Disorderly behaviour

28th November 1997 at 00:00
Jane was captain of the hockey team, a leading light in the school orchestra and a high achiever in class -- just the kind of model pupil who can succumb to a life-threatening eating disorder. Lorna Martin reports on how teachers can help

Jane is 18 and in her first year of a business degree course at the University of . Strathclyde. This is her story: "The image of a "typical'' anorexic is of someone shy and withdrawn, with few friends; or a person who's been bullied or abused; or someone who is selfish and attention-seeking. Yet I appeared outgoing and confident, I had lots of friends, a supportive family and was doing well at school.

Initially my illness had a positive effect on my school work. I'd spend hours studying as this enabled me to avoid food, and in fifth year I spent lunchtimes playing hockey, doing fitness training, coaching junior pupils or jogging. I would prolong the activities so that I would have no time to eat. I'd put empty sandwich wrappers in my blazer pockets and pretend I'd eaten lunch.

During study leave for my Highers I'd revise for two hours, go for a jog, and make a banana sandwich - most of which I wouldn't eat. Then I'd study for another two hours, then go jogging again. It was easy to skip evening meals. I'd smear food on a plate and tell my parents I'd eaten.

When I went to my room at night, I'd turn out the light and do more exercises. I knew exactly where to do them so that the floorboards wouldn't creak. I'd lie in bed starving, but I'd wake feeling happy that I'd achieved something because I hadn't given in to my hunger.

I always found reasons to justify my actions. When you have an eating disorder you have two voices: a quiet, rational one and a loud, irrational one which dictates your behaviour. I'd written about eating disorders for my Standard grade English discursive essay and, because I wasn't making myself sick or at a life-threateningly low body weight, I convinced myself I didn't have anorexia. But the goalposts kept moving. I'd promise myself I would stop if I lost another pound, and then it would be another pound, and on and on.

During the summer before sixth year I went to several hockey camps and began to eat normally again. When I started sixth year I'd put on a bit of weight and started to make myself sick after eating. This pattern of behaviour continued until January 1997. One evening I was crouched in a corner of my room crying. I forced myself to cry louder and louder. On one hand, I desperately wanted my mum to come and help me but, on the other, I was scared of being discovered and having to face what was happening.

My sister found me, and my mum phoned the doctor. The next day I was referred to Langside Priory Hospital in Glasgow.

When I entered treatment I hoped someone would take responsibility for my illness. I viewed groups on self-awareness, creative writing and cognitive therapy with cynicism. I simply wanted a doctor or dietician to tell me how I could get "better". But these are things you have to find out for yourself. You learn right away that the illness and your recovery is your responsibility.

I attended hospital two days a week, but I was still lying to nurses, psychiatrists and myself. My weight fell to just over five stones and I became an in-patient.

In the Priory you learn about yourself as well as the illness. You try to understand the underlying factors behind the eating disorder. I was a perfectionist and had built up a perception of my sister as being the perfect human being.

I always felt inferior and a failure - despite being captain of the school hockey team, joint games captain, playing in the school orchestra, singing in the choir, winning a silver medal in the Glasgow Schools 800m and a bronze in the Scottish Schools, representing Scotland in a reserve hockey match against England, gaining eight Standard grades and seven Highers. The pressure and the high expectations weren't coming from my parents or my teachers, they were all internal.

I don't think teachers can prevent someone from developing an eating disorder. What they can do is raise awareness about them. The road to recovery is long and slow. On bad days I wonder if my pre-occupation with food will ever go away. But on good days I can see the progress I've made. I know that a life not controlled by an eating disorder is possible and is better than a life lived under the rigid restrictions anorexia imposes".

Four per cent of 15-year-olds suffer from anorexia nervosa, the mental illness which, with bulimia nervosa, claims the lives of 18 per cent of sufferers. This is the highest mortality rate of all psychiatric illnesses. Can teachers do anything to help?

Louise Martin is co-ordinator of the eating disorders unit at Langside Priory Hospital in Glasgow, Scotland's only specialist, in-patient unit. She says that teachers can play a valuable role in increasing awareness and recognising symptoms at an early stage.

