t be near food, sit at a table or touch cutlery without screaming, scratching myself and bashing my head on any available surface.
Amazingly I progressed remarkably well, given the severity of my illness, and, when out of the initial critical stage, began to challenge the many rules dictating my day. I found in myself the courage and determination to fight, and fight hard (… I’ve never been one for doing things by halves anyway).
After four months in Sweden, and a further three months in San Diego, I returned to my family and friends in Australia. For the first time I was excited about my future and ready to step into the world – one from which I had been absent for too long.
The next few years were a great learning curve; I gained employment, began volunteer work and started studying for a nursing degree (despite missing my final high school exams). I socialised, made friends and discovered more about myself as a person. I continued to challenge myself and the last of my eating behaviours melted away.
My life went from great to amazing when, after getting decent scores in nursing, I was offered a place at university to study medicine in Sydney. Working as a doctor has been a lifelong dream; to this day I pinch myself to check this is real!
I am in my second year of studies and have happily settled into life as a ‘Sydneysider’. Both the studies and the extra-curricular activities keep me happy and busy. I’ve made great friends and have found myself as a person; I am at peace with who I am and where I’ve been. Being where I am today is nothing short of miraculous and it’s the best thank you I can give to the people who have helped me along my path.
The experience of suffering from and overcoming anorexia has given me the mental strength and fortitude to succeed at my goals. However, some pockets of society hold major assumptions about the illness which are hampering the efforts of myself, and others in similar positions, from becoming everything we can be.

A dream
You see, I have one other big dream I wish to fulfil, but people high up in the chain of command are delivering decisions on my future without meeting me in person. My goal is to work with the Australian Defence Force (ADF), specifically the Air Force, as a Medical Officer. If accepted I would train to be a general practitioner as well as receiving instruction in military procedures, aeromedical evacuation etc. Most of my time would be spent on base, participating in practice exercises and occasionally helping in humanitarian situations.
I decided to initially join the Reserves to get a taste for military life and started the application process in April 2010. I scored very highly in the aptitude test and things were looking promising. However, after handing in my completed medical questionnaire, I was told I was ineligible to ever join the ADF, in any capacity, due only to my history of anorexia nervosa. It wasn’t a case of ‘complete a psych test’ or ‘wait a few years and come back’, decisions I would have accepted, but instead a firm and unwavering ‘no’.
Now before I continue I would like to make clear a few things; I am not applying to work in the SAS or the SEALs. I am not required to undergo long periods marching through the bush with little food or sleep, nor am I required to carry my body weight on my back. In fact the initial military training required for a doctor is as little as four weeks, comprising a basic ‘knife and fork’ course teaching you how to salute and shoot straight.
Nevertheless the ADF reasoned that, having already suffered from a ‘mental health condition’, it was likely to reoccur. I asked for them to cite the journal articles on which they based these beliefs but this information has not been forthcoming. They insisted that those who have suffered from anorexia nervosa have other mental health conditions and lasting medical complications. I suggested they read the latest information regarding eating disorders (i.e. almost all psychological and physical symptoms are due to malnutrition and correct themselves with weight restoration and maintenance¹). They insisted that I wouldn’t be able to cope in a ‘high stress’ environment away from family and friends. I reminded them that I am thriving in my life, yet live 4000kms from my ‘family and friends’ and am pursuing a career that has me digesting textbooks.
I understand there is always a risk of relapse, but is that risk large enough to warrant exclusion from the ADF as a whole? I think not. Many things in life can go differently from planned (I don’t like using the word ‘wrong’). Every current member of the ADF is at risk of developing a variety of severe, possibly terminal, illnesses, yet they aren’t being booted out. Just by being male the current CDF (Chief of the Defence Force) statistically has a greater chance of getting cancer than I do of relapsing into anorexia nervosa^2,3 … so shall we, by such reasoning, kick all men out of the ADF?
The ADF has refused to seriously consider my appeals over the past two years. I’ve been fobbed off with the same old statistics, source unknown. I wonder what it takes to achieve an update of misinformed policies.
I know that things change over time, that I might want to pursue another medical path down the track and not join the ADF in a full time capacity. I also know that being allowed to apply to the ADF doesn’t necessarily mean being accepted; but if I get knocked back after an interview at least I’ll know that I’ve had a fair go (isn’t that what Australia is about?).
During the past two years I’ve met many clinicians, researchers and activists who back my quest 100 per cent. Details of the ‘experts’ quoted by the ADF when refusing to consider my application remain unknown.
Today, options to gain a review of the ADF decision are all but exhausted. I even went right to the top, sending a nice letter to our Prime Minister Julia Gillard who assured me that she would have the Department of Defence investigate. That was in October 2011. I haven’t heard a word since.
All I ask for is a chance to be judged by my strengths and not by what has been and gone. At a time when the ADF is talking about about a shortage of Medical Officers they are actively refusing someone who would be an asset to their organisation.

