Living with an eating disorder: "I realized it when I looked in the mirror and saw death"

Sheltered behind a dense haze of stigma and confusion, eating disorders are proliferating on the streets at a rapid pace.

Stop eating, eating and vomiting, or compulsive binge eating, are just the tip of the iceberg, what is seen - if it is seen at all.

But there is more.

Much more.

Marta, Raquel, Inés, Yolanda, Laila, Ingrid, Teresa and Esperanza, all day hospital patients of the Eating Disorders Unit (TCA) of the Sant Pau Hospital in Barcelona, ​​define it as follows:

- A bad management of emotions.

-A punishment.

- You stop loving and caring for yourself.

"It's a self-harm."

—When you stop controlling your life, there is one thing you can control: weight and food.

"It's a lot of suffering.

Behind an eating disorder hides all of this.

And more.

No two cases are the same.

At the express wish of the patients, in this report there will be no figures of heights or weights: the disease, they insist, is not that;

or not alone

The backpack of anorexia, bulimia and binge eating disorders —the most common EDs— is as immense and heterogeneous as there are patients: the prevalence is around 4% of the population (mostly women) between 12 and 21 years of age. , but these very complex diseases drag on, on many occasions, until adulthood.

It does not only affect girls or heal on their own over the years;

Nor is it essential to be extremely thin to suffer an eating disorder, nor do all patients fit into a certain pattern.

The gray scale is broader than the stereotypes embedded in the collective imagination, lament the patients, and no alert can be trivialized.

Except at a time when EDs are skyrocketing after the covid pandemic and the trickle of new diagnoses in psychiatry clinics does not stop:

a study in the United States warned of an increase in cases of more than 15% in 2020 compared to previous years;

In Spain, another study by the Jordi Gol University Institute for Primary Care Research, with data from Catalonia, concluded that ED diagnoses doubled in adolescents after the health crisis.

More information

The danger to health of risk behaviors that go viral

The relationship with food is just "a symptom" of much more, says Inés, 47.

She has been fighting this “double life” to which anorexia leads her since she was 18: “It was very difficult for me to become aware of the disorder, until one day I looked in the mirror and saw how thin I was to death.

It is a double life because it is not normal to eat and vomit or not eat.

When there is a family reunion, a wedding or an event, it is very difficult for me to attend and behave normally.

Or if I go to a restaurant, before I go, I look at the menu online five times thinking about what I'm going to be able to order because there's nothing there that works for me, ”she explains.

Patients already diagnosed arrive at the Sant Pau day hospital —in female, because they are the vast majority— from primary care or mental health centers for adults or children and adolescents.

They land there "due to severity or lack of response to the first measures taken," explains José Soriano, psychiatrist and coordinator of the ACT unit: "If the disease has taken root in the person's mind, they will ignore those early indications, you will continue those behaviors and put yourself at risk.

The care is mostly done in partial hospitalization (half day or the whole day), and if things get worse, we consider full admission.

But we think that the day hospital is the ideal place because we work on both the nutritional and dietary part, so that they eat and do not vomit,

Between the four walls of an old pavilion in the Sant Pau modernist complex, the hours go by.

Making crafts, group and individual therapy, with a psychiatrist always at hand and ensuring several meals a day to guarantee their nutritional recovery: breakfast, snacks, lunch, snacks and dinner are made there, under the supervision of a nurse and with individualized menus and designed by nutritionists and endocrinologists.

"What we see are girls who come with problems of anorexia or bulimia, although binge eating has also increased a lot, compulsive eating problems without compensatory behaviors, which can lead to problems of being overweight or obese," says Soriano.

Death risk

All his patients are aware of the disease, says the Sant Pau psychiatrist, but they are unable to interrupt these behaviors.

"What they are doing is almost a way of slowly committing suicide: if you stop eating, in the end your body gets worse," warns the doctor.

Anorexia is the only mental health problem whose symptoms can lead to death, he points out: "There may be cases of suicide, but also, that extreme thinness, after being maintained for a few years, can cause the death of the person because they make a mistake." extreme hypoglycemia or a cardiac complication.”

Between 2% and 3% of patients with anorexia nervosa, the doctor estimates, die.

In a huddle, sitting at tables for two, they, the patients, face the disease: anorexia, bulimia, binge eating or all at once.

There are no watertight compartments, insists Marta, 22: “There are many types of eating disorders.

In fact, the most typical is unspecified, which is everything that does not fall within the criteria of the psychiatry manual.

People who are underweight are very visible and we forget that a person who has dropped from 100 to 60 is at a healthy weight, but maybe they are not healthy, ”she protests.

She started at 11, "but since she wasn't underweight," she thought "nothing was wrong," she says.

"Until the typical thing happened to me: weight loss, people were alarmed... and I thought: I've been sick for six years and no one has told me anything and now that I'm underweight,

Is that when people worry?

It makes me very angry."

Yolanda, 55, paints in a book at the Sant Pau ED Unit day hospital.Albert Garcia

These ailments are multifactorial, different circumstances that come together at the same time.

Being a woman, adolescents, having low self-esteem or receiving criticism in relation to weight are risk factors, says Sara Bujalance, director of the Association against Anorexia and Bulimia (ACAB).

A clear trigger, she adds, is "starting a weight-loss diet without professional supervision," especially if you're a teenager.

Also going through significant suffering, such as a loss, or having experienced criticism and humiliation in social or family settings.

