"I am now 31, and have been struggling with intense bulimia or anorexia for about three years. I had a brief period of anorexia and bulimia when I was about 14, but my present difficulties were initiated by the break up of a long-term relationship when I was 28.

Throughout my education and work life, what now expresses itself through the eating disorder was being played out in other ways - drugs, drink, gambling, sex, obsessive study, obsessive pursuit of arbitrary goals, intense self-criticism and judgment. These were bad coping mechanisms, but otherwise I had mostly had a happy and fulfilling life. I maintained strong relationships, was socially confident, achieved well in my studies and progressed well at work - although I always hated the jobs I did. I started a long-term relationship when I was 20 that would last 8 years, and strayed into a career path that qualified me to become a financial adviser; but, hating the whole industry, I went back to university to study something interesting, and graduated with first class honors. I then applied to do a master’s degree, and it was in the intervening period that the eating disorder developed, which robbed me of most of my achievements in life.

When I finished my BA, I was in a job I loathed, waiting to start my MA. My relationship was troubled, and - an anxious mind with no immediate occupation – I began to obsess about diet and health. I learnt about nutrition and the science behind exercise and body composition, and decided to try and lose fat while gaining muscle. By the time the MA started, I was exercising hard, working full time, and was increasingly anxious about the relationship. I was constantly exhausted and often unwell, and after a few months something had to give, so I postponed my studies for a year with the view of saving up enough to go part time next year.  

I’ve never been one for Christmas, but the Christmas of 2005 was being attended by certain family members I didn’t get on with. This, plus the mixture of tedium, alcohol and high calorie food made the prospect of Christmas with the family very unattractive, so I decided to stay on my own. What I didn’t realise was that my relationship would pretty much fall apart just days before, and being alone would prove intolerable. My mother, bless her, wanted to make sure I had every conceivable food luxury for the day, while I’d received chocolates and bottles of wine and the like from friends and colleagues. On Christmas Eve, beside myself with worry about the relationship, unable to distract myself with crap TV, I ended up drinking and eating until I was so full I couldn’t move. I woke up appalled at myself, and with a great need to make up for it I spent most of Christmas day trying to burn those calories. I starved my way through 2 hours of intense weights and resistance exercise, and then about 6 hours of vigorous walking. I had given myself a cold, harsh, miserable, lonely Christmas day, and returning home, still worried about the calories I’d consumed, and unwilling even to ad milk to my tea. Pretty soon, I just gave in and binged. There was no way I was going to punish myself with exercise and starvation again so I decided to make myself puke even though I hadn’t done it for years and had never been very good at it.

I vomited what I could, but soon felt very weak and shaky and was at the fridge again. I spent the rest of Christmas 2005 bingeing and purging everything in sight, eating a massive block of cheese like it was an apple, eating so rapidly and animalistically I didn’t care much for how I would feel after. On awaking, though, I worried obsessively about how much my body absorbed from the binge, and the bulimic pattern begun. The vomiting felt like a friend who came to the rescue, but one who could only achieve so much, so I wouldn’t call upon them too often – only to take the edge off the a binge I was going to have anyway – a form of damage limitation.

In the New Year I split with my partner and had to find somewhere else to live. I was in no mood for this, so just took the first affordable bedsit I came across – a real shit hole as it turns out - unspeakably grim. Over the following months the exercise intensified, as did the obsession about healthy eating; and the bingeing/vomiting become more regular and intense. They started off maybe about 4,000 calories, but then ran into tens of thousands and lasted hours. I was becoming insensitive to fingers when trying to gag, so used utensils, then washing up brush handles, then unraveled coat hangers, then lengthy cables. My esophagus often tightened around these implements, and pulling them out would be painful and draw blood. Eventually, however, I had weakened my upper sphincter enough to bring up my stomach contents without using any implements. This was not helpful to my illness; vomiting became as easy as going to the toilet.

I couldn’t vomit in the communal toilets regularly, so used buckets and washing up bowls in my room. To dispose of it, I initially tried to poor it into bin-liners which I’d double or triple wrap, but this didn’t stop leakage, and there’d sometimes be a smell trail through the communal corridor. So instead, I’d strain the vomit though a colander, and allow the liquid drain down the sink. The vomit would drain slowly and clog the colander quickly, so I’d have to puor, wait, stir, puor, wait, stir - a painstaking labor that would last hours. I put the strained vomit into double wrapped bin-liners, and still there’d be a smell and occasional seepage as I took the rubbish out. The puke and the rest of the carnage from the binge would produce huge amounts of smelly garbage that would stink out the communal rubbish area, which was outside the window of the front flats, and was noticed by neighbors who thought it was a drainage issue. This was a constant cause of guilt and anxiety, but I tried so hard to stop, without success.

In October 2006 I re-started my MA degree, and sought treatment from my GP. I was referred to a psychiatrist, who proscribed 60g of Prozac daily and referred me to a psychologist specializing in eating disorders for which there was a waiting list of some months. Within a week of starting the medication, there was a sudden intensification in the bulimia – though at the time I didn’t suspect a link. All of a sudden, not only was I bingeing and purging every day, I was overwhelmed by a sleepless obsession about food, and given limited means, ended up shoplifting recklessly – in quantities that would have to be seen to be believed. Very quickly I became unable to work or study, as I was waking up in a terrible mess every day. The exercise and any concern about health went out the window; instead I walked miles and miles trudging massive shopping bags around all day, and rapidly lost weight. I could tell a hundred stories about the shoplifting – how I’d manage to get enough food for a family for a week every single day, often with no money - ways I used to get maybe four or five Bags-For-Life full of shopping from a single store without paying for it. I got caught many times, and was arrested three times, but luckily was never punished except for a fine, and never received a criminal conviction.
 