References

1= Dr Timothy Walsh, “Anorexia Nervosa: A persistent enigma”, UF Grand Rounds, 2012.

2= Cancer in New South Wales: Incidence and Mortality 2008

3= Mandometer, 2006

Comments are invited on this important issue – what is your view?
Do you know of similar experiences, or of an instance where an eating disorder has not meant immediate rejection to an application to serve in your country’s defence force? What happens if an eating disorder develops while in the defence force?
To contact Stephanie, write to june@junealexander.com

* a return to a normal state of health, mind, or strength: yes, even after 40 years, this IS possible.

* the action or process of regaining possession and control of a sense of self, stolen by/lost in the eating disorder.

• the action of regaining or securing a LIFE lost or spent by the eating disorder.
• the amount of self recovered: including contentment, self-esteem, freedom to eat three meals and three snacks a day without feeling guilty or anxious, freedom to love and be loved, freedom to be true to oneself and freedom to explore one’s potential to the fullest.
• the process of removing a negative energy source and replacing it with a positive energy source that knows no bounds. For me, this translates into writing books and raising awareness so that others do not suffer from an eating disorder anywhere near as long as me. Every day I receive correspondence from beautiful people who are struggling, bravely, against the pull of the illness.  The very act of throwing out a line of hope and saying ‘Come on, I did it, and I know you can, too’, helps me feel my life is worthwhile, too.

My deepest yearning, in the midst of my eating disorder, was to know the feeling of peace. I thought that if I could experience that feeling for just a day, if I could live one day without the horrid torment of the illness, I could die happy. Since the birth of my first grandchild in 2006, I experience peace and contentment every moment, of every day. The decades of suffering have served to enrich the joy of freedom.
I am a bit of a dinosaur (my grandchildren surely think so when they need to help me up from the floor after a playing a board game with them), but one that is young at heart, for I am busy catching up on life – my life. This is what recovery means to me. I love it.

* Share your definition on Carrie’s public blog, or email her at carrie@edbites.com
I look forward to your responses, too:-)

My Kid Is Back explains the Maudsley Approach, and 10 families share stories of recovery. The book also lists the signs and symptoms of anorexia.

This story is about a mother who has been alert to the early signs of ‘Ed’ but has been unable to get to first base in getting her daughter back. When anorexia develops in a child, recovery gets a head start when parents:
a) recognise the symptoms
b) know that early intervention is vital
c) know that the Maudsley Approach is the best  evidence-based ‘first stop’ treatment
d) know where to access this treatment.

The mother, “H”, emailed this afternoon. She can tick all the boxes, except one.  She recognised the symptoms, knew early intervention would give best hope of prompt recovery, and that the Maudsley Approach would be the best first stop treatment. But two months have passed and she has been unable to access the treatment for her daughter.

