Control, too much and too little of it, is something which characterises all eating disorders. Anorexia and its sister bulimia are on the increase.
For Jane Harris, being presented with masses of food was an open invitation to binge. Her worst nightmare was a buffet. "What do you do when there's all that food to go back and dip that celery in and all those crisps and stuff?" she asks. "What about Christmas parties, with all those mince pies sitting there? You're not going to eat just one."
All social situations involving food created immense complications for Jane. "You'd think going to a dinner party would be fun for a student, but I'd be worrying all day about what I could eat beforehand, and would I eat too much, plus all those calories in alcohol. Sometimes, it was a lot easier to go to bed than go out." Even an evening sitting and relaxing presented a threat - it might involve wanting to nibble, leading to the inevitable binge.
There were no half-measures for Jane; it was all or nothing. "Nothing" could mean literally nothing, or the strictest diet. Once she broke her diet, even in a minor way, she felt she might as well go for a full binge and eat everything she had deprived herself of - thickly buttered slices of bread with jam and cream, chocolate bars, biscuits, cakes, apple pies, all consumed at high speed, followed swiftly by large quantities of laxatives. She felt totally out of control when bingeing, and quite unable to stop herself in the middle.
Jane started dieting at 14, believing that "if you're young, thin and beautiful, you can have good relationships and be successful. You look up to people a few years older who you see as being successful and they have boyfriends and they're thin." Gradually, this inflated belief in the prime necessity of being thin dwarfed all other achievements. Jane says: "How well I did depended on how much I had eaten, not how good my day had been. You value yourself by how much you've eaten, not by what you've achieved."
Jane helped herself by reading and using Bulimia Nervosa and Binge-eating: A Guide to Recovery by Peter Cooper, professor of psychology at Reading University. It is a guide and self-help manual which aims to provide people with the information and means with which they can regain their self-control.
Bulimia is distinguished from anorexia nervosa partly by this totally uncontrolled binge-eating, followed by a compulsion to vomit or take laxatives. There is an urgent need for new strategies to treat it. Although the disorder was only properly recognised in the late Seventies, its incidence has increased so sharply that some authorities estimate one in 20 (or more than half a million) British women aged between 17 and 35 has bulimic symptoms. Eighty per cent of them receive no treatment. Those who do may receive treatment which is inappropriate and ineffective. Most psychiatrists are not trained to deal with the disorder and there are few specialist clinics across the country, experts say.
There are, however, proven and effective treatments for bulimia. The most reputable is cognitive behaviour therapy, used in most specialist clinics and practised by Professor Cooper at the Cambridge clinic he ran for 10 years. The treatment is designed to change aspects of disturbed behaviour as well as aspects of disturbed thinking. It combines behavioural techniques to tackle the immediate eating problems and cognitive therapy for the underlying beliefs about the importance of weight and shape.
His book provides information on bulimia in the first part, and a self- help manual based on the approach used in his clinic in the second. Unlike many self-help manuals, it has been evaluated using approved methods by Cambridge University researchers and has been shown to help the majority of users. The idea is that the book should be used with minimal supervision, consisting mainly of encouragement and support which could be provided by someone like a GP.
The manual is arranged in six carefully structured steps. "When people are fasting all day, bingeing all evening and then vomiting for hours, it's no use sitting down and talking about beliefs and values. You've got to do something about restoring some control to eating as a first phase," Professor Cooper says.
The first step is keeping a daily diary of what is eaten, and the second is a making a meal plan. The third step teaches techniques to prevent bingeing, while the fourth shows how to recognise what triggers a binge (preparing food for others, relationship problems). Step five involves learning techniques to eliminate dieting, and the sixth helps change beliefs about the desirability of being thin.
By keeping a food diary, people have to see what they are doing to themselves and the discipline of keeping a record begins to impose some kind of order. Each step needs completion before a start is made on the next. The professor's experience of working with bulimics shows. "It's as if the manual was written for me," Jane says.
She found it was better for the "difficult" tackling of beliefs and values to be left to the end: "You just can't confront the psychological side until you feel physically well." But the final step, called "Changing Your Mind", is crucial because it will help to protect sufferers from relapse. Professor Cooper acknowledges that this is the hardest part. Changing a person's beliefs is not easy from the pages of a book.
"You can only point people in the right direction and let them do it themselves," he says. Jane has taken on board some of his ideas, such as treating herself as she would her best friend. That means not judging herself by how she looks or whether she has put on weight. Jane says: "I'll still ask my boyfriend, 'Do I look fatter?', but I recognise that is just me saying, 'Am I all right? Am I an OK person?'"
Lack of self-esteem is common in sufferers, but it is also acknowledged that this is fuelled by social pressure on girls to be thin. Jane would like to see more education in schools on eating disorders to counterbalance the messages and myths in the media from the beauty industry, fashion models and advertising.
She found facts in the manual useful. She will never take laxatives again after learning that they do not reduce food absorption. She has stopped bingeing and eats normally, but still thinks about food a lot and feels better if she has not eaten much.
"The really important thing has been the availability of the manual," she says. "I can refer to it privately as a confidante, as a friend. I have turned the corner and I know I will be all right.'
Jane Harris is a pseudonym.
'Bulimia Nervosa and Binge-eating: A Guide to Recovery' by Peter J Cooper (Robinson Publishing, pounds 6.99).Reuse content