Aside from the binges, my basic diet was low carbs, veg, and low fat protein, with copious amounts of green tea and coffee. I was chronically fatigued, became very underweight, had hardly any sleep, and on those rare occasions I chose to rest, all I was capable of was zoning out to trashy daytime TV. I was having to put so much energy into finding money, buying and steeling food, disposing of vomit, trying to keep things, if not clean or ordered, at least functional, that there was no room for anything else. I became paranoid and isolated and afraid to read my mail; I used to wake up with food and vomit everywhere – splattered on the carpet, on my body, in my hair and in my bed. My room stunk, and my carpet looked like the scene of a crime – a mass murder, except dirty pots, pans and plates for bodies, and puke for dried blood in dank Technicolor. From time to time, neighbors or other visitors would knock on my door and sometimes want to come in. I had a basic bedroom style door so if there was any sound or light from my room I couldn’t pretend not to be in. I’d be on edge all the time, turning everything off every time I heard the front door shut or footsteps coming up or down the stairs, and when people did catch me unaware, I’d talk through the closed door, refusing to open it.

There is no way I could do justice to the pure horror of my life during this period; there are so many stories. I had an electricity meter, and one night, in the middle of a binge, the electricity went and I had no money to re-activate it. I had no means of lighting the room so had to abandon the binge and find my way to bed. I ended up putting one foot into a washing up bowl of puke, and then kicked over a bucket of puke, and there was nothing I could do about it, so I had to leave it, and I crawled, puke covered, into bed. Another time I must’ve fallen asleep mid-binge, because I had a bowl of ice cream in front of me, now melted. Panicked, my instinct was to quickly eat everything left and then puke. Half way through the ice cream there emerged a piece of broccoli, which made me realize I’d already eaten this – I was eating a bowl of puke.

So, my bulimia had become totally pathological after taking the Prozac, and the following months saw my life fall apart in every conceivable way. I had to quit Uni. again, lost my job and was without money all the time and constantly in need. I was powerless over my situation, and extremely frightened and this created a trauma that continues to haunt me.

The turning point began when, by chance, I discovered a connection between my worsening symptoms and the medication. It became clear when I lost the Prozac and couldn’t be bothered to get more. I noticed a daily strengthening of my mental grasp on life, which after a week or so was strong enough to gain a perspective on what was happening with me. It was also about this time that I received the appointment with the psychologist, and this allowed me to embark on a long and incremental process of taking back some control back over my life. The therapy lasted for about 9 months and enabled me to develop some control over the bulimia, although it took a whole year of daily bingeing and purging before I was able to have a single day without it. I left therapy much more stable, thanks to my great therapist, yet still severely bulimic. The therapy introduced enough stability to make it possible to move out of my awful bedsit into a one bedroom flat, and to take up my studies again. Although I would have liked it to continue, I feared becoming too dependent on my therapist, and didn’t feel my needs justified her help, which was in great demand. I continued to make progress with the bulimia beyond therapy; it was like I had internalized her voice and wisdom, which had set up a useful agency in my psyche; but the underlying anorexia was never dealt with. Anorexia was never a problem for me, and I probably tended to cover it up. Through bulimia I was at least exposing myself to different foods; without it, the anorexia was beginning to show through, and in fact get worse.

I made my doctor aware of this in January 2008, but unfortunately I got a completely different reception from the one I’d encountered before. I was with a new practice, and saw different GPs all the time. There were lost referrals, referrals to inadequate services, and a great deal of ignorance and prejudices regarding treatment for eating disorders, much of which I’d put down to my gender and my age. I didn’t present as the stereotypical eating disorder sufferer; an adolescent girl under the care of her family. The diagnosis of an eating disorder seemed to be forgotten, and the target for treatment became depression or anxiety. Of the various health professionals I saw, some were sympathetic, some suspicious, almost all without insight into eating disorders. The National Institute for Clinical Excellence (NICE) guidelines are very clear about the appropriate treatment for people with anorexia or bulimia. However, I experienced no such awareness among the GPs. One said “you’ve had treatment– what more do you want?” Another asked “What do you think we can do about it? All you need to do is eat a healthy, balanced diet”. This same doctor argued against monitoring my nutrient and electrolyte levels on the grounds that “it is likely to be normal in fit and healthy young men”, and refused to prescribe nutritional supplements on the grounds that I should be obtaining these from a healthy balanced diet. This was despite the fact that I conformed to the entire diagnostic criterion for anorexia, and for bulimia where bouts re-emerged.

When my GP was finally persuaded to carry out a physical examination and blood tests, these revealed “hyper calcaemia”, “hyper cholesterol anemia”, “hyper protein anemia”, “raised foliate and B12”, and body “ketotic” and a “deeply catabolic state”, and a very low BMI.

I am finally being listened to, but still await any concrete news with regard treatment. Much has been lost during this treatment limbo, but I have now woken up to the seriousness of the trajectory my illness is taking me on. Without professional help I’m going to find it extremely difficult, perhaps impossible, to overcome my eating disorder, but I feel at least hopeful I can stop it from getting any worse. There are absolutely no local services for eating disorders, and an obstructive and complex process for out of area referrals; but things appear to be moving forward and I am hopeful of getting this help soon. In the meantime, I take what baby steps I can to try and keep in check the decline in my physical health. Every meal is a fight, but I have a supportive network now, and I am at last optimistic."

Aaron, 31