It riles me that some 30 years after the Maudsley Approach was found to be a successful family-based treatment for early intervention of anorexia in children and adolescents, that access to this treatment remains out of reach for many families. Yes, I am beating my advocacy drum.  ”H” writes from Gippsland, in Victoria, Australia – the same region in which I developed anorexia 50 years ago. My mother didn’t have a clue how to help me, in 1962. Today’s mother does have a clue – she is very well informed – but without service delivery, her anguished helplessness matches that of my mother, five decades earlier. This is not good enough. I suffered 44 years. Today’s Gippsland girl, with early intervention with FBT, would have every chance of  being free to resume her life within 44 weeks. But TWO precious months already have been lost – allowing the illness time to embed itself. “H” writes:

‘My dear friend, “C”, gave me your book (My Kid is Back) last November when I first noticed the signs of anorexia in my daughter. Having had a sister with anorexia 30 years ago I was aware of it quickly.

HOWEVER (and this is unbelievable) I have not been able to get help even with my early detection. I live in Gippsland and there is NOTHING in the country. So, I immediately (1^st week of November) saw our local GP. She agreed with me that my daughter was in trouble and booked us into the specialist ED clinic at Monash Hospital, a two-hour drive away in the Melbourne suburb of Clayton (we were told the Royal Children’s Hospital, which offers the Maudsley Approach in Melbourne, is unable to take us due to being outside their geographical area). 

The first available appointment was February 16^th – more than 2 months ahead. Of course we booked it immediately. It is now only 10 days away.

Despite our stumbling efforts, “N” has lost more weight. We have not been very good at it as we have only just realised it is not her but the AN we have been negotiating with. Her medical signs remain on the borderline for admission to hospital but I have read your book! I understand that this will not solve the problem and, to be honest, have tried to avoid that.

My daughter (age 17 by the way) sees a psychologist on her own who has been great in handling her anxiety issues in general. She is also a qualified Family Therapist with ED experience but I’m unsure if she is familiar with Maudsley.

My questions are:-

• Do you think we should pursue FBT with ‘D’s current psychologist (‘D’ was mortified  when I suggested it) or a separate one?
• ‘D’ has been so distressed when we make her eat something that she doesn’t want to that she has actually asked us to book her into hospital as she says at least she wouldn’t have to stress all day about food – that it would be forced upon her and she would avoid the conflict with us. Do you think it would be a good mental break for her or is it likely to make matters worse? 
• Finally, in re-feeding, do you think it is ok to provide the list of  planned meals for the week ahead to “N” (she wants me to) or will that just cause more anxiety and hence more stressful “negotiation” attempts?

I’ve been on a parents’ support website and it gives me internal strength but practically I don’t know how to cope with the stress at meal times which starts escalating 2 hours before dinner every night.’

I’m sure every parent who has been, or is on a recovery journey with their child, is feeling for “H”. Dr Michael Kohn, of the Children’s Hospital at Westmead, Sydney, suggests following up with local and state services, and a call has been put out. Meanwhile, Jane Cawley, of Maudsley Parents, writes: 

‘I’m so sorry to hear this family is having such a hard time. I agree with Dr Kohn that starting with the current provider and working from there is a good start. If the mother wants to do FBT she should feel free to ask the therapist (either the current one or the one they’ll see in 10 days or both) about that and discuss how to proceed. There’s some basic info for therapists who want to learn about FBT here. The manual is a good resource and the therapist might want to seek supervision from someone more experienced. The training institute offers consultations, but the therapist probably can find someone closer. Or she may be able to refer to someone else.

From what the mother is describing, it seems like firm, consistent expectations around eating have been a sticking point (understandably enough, since they haven’t yet gotten professional advice on managing the illness at home). I do understand how heartbreaking it can be to see a beloved child so distraught. In the midst of things it can be tough for a parent to remember that it’s the anorexia itself that’s causing the suffering. It’s not going to walk out the door on its own–it needs to be pushed out. It’s normal and expected that eating will be very anxiety-provoking in the early stage. That’s one of the things that makes anorexia so diffcult to treat. Having the right professional support can make all the difference.
Parents can easily feel like they are “making things worse” when meals and snacks are so miserable and anxiety is dialed way up.  An experienced therapist can explain the usual course of treatment and let parents and patient know that there’s a light at the end of the tunnel. In many ways, treating anorexia is similar to treating anxiety disorders, phobias, or OCD–fears are confronted, rather than avoided. It’s very difficult initially, but chances are very good that these awful thoughts will improve dramatically with behavioral change and weight gain. They’ll want to focus on that first since it’s a crucial to both psychological and physical recovery.