Anorexia is not primarily about food and weight. "Eating disorders are a way of expressing psychological and emotional distress," says Miss Martin. "The body and food are symbols for expression, a way to vent feelings like anger, sadness, guilt, loss or fear. They are not slimming diseases, attention-seeking behaviour or a way of committing suicide. They are a way of coping with life."

Many factors can contribute to the onset of an eating disorder: family or school problems, bereavement, perfectionist values, bullying, not wanting to grow up and sexual or emotional abuse.

An eating disorder is an addiction and, like any other addiction, it holds no prejudices. It can grip anyone - male or female, young or old. For each sufferer there will be a different set of contributory factors.

Numerous medical complications are related to the illness. There may be risks of infertility, osteoporosis, erosion of tooth enamel, damage to the colon, low blood pressure, dehydration, kidney failure, anaemia, skin problems, poor concentration and decrease in muscle mass. No organ system is spared from the effects of a serious eating disorder, but with treatment most of the physical complications can be reversed.

This treatment must address the physical, psychological, behavioural and social issues simultaneously. "Our recovery programme does not focus on food, unless the patient is at a life-threateningly low body weight," says Miss Martin.

"Authoritarian, punitive relationships simply diminish self-esteem - we are aiming to re-establish it."

Group therapy constitutes the largest part of the treatment programme at Langside Priory. Cognitive therapy enables patients to recognise and begin to challenge their negative thoughts around food and weight. Educational sessions aim to increase the insight into the causes and effects of the disorder and to establish and maintain motivation to recover. Body image therapy explores the distorted perception sufferers hold towards their own bodies as well as societal pressures for thinness. Patients also attend groups on anxiety and stress management, assertiveness and goal-setting.

The difficulty for teachers lies in detecting the illness, since a symptom of both anorexia and bulimia is secretive behaviour, and elements of the behaviour of the anorexic can resemble that of a model pupil.

"Anorexics are perfectionists. The work they produce is probably exemplary. They may also excel at sport and be heavily involved in extra-curricular activities," says Miss Martin.

Symptoms to look out for include severe weight loss, personality change, a lack of interest in normal activities, the avoidance of lunchtime through studying or playing more sport, difficulty in concentrating, increased interest in food and calories, becoming withdrawn and perhaps losing friends.

Bulimia is more difficult to detect, since a sufferer's weight is likely to be normal. Some people can suffer for years without family or friends knowing. Symptoms may include dry or poor skin, lethargy, depression, mood swings and an obsession about dieting.

In the early stages of the illness, most sufferers will deny there is anything wrong. They are likely to feel ashamed or disgusted by what they are doing and will not want to admit what is happening to them. Deep down they know they are ill and often want help, but are afraid of the reaction of people around them. The sooner a sufferer seeks help, the quicker and easier recovery is likely to be.

u A pupil with an eating disorder should be strongly encouraged to visit their GP, who will refer them for specialist treatment. The Eating Disorders Association has a youth helpline: 01603 765050, for people under 18. It is open from Monday to Friday, 4-6pm uA useful book, Eating Disorders - Guidance for Teachers, published by the Family Reading Centre, is available from the Eating Dis-orders Association, Sackville Place, 44 Mag-dalen Street, Norwich NR3 1JU. Cheques for Pounds 3.50 should be made payable to the Eating Disorders Association * The Eating Disorders Unit at Langside Priory Hospital in Glasgow can be contacted on 0141 636 6116


ANOREXIA: The relentless pursuit of thinness through starvation. 90 per cent of sufferers are female, but in the 7-14 year age group about one quarter of patients are boys.

* severe weight loss

* excessive exercising

* loss of menstrual periods

* perfectionism and other obsessions

* feeling cold and poor circulation

* growth of downy hair all over body

* misconceptions about weight

* avoiding meal times

* secretive behaviour

BULIMIA: Binge eating followed by self-induced vomiting, periods of starvations, the misuse of laxatives, diuretics or enemas, or excessive exercise. About three per cent of women are sufferers.

* vomiting and purging

* frequent visits to the toilet after meals

* menstrual disturbances

* sore throat and erosion of tooth enamel

* poor skin condition

* lethargy

* low self-esteem

* feelings of guilt and self-hatred

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