Understanding anorexia: A thin excuse

Naomi Hooke has delved deep into the causes of the anorexia that nearly killed her. But of one thing she's sure – it had nothing to do with 'size 0' models

It was two days before Christmas, and for the third time in my 20-year-long existence I found myself having my blood pressure monitored, my blood taken for biochemical analysis and my mental state being assessed for risk of self-harm and suicide. Once again, I'd been admitted to an eating disorder unit, rescued from my own little world of self-destruction. The day before, I had filled my every hour with food (or rather the avoiding of it), exercise, my ongoing obsession with academic work, and fantasies about a future where I wouldn't be there to spoil everything.

My parents came to visit, my younger sister excited in anticipation of present-opening. It hurt to sit up, and hurt to lie down, yet I refused to believe that this was due to starvation and muscle wastage. My family brought me a stocking, but I couldn't understand how they would ever think I deserved nice things. I left the presents unopened for over a month.

I'd suffered from anorexia to varying degrees since I was 11, hiding food and concealing my body under layer upon layer of clothing, and once again it had caught up with me.

As London Fashion Week continues, the controversy surrounding "size zero" models is once again up for discussion. Prompted by the Madrid ban on models with a BMI below 18.5, fashion capitals around the world have undertaken enquiries into the links between eating disorders and the catwalk. Although any measure to protect models at risk of eating disorders is to be applauded, to believe that the fashion industry causes eating disorders is to completely misunderstand this most complex of illnesses.

At 11, I was showing early signs of puberty, and the prospect of an adult life ahead terrified me. I was afraid of responsibility, of a time when I would have to face the world without my parents' hands to hold. But most of all I was scared of men and sex.

Throughout my illness, even when I was motivated, I was convinced that recovery was impossible. But miracles do happen. I was in the grip of anorexia nervosa for more than eight years, but with a lot of help from family, friends and professionals I was able to turn my life around.

Anorexia has often been perceived as a quest for model-like beauty, as a teenage fad or as a diet gone wrong. It has even been described as a lifestyle choice. Seldom is anorexia acknowledged as the life-threatening medical condition that it is. Many anorexics detest their bodies, refusing even to pose for family holiday snaps. I, like many of the eating disorder patients I have met, never sought beauty; instead, I spent years trying to make myself look as ill as possible in order to avoid male attention.

As far back as I can remember, my self-esteem was low and I lacked confidence. Children can be cruel, and although they weren't the "cause" of my eating problems, the bullying I endured throughout my schooldays only added to my feelings of self-hatred.

It is often assumed that the distress in anorexia revolves solely around food and weight. However, the vast majority of eating disorder patients have numerous other difficulties, including low self-esteem or confidence, lack of self-care, and social difficulties. Sufferers are often presumed to pour over the pages of glossy magazines and starve themselves in their aspiration to become glamorous, thinner-than-thin sex goddesses. From my own experiences and from those of numerous other eating disorder patients I have met, I can say unequivocally that nothing could be further from the truth. Beauty has very little to do with eating disorders, and the desire to be thin is merely one of many symptoms. Rarely can a single "cause" be identified.

On the ward, Christmas had been and gone, and it was beginning to dawn on me that I would not be well enough to return to university. I was convinced that, once again, I had failed. During those weeks, I hit rock bottom. After years of pretending, I finally opened up to staff at the hospital, and began speaking about some of my troubling innermost thoughts.

I had never felt so ill; the pain was excruciating. My memories of this hellish period are sketchy, but I have since been told that my kidneys were failing and that I was at risk of cardiac arrest. I had many meetings with the doctors, and eventually I agreed to be fed via nasal gastric tube. It was horrible when they passed the tube, though deep down I know it probably saved my life.

It was at this point that something flicked inside my head. It was as though I'd "swapped sides": I stopped fighting everyone who was trying to help me. As the weeks went on, my stomach ached as it was stretched to accommodate food again. It still took me hours to eat a bowl of soup, and I still had a tube up my nose, but nevertheless, things were getting better.

I wasn't an easy patient. I cried and screamed and threatened to run away. But in spite of everything, staff at the hospital never gave up on me, and I'll remain eternally grateful for every hug and kind word.

Although my first trip home was challenging, it did open my eyes. At last I began to see how much anorexia was holding me back. I was getting stronger, thinking more logically, and perhaps most importantly my sense of ambition was returning. I started to dream about getting back to university and one day being able to help people with mental illness myself.

I spent seven months as an in-patient and two more as a day patient. I regained a healthy body weight, spent numerous hours discussing my underlying fears and was slowly beginning to develop a sense of self-worth.

My fall into the dark world of anorexia was never influenced by fashion or waif-like celebrities, though I knew others whose recovery from life-threatening illness was indeed hindered by the Western world's culture of thinness. I believe that the British Fashion Council's guidelines will go some way to protect the models themselves (of whom 40 per cent are said to suffer from eating disorders). However, I see problems both with the approach taken in Madrid of banning models with a BMI under 18.5, and the recent health certification scheme proposed in Britain.

Although BMI can offer a crude measure of physical health, it can never quantify psychological distress. Despite popular belief, low weight is not the only danger of eating disorders. There have been times in my life in which my BMI has been in the healthy range and yet my eating behaviours and mental state were far from healthy. I would starve myself for days on end before my body gave in to the pains of hunger and I would binge, after which I would feel so disgusted with myself that I would make myself vomit and/or cut myself with razor blades.

As for doctors' certificates, it takes considerable time and skill to assess whether an individual has an eating disorder, not least because sufferers often go to great lengths to hide their illness. I've been there, told the lies and tricked the scales.

It is a fact that a higher proportion of models suffer from eating disorders than do the general population. The "grooming" and competitive atmosphere undoubtedly perpetuate eating disorders within the modelling profession, but I am personally of the opinion that young girls with existing eating disorders are selected by modelling agencies because of their tiny figures. But, although the fashion industry may be rife with anorexia, the majority of eating disorder patients have not become ill through catwalk influences. And nor are they models.