It can be helpful for parents to be clear and authoritative at this stage. Parents are used to talking reasonably with their kids about decisions that involve them, but that’s not such a great idea with anorexia. The daughter is ill and terrified of eating. It’s really too much to expect her to sensibly make decisions on therapists, hospitalization and meal planning. (The daughter seems to hint that this is too overwhelming when she says she’d prefer to be “forced” to eat in hospital. It can be a relief when someone–maybe a parent–takes over responsibility.) First and foremost, whether or not to hospitalize is a medical decision and she should rely her GP for advice there. It’s worth remembering that patients don’t come home “all better” so the ball will be back in her court again. I wish I had more to offer but finding a therapist to help them work out day-to-day strategies is really the first step so the parents can find is find things they can agree on and implement consistently.’

Ten families are the 'voice' of My Kid Is Back .

Exercise is good, but excessive or compulsive exercise can be dangerous.

At age 13, Kristen embraced the outdoors and enjoyed cross-country running at school. She was not overweight, had never been a big eater, ate little junk food and was not concerned about her body image, but she did want to improve her personal best running times.  One way to do this, she decided, would be to lose a little weight, so she would have less to carry.

“I thought ‘if I am thinner, I will run faster’,” Kristen said. “I don’t think there was any trigger to this thought except one day at school we had a ‘Beep test’, where I was weighed and ran for a fitness assessment, and I became determined to improve my times. I just started to cut back my food and I kind of had my own set of rules, which got bigger and bigger.

“First I got rid of all takeaways. No more fish and chips, hamburgers, chocolate, sweets, sauces, gravy or cream. My mother didn’t seem to mind so long as I still ate healthy foods.”

Kristen stepped up her exercise at the same time. Her cross-country times were improving; she ran until she was exhausted and then would run some more. “We have about an acre in our back yard and I ran in the dark at night, and in the morning before my parents got up,” Kristen said. “I did this until they started catching on to it.”

Her parents’ concern grew when Kristen’s sports teacher called to say that measurements of weight and height taken in a second Beep test had revealed a marked weight loss. The sports teacher confronted Kristen and asked if she was okay. Kristen broke down, feeling scared at her ‘secret’ being revealed, and said ‘I think I have anorexia’.

Her dad said:  “As a parent, to see your child want to exercise is great. We had begun to think she was becoming a little obsessive about her cross country training, running laps around our backyard, but we didn’t know that was only part of it – we didn’t know she was exercising behind closed doors, so her illness was out of control before we knew about it.”

Kirsten was right: she had developed anorexia nervosa.

Kelly

Kelly’s childhood was filled with a love of the outdoors. She played soccer and netball, did surf lifesaving and competitive swimming and later on took up long-distance running.

A conscientious student, Kelly enjoyed school and achieved high marks with little effort. But when she was 14, kids at school called her fat. She became more self-conscious and food-conscious and began to compete in cross-country running.

Kelly began avoiding desserts and food containing fats, and preferring fruit and vegetables. She began Year Nine and stepped up her involvement in sport, especially netball. She played in as many as five teams and was selected in the regional schoolgirls’ team that played at State level. She also trained with a squad for cross-country running. She had never been overweight but people were commenting on how fit and athletic she was looking and she was clocking personal best times with her running. At this time, Kelly’s exercise program did not seem obsessive to her parents. “We thought she was just ‘doing sport’,” her dad said.

