Shomit – The following is an extract from an article written by an ex-client of mine, Niamat Bakshi. I first met Niamat many years ago at the Priory, Roehampton. She was suffering from anorexia and was at a dangerously low weight. She is now a lawyer, a model, a mother of two and is starting the first Eating Disorders Unit in India.

Client – Looking back, it’s hard for me to pin point an exact event or incident that triggered what was to be an 20 year “relationship” with ED (Pronounced Ed – which is the name many sufferers have given the destructive voice that eating disorders places in their heads). But it was a relationship that revealed itself to be more complex than any other I had ever had or that perhaps that I will ever have in the future. ‎It was deceptively comforting, rewarding and fulfilling. And devastatingly painful, isolating, controlling and lonely. But that was the beauty of anorexia – it made me feel like I was in complete control of my life, that I was invincible, that my armour of “thinness” was impenetrable. But the truth was the exact opposite. I had no control, the armour that I thought was protecting me was in fact keeping me isolated, away from my closest friends and family and therefore anyone that could help me. The relentless pursuit of thinness drove me into increasingly masochistic behaviour, into telling more lies, and into seeking out more seclusion. And with this cam more shame, more guilt and more pain. My entire sense of self was based upon a number on the scale, my self-worth was determined not by an inherent belief that I was valued but by how much food I could restrict that day, and my sense of security was based entirely on how many hours I could exercise each day. I only felt “worthy” if I could see the blisters on my feet from my hours of exercise, or the hollowness in my face from having dropped a few more hundred grams that day. If I didn’t achieve my target I was consumed with shame and self-loathing. I buried myself in my self-imposed prison where I restricted what I ate, over-exercised and waited for my own life-sentence to play itself out.

Almost everyone that I have ever met or spoken to who has recovered from ED can recall a specific moment when they decided that they had enough – enough pain, enough lies, enough self-hatred, enough fear, enough loneliness. This moment doesn’t come as an epiphany where you think you are ready to be “cured”.

Recovery takes time and, in some cases, many tries. But the first step towards getting well is to admit that something is not ok, and to recognise that the loneliness, the tiredness and the anxiety are not inevitable. The next – very difficult – step is to hand over control of food intake and exercise, to give up the very rituals that have kept the patient supposedly “safe” and outside the reach of whatever they are hiding from. This of course involves gaining weight – and there was nothing I feared more. But I did it. I don’t think I actually knew that I wanted to get well but I did know that I wanted to have the choice. I wanted to bring myself to a place where I was choosing if I wanted life or if I wanted to continue to live in the half-lit world of my anorexia. I wanted to give my body a chance to decide if it wanted health and strength or frailty and perhaps, ultimately, death. I wanted my mind to know the difference between being alert and receptive or vacant and dull. Most of all I wanted my spirit to know what it felt like to choose between loving myself and treating myself with shame and self-loathing. At that point I did not know what I would choose, but I did know that I wanted the choice.

Shomit – The reason I find Niamat’s article so instructive is that it makes the point that anorexia is not as much about appearance as fear, pain and control. When the body goes into “starvation mode” it becomes entirely obsessed with food intake, over which the patient of course has some control. Other life issues, such as taking responsibility in the realms of study, work and personal relationships (over which the patient usually feels she has little or no control) get automatically consigned to the periphery of the patient’s consciousness or even blotted out altogether. Thus starvation, although painful in itself, is seen by the sufferer as a form of pain control.

The treatment I recommend involves five phases:

1. Setting up a strictly regulated “regime” of food intake and exercise geared to achieving a slow, steady weight-gain.

2. Dealing with the fear this inculcates through hypnotherapy.

3. Exploring the underlying emotional issues through gentle, exploratory regressions designed to locate and heal the wounds that have caused the problem in the first place.

4. Setting an engaging but realistic objective for the medium term

5. Equipping the patient with the psychological and emotional tools she would need to achieve that objective through techniques such as guided visualisation.



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