Some Definitions
Let’s think a bit about what eating disorders (ED) and self-harm (SH) are, how and why they might work and what difference the gospel makes to those who struggle in these ways.
Firstly, they’re complicated.
When I was trying to overcome anorexia, my mum would sometimes look at me and ask, ‘what did we do wrong?’ But it’s rare that there’s one big reason – in all likelihood there are lots of different factors involved. These range from personality type (e.g; high-achieving, perfectionist, thinks in black and white categories, low self-esteem), to culture, (a media obsessed with the body, conflicting messages about what it means to be male or female, lack of positive older role models)…the list goes on. This can be a big help in terms of recovery too – as we try to negotiate the territory between sickness and sin. Am I a victim of circumstances beyond my control? Well, to some extent, yes. Maybe I’ve been hurt and sinned against in terrible ways. And that’s something to be genuinely grieved over. But is that the end of the story? Using the language of sickness and victim-hood seems to be the most loving approach. But in fact, it can actually take away our hope. If I am the victim of say bullying, then I’m under the bully’s power. Not just my sickness, but too often my recovery, may depend upon someone else. But that’s another post.. The point for now, is that life and people are complicated – there are rarely simple causes and consequences to anything.
Every person and every story is unique, but at the same time, there may be common factors or traits which predispose certain people to manage stresses in this way. And before we dismiss these weirdos, take a minute to think about the spectrum of ‘normal’ behaviour ..
This morning, for example. I lost my phone. My brain was saying, ‘Emma, you IDIOT. Why can’t you just get organised. You’re so STUPID.’ Well, that looks a lot like self-harm – not as extreme as some, but coming from the same heart.
Or maybe I’ve had a really horrible day. I come home and crack open the Haagen Daas. Before long, it’s just me, the empty pot and a spoon. Comfort eating? Or a binge?
I can’t help thinking that to help others who are struggling, we need a real awareness of our own weakness. All of us are in a mess – and all of us need a Saviour. Too often we can dismiss other people because they don’t fit our categories of acceptable sinners. But for many struggling with eating disorders (ED) or self harm (SH), these behaviours are not problems but solutions. Not ways of trying to cause pain, but to deal with it. Not ways of trying to die, but to learn how to live.
Here’s a very brief intro to some of these methods:
Self-Harm
What?
Intentional injury to your own body.
Includes: cutting (most common), burning, poison, hitting, hair-pulling, head-banging, breaking bones, drug OD, taking stupid risks, staying in abusive relationships, anorexia/bulimia, not looking after self.
Who?
· 1 in 12 UK adolescents self-harm on a regular basis – highest rate in Europe
· 10% of 15-16 year olds have self-harmed (usually by cutting).
· Most common reason = ‘to find relief from a terrible situation’
· Each year 170 000 young people turn up at A&E having self harmed
· Self-poisoning is most common at A&E. Cutting is most common in private.
· 50% of 15-21 young people know someone who self-harms.
· Girls are 4 times more likely to SH than boys.
· Majority of SHers aged between 11-25.
Anorexia Nervosa
What?
Restricting food intake to cope with and control life.
As it progresses, chemical changes affect the brain and distort thinking.
This makes it more difficult to get help or think rationally about food and weight.
Typical symptoms include:
· unable to maintain a minimum body weight (for example, 85% of expected weight)
· disrupted periods
· intense fear of becoming fat, despite being underweight
· a distorted perception of their body shape
· will usually deny any problem
· other symptoms can include constipation and stomach pains, dizzy spells and fainting, swollen stomach face and ankles, downy hair on the body or loss of hair on the head when recovering, poor blood circulation, loss of libido.
· may show personality changes, become secretive, restless and hyperactive, wear baggy clothes, develop certain rituals when they eat food such as cutting things up into pieces, vomit and take laxatives.
Who?
· Estimates vary but… 1.4 million women in Britain with an eating disorder
· 140 000 with anorexia
· Average age onset: 16
· 5% of cases fatal – (perhaps) the most deadly mental illness.
Bulimia Nervosa
What?
Eating large quantities of food, then purging or otherwise controlling weight.
This involves vomiting, laxatives, diuretics or excessive exercise.
It usually begins in adolescence, but many don’t seek help until 30s-40s
Typical symptoms include:
· Frequent weight changes, disappearing to the toilet after meals in order to vomit, a sore throat or tooth decay, swollen salivary glands, poor skin, irregular periods and lethargy.
· Uncontrollable urges to eat vast amounts of food, an obsession with food, a distorted perception of body weight and shape, anxiety and depression, low self-esteem and feelings of isolation.
· May use laxatives, go through periods of fasting and excessive exercise, become secretive and reluctant to socialise and may even begin shoplifting for food.
Who?
· Now UKs most common eating disorder, affecting 1-2% of population.
· Average age onset: 18-19
Eventually, half of those struggling with anorexia will go on to develop bulimia.