Shortly after, Kelly went away to compete in a netball championship and came home 2kg lighter. Although not consuming enough food to compensate for her activity, she was determined to next play in her team’s netball grand final – but she was beyond being able to participate. Her weight crashed. She had to pull out of school, unable to complete Year Nine. She had developed anorexia nervosa.

Matthew

At first Matthew’s parents thought his rapid weight loss must be part of a growth spurt because ‘surely 10-year-old boys don’t get eating disorders?’ Matthew had been a typical chubby little boy, full of laughter and happiness. The nightmare had accelerated when Matthew became obsessed with exercising and increasingly fussy about what he would eat. He developed a self-loathing, which deepened each time he looked in the mirror, checking his fat.

“I’m a hippopotamus!” he shrieked in horror when he looked into the mirror and tugged his cheeks with his hands. Matthew had a beautiful round face, complete with dimples, but to him it appeared fat and ugly. He remembers how his life began to change. “I decided I had been eating quite a lot and was feeling fat so I began to go for a little jog to help me feel on top of things,” Matthew said.

Small but significant events heralded the onset of his illness. A friend had celebrated a birthday by bringing a cake to school to share with the class but when slices were passed around, the normal cake-loving Matthew said he didn’t want any. He was on a get-thin mission, progressively eating less and jogging more. His jogs became hour-long and he cut his meals back to one a day. But this wasn’t enough so he added cycling to his exercise routine.

Matthew clung to the belief that losing fat was the key to making everything in his world seem manageable. So therefore he would need exercise more and eat less.

Matthew was diagnosed with anorexia nervosa.

Fine line

There is a fine line between healthy exercise and too much or compulsive exercising. Over exercising can become a tool for gaining a sense of control over life – for example, to manage anxiety or low self-esteem. It’s not a good sign when exercise “has to be done, no matter what” rather than being part of healthy living. Often, children and adolescents who engage in excessive exercise also have disordered eating.

Some signs that indicate a child is exercising too much:

• Rigidity about exercise and sport sessions, persisting even if ill or injured.
• Frustrated or anxious if an exercise session is missed.
• Exercise is a ‘must do’: a way to lose weight or feel good.
• Obsessive about not only exercise, but also calories and weight.
• Adds exercise sessions if extra food is consumed.
• Noticeable weight loss.
• Skips social activities and responsibilities in order to exercise.

Symptoms of eating disorders include:

• Extreme weight loss (usually about 15 per cent or more of ideal body weight) or a refusal to maintain a healthy weight for age.
• Over-valuing thinness in that nothing in life seems more important than the number on the scale.
• When a child thinks they are overweight or fat while everyone else can clearly see that they are thin.
• For females, missing three consecutive menstrual periods when at an age where regular menses are expected.

If your child has two or more of these over-exercising signs or eating disorder symptoms, discuss your concerns with a doctor. The sooner treatment is begun, the better the chance of fast and full recovery.

Further information:

• The National Eating Disorders Association
• F.E.A.S.T.
• Beat 
• The Butterfly Foundation 
• The vignettes in this article are drawn from My Kid Is Back – Empowering Parents to Beat Anorexia Nervosa – by June Alexander with Professor Daniel Le Grange

Note: Recovery from an eating disorder is possible at every age. See my memoir, A Girl Called Tim – Escape from an Eating Disorder Hell.

The Woman in the Mirror - How to Stop Confusing What You Look Like with Who You Are

Dr Cynthia Bulik, author of The Woman in the Mirror, reminds me of my pocket rocket, two-year-old grandson. Both are lively, alert, have lots of energy, are always on the go; both have very busy minds; both are entertaining, innovative and, well, it’s hard to guess what they might do next. Both have a passion.

My grandson loves numbers – on a walk to the park or shops in the stroller, he continuously reads car registration plates, letter box and street numbers, supermarket poster specials, advertising sign phone numbers. On the swing in the park he counts every push – all the way to 100 (at which point my arms get tired). At home, in my little Myne Cottage, playing cards provide amusement. At age two, he already seems to be playing ‘Patience’. When offered  a jelly snake as a treat he turns it into a number, such as a ’6′ or a ’9′, before grinning widely and devouring it. His self-esteem is very healthy indeed.