It all adds up.

The pandemic, in fact, was "the perfect storm", Bujalance points out, because it combined risk factors (such as uncertainty or situations of loss) with the lack of protective factors (leisure in the open air, quality social contacts, a break in personal projects...).

Dolores Picouto, a psychiatrist from the ACT unit at the Gregorio Marañón Hospital in Madrid, sees the most serious cases in children and adolescents, those who require admission: “It is very striking.

After the pandemic, demand has doubled.

There are more cases and our impression is that they are more serious and younger, with more incidence in early adolescence.

They arrive in a situation with lower weight and with other mental health problems, such as anxiety, depression and suicidal ideation.

The health crisis exacerbated isolation,

Being a woman, adolescents, having low self-esteem or receiving criticism in relation to weight are risk factors

The trigger for an eating disorder, in any case, is variable.

It can be a death or a simple flirtation with practices like “

or

”, Marta agrees.

For her, all those disruptive behaviors with food ended up giving her "peace of mind."

“The fact of planning, of structuring gave me peace of mind… I was very organized and just as I plan my studies, I planned my relapses and that gave me peace of mind.

I think it's a way of feeling things that you want to feel and that you can't feel any other way, ”she explains now.

Raquel, 42, began, in the context of depression, when she was practicing the keto diet: she began counting carbohydrates and calories until she ate only once a day.

She has anorexia, bulimia and compulsive binge eating: everything that "exceeds" what she allows herself to eat, generates such a feeling of guilt that she compensates with laxatives.

It's not just about losing weight, she admits.

There is more: “The thing about laxatives is like once I go to the bathroom, I release everything: all the tension, frustration and anger;

I release them and that's it.

And I still need that, eat a lot or eat a little”.

The precipitator of Teresa, 63, was also a depression: she stopped eating, to the point of not holding herself up: “I couldn't go out alone, I had to be accompanied and held by my husband's arm.

A couple of times when I went shopping, I fell because my body wasn't pulling and my head even less so”.

a vicious circle

It is not easy to break those risky behaviors.

The disease itself is a vicious circle, admits Soriano.

“Once you fall into the well, you can't get out anymore because the same anorexic or bulimic process is self-perpetuating.

When someone has already stopped eating and has lost a lot of weight, on a physiological level, the stomach also reduces in size and if you want to eat normal again, it will hurt, you will not be able to.

It's hard to re-feed."

And in bulimia another blind alley is drawn, he explains: "Anxiety leads to binge eating, overeating leads to guilt, guilt leads to vomiting, vomiting later leads to stopping eating in case you have not vomited all and that leads to anxiety again.”

Social media doesn't help either.

They encourage an unattainable stereotype, says Laila, 22.

She had to uninstall Instagram multiple times because it was "too harmful."

“There is a beauty canon that plays against.

And, in the end, you see one thing that, even if you try your best to be like them, you can never reach that ideal that they sell you on the networks”.

For Marta, who is the same age, these platforms play a role in “maintaining the TCA”, with “minimundillos”, she says, where she frivolizes with these issues.

José Soriano, coordinator of the ACT Unit of Sant Pau.Albert Garcia

The therapeutic process is long, several years.

And it doesn't always go away: around 60%, Soriano points out, are cured;

20% improve, although they continue to have problems with food or risk behaviors in a timely manner;

and another 20%, it becomes chronic.

As they usually begin at very early ages, in the group of patients in which the disease becomes encysted, the impact on quality of life is immense and very prolonged over time.

Ingrid, 47, has been suffering from anorexia since she was 13.

She later she was added bulimia.

In silence, without ever telling anyone, she purged herself so much that she vomited blood, she admits.

Her son, she says, opened her eyes: the fear that he would be left alone if something happened to her made her ask for help.

She has been in the day hospital for a week.

“I also have lupus and because of the medication I take, I gain weight.

I have to live with it.

I do not know how to do it.

I suppose they are going to help me here, ”she resolves with a half smile.

more resources

Patients demand, above all, resources and attention.

It is not enough, they warn, to control height and weight from time to time in the mental health center or have a visit per month with the psychologist.

Yolanda, 55, took two years to get a job: “I was about to die.

It was no use for me to go to the mental health center, half an hour every three months: each time you had a different nurse or the psychiatrist was on leave and another came and you had to explain everything again.

I was in mortal danger, I needed urgent help, ”she recounts.

At Sant Pau, they all agree, they feel "support" and understanding.

And they learn feeding guidelines.

And they become aware of the disease.

"They treat you like a person," says Esperanza, 65, who has had eating disorders since she was 15.

But the places (20) are limited.

Bujalance warns that spaces and healthcare resources have been lacking for a long time to treat these ailments and now, after the pandemic, even more so.

Marta stirs: "It can't be that a disease like an eating disorder, which worsens at all, has a waiting list of months."

It is not easy to get out of the "pit", admit doctors and patients.

These ailments, Picouto specifies, mean "continuous suffering": "They invade your whole life and imply a tyranny over the person because they imply a loss of the ability to eat healthily, which is a basic function."

The psychiatrist launches several warning signs towards the population: to begin with, "it is not normal to eat and feel guilty or have prohibited foods";

and be careful if an adolescent begins to compare their body a lot with others, if they change their physical appearance or weight, if they change their eating patterns, if they avoid social situations that involve exposing their bodies or going out to eat, if they go to the bathroom after dinner food.

All of these can be warning signs.

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