NOS: Quite often, the symptoms of these eating disorders will cross over, and therefore not fit a specific diagnosis; doctors may call this an eating disorder ‘not otherwise specified’ (NOS).
Eating Disorders and Self-Harm: What’s Going On?
People recovering from eating disorders often struggle with self-harm and vice-versa. As one behaviour is brought under ‘control’, another may take its place. This suggests that they appeal to certain kinds of people and fulfill some of the same purposes;
Personality traits:
· ‘Good’ girl or guy:
• conscientious
• bright
• perfectionist
• very high standards for self
• more common in girls (but increasing affects guys too)
• copycat – more likely if friends do it, can happen in groups
· ‘I’m rubbish’:
• often raised in environments that discourage expression of anger, and therefore find it hard to express their emotions.
• Common factor = feeling of helplessness/powerlessness
• strongly dislike/invalidate themselves
• very anxious
• are hypersensitive to rejection
• black and white/extreme thinking – e.g; ‘I’m terrible’, ‘everyone hates me’
• can be very angry, usually at themselves – but may not be aware of this or try to suppress or direct these feelings inward
• often lack a good social support network
• coping behaviours can lead to increasing isolation and shame
• MAY have history of physical or sexual abuse
• feel like life is out of control or that they can’t cope
What they promise: life
· Communicating dangerous feelings– writing on my body what I can’t say with my mouth.
· Getting rid of emotionsI can’t handle. Transferring feelings to the physical – eg; by physically purging or harming myself. Doing this temporarily relieves intense feelings, pressure or anxiety.
· Trying to change myself – if my physical wounds can heal, then maybe my emotional wounds can heal too. If I look different, maybe these problems will go away.
· Distraction – ‘I’m fat’, not ‘I have no friends, I’m scared of growing up, my body is changing’..
· Comfort – If I’m really as bad as I think I am, then I need an excuse to look after myself. Self-injury followed by tending to wounds is a way to express self-care, to be self-nurturing, for someone who never learned how to do that in a more direct way. For the bulimic, stuffing self with food is comforting and then getting rid of it feels like getting rid of all the messy emotions. For the anorexic, the control over your body may bring a high, a sense you are stronger than other people or protected from the world. As you kill and master your physical appetite, you can also kill all those feelings and desires that make you feel bad.
· Self-punishment- feeling that it is not ok to have negative feelings, that I deserve to be hurt
· Gaining control – over emotional pain by managing my body
· To feel something – Ironically, not just to kill pain, but to cause it. When people suffer trauma, they often try to cope by pretending didn’t happen – but then suffer feelings of numbness or deadness and detached from the world and their bodies. SH in particular can be a way of feeling more connected and alive.
· Trying to affect others- to manipulate them, make them feel guilty or bad, make them care, or make them go away
· Trying to get help – not simple attention seeking – a complex way a cry for help. Not an attempt at suicide – they want to wipe out their feelings not their life.
What they deliver: death
Spiralling down – How they’re addictive:
• Addictive – physically and psychologically. What starts as the solution, becomes the problem.
• Creates a sense of being in control but then becomes very out of control.
• In ED, sufferers may experience a ‘whirlpool effect’, where as weight is lost the person experiences a physical ‘high’ and thinking and reasoning is effected, meaning that they become more and more obsessed with losing weight, and less able to break the cycle of over-exercising, laxative dependence etc.
• A person who becomes a habitual self-injurer usually follows a common progression: the first incident may occur by accident, or after seeing or hearing of others who engage in self-injury. Before the event, they have strong feelings which they feel are unacceptable. These build and without a way of expressing them directly, self-injury provides a feeling of release. This relief is followed by guilt and shame – they then feel compelled to repeat the pattern
In both ED and SH sufferers may
• need to go further each time
• develop complex ‘rules’ or rituals around cutting or around food which become a part of making life ‘safe’. Often they will suffer Obsessive Compulsive Disorder (OCD), where they feel compelled to follow certain patterns of behaviour to prevent something bad happening or to feel safe.
• experience a physiological and psychological high when they give in to these behaviours – and panic or depression when they resist them.
Cutting off – How they’re isolating:
• shame – I felt like this already, but the behaviours that started as a way of helping me feel better are now making me even worse
• my life is full of secrets – hiding my body with long sleeves or baggy clothes, lying about what is going on and pretending to be ok
• others can’t understand – my behaviour arouses strong feelings/judgements in others, which makes me turn inwards. In fact,
• Other people become more and more a threat to my only coping mechanism.
• The weirder I feel, the weirder I act…
• Social interactions are about food and bodies! We go for a walk or a swim or dancing, we eat meals together – SH and ED means retreat.
Torn in two – How they tear you apart:
• Feeling in charge but out of control
• Feeling more and more distant from your body – your body becomes an enemy
• But at same time you obsess over it – the anorexic hates food but can’t think of anything else. The self-harmer mutilates their body but cares for it too.
• Desperately wanting help but terrified of losing only avenue of self-expression/control/coping
• Saving me but killing me:
• Hidden but obvious