I don’t know what Dr Bulik was like as a toddler but I’m sure she was a pocket rocket too. There is just one difference to that of my grandson. She was a girl. A girl who defied the odds, as a female, to rise and become a leading, shining light in researching the cause of eating disorders. When I first met Dr Bulik at the 2009 NEDA Conference, Minneapolis, I thought ‘wow’. She was talking about genetics with the theme “Eating Disorders: The Science You Need to Know”. She was talking quickly, energetically, and lights were going on everywhere in my brain. I have come to know that this is Dr Bulik’s way – her talks are always like bubbling brooks, full of ‘the new frontier’ in cracking the code of the eating disorder illness. She makes science sound interesting, like it is a mystery and these are the clues; like she is zapping ‘ED’, bang, bang, bang, and if anyone can, she can.

But Dr Bulik is more than a scientist. She is a mother of three. (‘How did she find the time?’ I wondered) and a psychologist, and the list goes on. She is a lead author in the chapter on ‘Couples therapy for anorexia nervosa’ in A Collaborative Approach to Eating Disorders, and a lead author in a text book that I am editing on binge eating disorders to be released next year. Her high standards of professionalism make her a delight to work with. And I’m only one of many, many people she works with and leads.

The Woman in the Mirror - Australian version - by Cynthia M. Bulik.

But Dr Bulik does more than write academic papers and books. She writes for us – ordinary people – too! In a language we can understand, relate to and adapt in our lives. First there was Crave: Why You Binge Eat and How to Stop and now there is The Woman in the Mirror – How to Stop Confusing What You Look Like with Who You Are. 

This book is a ‘must’ for females of all ages. I will share my copy of The Woman in the Mirror with my daughter, daughters-in-law, women friends of all ages – because there is wisdom in this book for each of us. I wish it had been around when I was a little girl for my mother to read. I wish my sister had read it, too. Who knows, maybe then I would not have developed anorexia at age eleven. Or if I did, quite likely my recovery would have taken place in 44 weeks rather than 44 years!

The Woman in the Mirror looks at why girls and women struggle with identity and self-esteem – a struggle that often manifests as an obsession with bodily imperfections. (Do you glance sideways in the store window when you walk along the street? Alas, I must confess that I do – to make sure that my t-shirt is pulled down at the back, of course). The book is divided in two sections – firstly, how we see ourselves from kindergarten to the nursing home; and secondly, intervention. This is a book that will help you help yourself. You can learn how to be your own inner coach, something that I spent years trying to do, and which was essential to gaining freedom from ‘ED’.

I feel honoured to be mentioned in The Woman in the Mirror: in the chapter “Protecting the Next Generations”, under ‘Ten tips to teach your daughter about a healthy relationship with food’. I am quoted under point number five: Watch for strange or restrictive eating habits. … June Alexander, a fifty-nine-year-old grandmother who struggled with anorexia and subsequently bulimia from ages eleven to fifty-five, says she often shunned food until after six p.m. The coauthor of My Kid Is Back: Empowering Parents to Beat Anorexia Nervosa worried that if she ate earlier in the day she would be unable to control herself and would eat too much.

Yes, I did worry, and the sad thing is that I worried about this in my adolescence, twenties, thirties and forties. I was aged forty-seven when a wonderful therapist, Belinda Dalton, explained the illness and my thinking patterns and behaviours  in a way that helped me enormously in dismantling my ‘ED’. Eight years later, I was free. Free to eat three meals and three snacks a day, and free to live MY life. If you worry about your weight even a little bit; if you diet, purge, punish yourself with exercise; if you are not feeling happy with who you are, The Woman in the Mirror may help you feel more comfortable with your self. Very likely this book will help you value yourself not for your appearance, but for who you are and what you contribute to the world. Nothing more important than this.

