Eating disorders affect boys too - about 10 per cent of anorexics are male. They have to overcome not just their own inner turmoil but the prejudice of peers, parents and teachers, reports Kevin Berry
Darren Smithson stopped eating when he was 16. After six weeks, his parents took him to the family doctor where his mother mentioned anorexia. But the GP snorted and said, "Anorexia? No! That's a girls' disease!" Not so, according to those researching the condition. Current estimates are that 10 per cent of anorexics are male, but because the condition is so strongly identified with girls, boys are unwilling to admit their problem. The Eating Disorders Association suggests that more than 10 per cent of all adolescents could have some form of eating disorder, though the Mental Health Foundation puts it closer to 25 per cent.
Researchers agree that boys suffering from anorexia or bulimia nervosa are more inclined to have been overweight, but thinking of anorexia as a slimmer's disease is too simplistic. The plumpness that can come with puberty can be frightening; the onset of adolescence is an anxious time. Anorexia restores the body to its pre-pubescent state.
Arthur Crisp, retired professor of psychological medicine at London's St George's Hospital, has identified panic over sexual identity as a contributing factor with many male sufferers.
"Around 50 per cent of teenage male anorexics are wrestling with gender doubt," he says. "They show a history of panic or conflict over an awareness that homosexuality might be an important ingredient in their nature. Anorexia is one way of retreating from that."
Darren (not his real name) carried on starving himself. He drank water before meals to dull his appetite and made himself sick after meals. He was down to five stone and ended up in hospital, where he was bullied into eating, but the moment he left he fell back into anorexia. Within weeks he was rushed back to hospital, close to death.
"Concentrating on losing weight blotted out everything else," he says. "When my weight was dropping I felt happier than I had for some time. It was something I was doing to myself, something I could control."
Darren had tried talking to his parents, his form teacher and his personal tutor. They listened, he says, but could not understand his anxieties.
"I wasn't coping with male aspirations," Darren, now 21, explains. "The whole thing about being tough, not showing your emotions, about going out into the world, getting a job, being a success, having a big house, big car - I couldn't see how I could do it."
Darren experienced tremendous difficulty with relationships the moment he started secondary education. He felt he didn't belong; he was not included in teams, not invited to parties. "When I began losing weight, the other kids started to notice me. When I was in hospital some of them wrote to me, but I was Darren The Anorexic and felt I had to stay anorexic to keep that popularity."
Anorexia is an emotive subject. Many people fear the behaviour will be copied, and the mere sight of a severe anorexic instils dread.
"I was socially isolated," says another sufferer, Keith, 18. "I know what it must be like to be HIV-positive. I lost half my body weight and was in hospital, but none of my friends came to see me. Their parents stopped them.
"When I got back to school my housemaster shouted at me, called me a dirty, filthy object for making myself sick and said he was going to make me eat. He did, but as soon as his back was turned, I threw up.
"I left the school. I was a failure - they didn't want me."
Parents of boy and girl anorexics say that psychiatrists and doctors seem over-eager to blame families. One father sums up their feelings: "It's as if they've come to the word 'anorexia' in the medical dictionary and decided that we, as a family, fit the pattern - the family gets the blame."
I telephoned five boys' schools to see if any had a policy for dealing with anorexia. None did.
Yet a recent conference held by the British Olympic Association, UK Athletics and The Eating Disorders Association highlighted the fact that eating disorders such as anorexia and bulimia are becoming common among top male athletes.
Leeds psychiatrist Dr Lorenzo Pieri, who runs the Yorkshire Centre for Eating Disorders, admits to being terrified by the sight of an anorexic.
"I was a doctor in the Army," he says. "I saw bullet wounds, guts hanging out, half chopped-off legs. But the thing that causes me most distress is to see someone who is suffering from anorexia. If that is true for me, how must it be for parents?" Their problem is compounded by the reluctance of many schools to admit there is a problem. Dr Pieri, who lectures on anorexia around the country, has come across only one school - Leeds Girls' High, a fee-paying school with a formidable academic reputation - that deals openly with the the issue.
When Sue Fishburn was appointed headteacher at Leeds two years ago, she realised there was a perception that anorexia was widespread in the school. She sought advice from Dr Pieri. Though he confirmed that, statistically, incidents of anorexia were no more than would be expected for that age and gender group, Mrs Fishburn wanted him to talk to her staff.
"I wanted to raise awareness," she explains. "By the support systems we are building, we hope that we can help whenever anorexia arises, before it gets to a crisis point."
Any teacher who is approached or identifies a problem knows there is a network of colleagues to help work out a strategy. The school also has contacts with trusted professionals.
"But most of all you have to have a culture among pupils of confidence in the staff," says Mrs Fishburn, "so that they will come forward and express concerns where they see someone in their peer group perhaps beginning to experience a problem."
Where to go for help: Dr Pieri will give advice and put you in touch with a professional in your area.Tel: 0113 206 2068 The Eating Disorders Association has two helplines, tel: 01603 621414 and 01603 765050 (youth helpline)4-6pm Anorexia and Bulimia Care (ABC), a Christian organisation, has two helplines: 01695 422479 for the north of England and 01449 740145 for the south. The Cullen Centre at the Royal Edinburgh Hospital will go into schools to help and advise. Tel: 0131 537 6000.