Lately, I’ve been thinking a lot about early intervention in eating disorder treatment. As someone whose had anorexia for over a decade, this might seem like an odd thing to do, but there’s a reason behind it.
If you’ve ever looked into eating disorder statistics – particularly in relation to the effectiveness of treatment – you will probably know that early intervention is seen as vital.
In ‘A Critical Analysis of the Utility of an Early Intervention Approach in Eating Disorders,’ Laura Currin and Ulrike Schmidt discuss the significance of early intervention in the treatment of Anorexia Nervosa (AN) and Bulimia Nervosa (BN), giving particular attention to the role of schools and primary care providers.
In the paper, Currin and Schmidt identify “mid-adolescence into emerging adulthood (ages 15-25)” as the most common onset age for both presentation types, and consider the potential positive impact that early intervention can have on sufferers, particularly as they enter and progress through puberty.
In the Royal College of Psychiatrists’ Position Document (2019), early intervention for eating disorders (AN and BN) is described as “essential”, since supporting evidence suggests that it “may help to prevent illness onset or lead to an improved course of illness, e.g. through enabling earlier recovery, reducing or averting risk of chronicity and complications, preventing / lowering distress and avoiding disruption in people’s development and associated secondary disabilities.”
With regard to the nature and success of early intervention, the document acknowledges the impact of different illness stages, identifying the significance of different brain responses at each stage. Overall, in the early stages of developing an eating disorder, sufferers’ brain responses are likely to be more malleable (Treasure et al, 2015) and flexible, whereas in the later stages of illness, responses may become increasingly compulsive, habitual and entrenched, and the illness itself much more persistent.
In terms of statistics, this research found that as many as 60% of sufferers with a short duration of illness (3 years or less) achieve full recovery (referred to in the document as “remission”), compared with 20-30% of sufferers with a more sustained, longer period of illness.
The document states that primary care facilitators (such as schools, universities and GPs) play a key role in the identification, diagnosis and provision of early intervention treatment for eating disorders, and that things such as a lack of awareness, knowledge and specialist skills could result in underdiagnosis, misdiagnosis or delays in appropriate care.
Unsurprisingly, reading this document led me to think in more detail about my own eating disorder history. I’d never have thought to describe myself as a chronic case, nor as someone who might ever be referred to as a ‘revolving door patient’, but in terms of the duration of illness, I certainly fall into the more chronic category.
As a stand-alone realisation, this didn’t have too big an impact. That is until I began to think of it in relation to the aforementioned recovery – or remission – statistics. Having had anorexia for almost 12 years, there could be no doubt about the fact that, of the estimated 1.25 million people in the UK living with an eating disorder (BEAT, 2021), I am among the portion of long-term, enduring sufferers.
This struck me for a number of reasons, but particularly in the context of recovery. According to the statistics released by the Royal College of Psychiatrists, as someone with a sustained, longer period of illness, my chances of total remission from anorexia fall between 20 and 30%, as opposed to the 60% chance of those with a short-term history of being unwell.
Of course, I know that this research doesn’t represent everything (anyone who’s listened to the amazing Radio 4 podcast More or Less will be aware of the pitfalls of statistics). And I’m aware that just because I’ve read a bit of research, it doesn’t have to become a self-fulfilling prophecy. But I can’t pretend it didn’t have an impact.
Although eating disorders are not a choice, I very much believe that recovery is, and in this sense, it’s not in my interests – or my nature – to lay blame on anybody. But looking back at my own history, especially in relation to early intervention, I can’t help but feel I’ve been let down.
During my first year of university, when my eating disorder initially began to take hold, I remember reaching out to the GP on campus at the suggestion of my friends and housemates. I explained the difficulties I was having with eating, and the extent to which I felt that food, weight, shape and exercise were dominating my life. Although the doctor I saw seemed to understand my worries, he did nothing by way of investigation, referral or even basic monitoring. I was never weighed, no bloods were taken, and there was certainly no referral to the eating disorder service – nor even any mention of the prospect. He just warned me of the eventual chances of organ failure and death, prescribed me some antidepressants, and sent me on my way.
At the time, I thought little of any of this. It simply confirmed the – anorexic – idea in my head that the way I was living totally fine, and gave me the green light to carry on. For the rest of that academic year, things continued to worsten, until eventually, I was forced to take a leave of absense from my studies, on account of my mental and physical health. Once at home, under the care of my mother, I reached out again to my family GP. Although she was clearly startled by the obvious weight loss, this doctor did nothing in the way of offering any real support. Group treatment was mentioned in passing, and then waved away because of the likelihood that, despite being obviously underweight, I wasn’t really “thin enough”, and there would “probably be lots of people who were smaller and more unwell.”
Until my recent inpatient admission, more than a decade into my eating disorder, I haven’t thought too much about what happened during my first year at university. But, stuck in an EDU with nothing except time on my hands, it dawned on me just how negligent – and dangerous – the treatment I received really was.
Apart from the impact on my physical health, one of the biggest and most lasting effects has been on my mental wellbeing – particularly the extent to which anorexia has been allowed to dominate my life.
I am, and always have been, quite high-functioning. The perfecionist in me drove me to achieve First Class marks in my BA and MA, as well as numerous jobs in journalism, copywriting and teaching – all in spite of my eating disorder. I’ve travelled across Europe, America and Asia, formed life-long friendships, held down jobs and had lasting relationships, all with anorexia in tow.
By most people’s standards, I’ve lived a full and successful life so far, I don’t dispute that. But what I do know for sure, is how much better – and happier – things could have been if I’d receieved the help I so desperately needed as a young adult.
More than this, if I’d benefitted from early intervention, I’m about as certain as it’s possible to be that I wouldn’t be in the situation I am today: two months out of a (largely unsuccessful) inpatient admission, and struggling.
Thinking specifically of anorexia and any of the associated behaviours, I also know that for me, early intervention could have had a profound, life-altering impact. From the outset, restriction became the way I made sense of things, and learned to cope with finding my place in an increasingly chaotic, hard-faced and unfamiliar world, particularly as someone with a physical disability. Almost inevitably, with restriction comes weight loss, and an often noticable change in body shape.
As such, I have come to know and understand my adult body, only through anorexia’s distorted lense. It has controlled and manipulated my life in many ways, but most specifically – and noticably – in terms of my body’s weight and shape – ultimately, the space it takes up, and the way it moves through the world. Although there has been a slight shift in my presentation over time, the patterns, behaviours and compulsions I experience are very much ingrained, and the habits incredibly hard to break.
In the context of this, I know that there’s nothing I can do or say to change the outcome of things as they currently stand; hindsight is a wonderful, and at times, heartbreaking thing. But, if I could go back and say anything to my younger self, it would be this: don’t take ‘no’ for an answer.
And that, I suppose, is the point of this post. If there’s anyone out there in the position I was in more than a decade ago, I would urge you not to give up. If at first, seeking help gets you nowhere, keep trying until you get the support you so rightly deserve.