Thank you, Dr Bulik:-)

I just want to take ‘K’ by the hand and assure her that life does not need to be this way – a constant roller coaster – in and out of control – I know it’s really scary letting go of the eating disorder, but let it go you must, to be free – and you can’t do this alone. You need to really place your trust in at least one recovery guide and let them make decisions for you until your body is fully nourished – and when fully nourished, you will find the ups and downs will dissipate and you will be able to focus on the joys of really living YOUR  life.

Memories of those dark places and feelings of helplessness and self-loathing are with me forever. But I got out into the light and so can you. The first strategy is: NEVER GIVE UP.

Secondly, choose your support team: this can comprise one person, or as many people as you like. This is where the bravery comes in – getting brave enough to trust the recovery guides when the eating disorder is the only thing that can be heard. Because they have our best interests at heart, the recovery guides know what is best for us. Yes, they are interested in what is best for us – not what is best for the eating disorder. My recovery guides included:

* Psychiatrist
* General Practitioner (GP)
* Eating disorder therapist (also dietician)
* Church Minister
* My four children and their dad
* Two cats and one dog
* Best friends

Quite a team! Years passed while I struggled to gain enough courage to trust them. They were patient. They did not give up on me. When I wanted to give up they reminded me that was not an option. They stuck by and believed in me when ‘ED’ was so loud I could not listen to or believe in myself. I am so glad they did. Gradually I reached the stage where I could trust myself, and resist the voice of ‘ED’. By learning to trust others and my self, the voice of ‘ED’ gradually faded, and the illness lost its power to isolate and dominate my every day.

These strategies have been helpful in regaining my self and maintaining recovery:

• Without fail, eat three meals and three snacks daily. Food is medicine.
• No calorie counting, and no weighing.
• Employment or volunteer work can provide a sense of purpose and self-worth at a time when nothing else does.
• Be candid with understanding family members and friends, as they provide ongoing support.
• Keep a journal and list daily accomplishments like planting seedlings, baking a cake, phoning a friend.
• When anxious, divide the day into quarters. Make it to 10.30am, and record feelings, again at 1pm, and so on. Record the positives. Draw big smilies.
• Pets are loyal and trusting friends. Cats and dogs are always ready for a hug.
• Repeat affirmations, such as ‘Action beats anxiety’ and ‘I deserve to be treated with respect’, at times of stress.
• Take up a hobby to help live in the moment. I chose needlepoint and tapestry.
• Accept that prescription drugs, while causing side effects, are at times essential.
• Separate self from illness. This self-awareness tool helps to recognise and avoid people and situations that feed the illness. Practise this strategy at all times.
• Imagery is helpful. I picture a raw egg, with the yolk my soul, and the white the world around me. No matter what goes on in the white, I strive to protect my yolk. It is my haven. Don’t let it scramble.
• Be my own best friend. Would I want to bruise or starve my best friend or make her run 10 miles because she ate dessert? No, no, no!
• Ask: Does this thought belong with my illness, or with me? If with the illness, hit the delete button fast.
• When feeling vulnerable and confused, allow trusted others to provide a lifeline to safety.
• Attend to feelings quickly to diminish food as an issue.
• Daily walks. Embracing the beauty of nature is food for the soul.
• Test boundaries — facing a stressful situation or fear achieves personal growth.
• Participate in safe, supportive social groups to connect and strengthen oneself. Connect with at least one person other than self every day.
• Acknowledge the right to be born and to live; feel empowered by this. Life is a gift.
• Acknowledge the right to happiness. Embrace every moment; choose fulfilment, pleasure and fun!
• Acknowledge the right to be treated with respect. Steer clear of those who do not treat you right.
• Remember that ‘action beats anxiety’ every time. Anxiety can feed ‘ED’, so act quickly – call a recovery guide.
• Focus on being true to self and everything else will work out. Beautifully.
  _ from my memoir, A Girl Called Tim.