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Undergraduate student Jenny Tan describes her struggles with anorexia, highlighting the importance of consistent mental healthcare and offers advice for nurses
I started experiencing disordered eating when preparing for my GCSEs at the age of 15. For the first time I was facing the stress of big exams and feeling out of control of lots of things in my life.
Nursing Children and Young People. 35, 2, 13-14. doi: 10.7748/ncyp.35.2.13.s6
Published: 02 March 2023
My dad was experiencing a heart issue at the time and was about to have an operation, and I was about to do my Duke of Edinburgh’s Award expedition. I was under more stress than ever before, which affected my appetite, leaving me unable to eat.
On the first day of the expedition I felt too sick to eat at all. By the afternoon I was so drained and exhausted that I broke down crying and told my group I could not go on. It was from here onwards I found myself restricting my eating more and worrying about my weight.
I first spoke to a GP in 2018. I told them all my symptoms, but my GP did not recognise what was going on. Even though I had not had a period for several months and was feeling cold, dizzy and shaky most of the time, the GP seemed reluctant to investigate any further, claiming my symptoms could be due to a number of ‘minor’ issues, and I wasn’t given a referral or diagnosis.
It was not until February 2020, nearly a year and a half after I initially reached out for support, that a doctor weighed me. My parents, who had realised I was not getting better, had to push for the doctors to support me in the way I needed.
I was referred to an NHS eating disorder clinic near where I lived, where I finally received an official diagnosis of anorexia and started receiving treatment.
As the country was going through the first stages of COVID-19 there was a lot of extra pressure on the nurses and other clinicians. At times the treatment I received felt clinical and dehumanising. The staff often seemed frustrated because they couldn’t find an answer to my problem.
I remember a physical checkup at the clinic that involved lying on a hospital bed while the nurse poked and prodded around. The nurse was not empathetic with me and was quite rough – she was focused on doing a job, not looking after a human being.
It felt clinical, like it was just time to get the job done and move on. In that moment I did not feel like a person, I felt like a patient. If she had tried to get to know me – just some small talk – it would have helped.
My treatment process was made more difficult as I did not fit the models which clinicians use to judge when you are well enough to be discharged. I am British Asian, but the models were based on a typical British white person.
The doctors struggled to say how much weight I needed to put on, and none of the clinicians could work out why my recovery was at a different pace. I had to endure several scans at different hospitals to produce quantifiable data about the state of my recovery.
Learning that I was even more ‘abnormal’ was distressing for me, and my weight restoration slowed dramatically during the time I was waiting for the scans and my results.
In December 2020 I was discharged and judged physically healthy enough to resume my life. Unfortunately, physical health is only one part of living with an eating disorder.
During my recovery there was no focus on my mental health – the nurses and clinicians only seemed to care about my physical health.
Yes, improving physical health does help. But without adequate mental health support I was still vulnerable to the many triggers that can lead to disordered eating, such as discussions about weight gain and exercise. Getting the mental-physical health balance better would better help people with eating disorders.
After I was discharged from the clinic’s physical care I was told I would receive no NHS mental health support, despite having been promised it throughout my treatment.
I was cut off from the clinic and left to continue the fight for my mental health on my own.
Christmas is a difficult time for people who struggle with disordered eating, so being discharged in December was particularly challenging. Nothing was provided to help me get through the mental health challenges I was facing.
I have struggled at times with my mental health since, and have been to see my GP for support with bouts of depression. I take antidepressants and have been seeing a therapist privately.
My therapist says my depression was my mind and body trying to process what I had been through. Because I had not had proper support, I was processing this on my own, but I did not have the tools to do so. Thankfully, the medication is helping, but if I had received more mental health support while in recovery I could have avoided this.
» Monitor physical and mental health during treatment
» Understand the impact starvation and poor nutrition has on an individual’s physical health, cognition and emotions
» Recognise the importance of diet, nutrition, weight restoration and stabilisation in the early stages of treatment on physical and mental health
» Acknowledge the impact the illness has on parents, carers and members of the wider family and involve them in the planning and implementation of care
» Recognise that diet restriction, exercise and other compensatory behaviours are symptoms of the illness and are often fuelled by intense feelings of fear, anxiety and other difficult feelings. The described symptoms can serve the purpose of numbing emotions. Difficult feelings and levels of distress often initially increase when symptoms are managed
» Do not underestimate the value of giving someone time, understanding, care and compassion
» Anorexia is not a short-term illness with a quick, easy fix. What works for one may not work for all. A collaborative approach to care is likely to be most effective
I am doing much better now but I still depend on the support of a private therapist who I see weekly. Consistent mental health support is crucial even after the weight restoration phase, and the mental health side of the illness is definitely a long-term battle.
It has now been nearly three years since I received my diagnosis, and living with my eating disorder is difficult but manageable on a day-to-day basis. However, when stress flares up my symptoms do tend to get worse.
When I started university I was uncertain about how I would manage food, and my parents were worried too. It was important I got the balance of control right. To help me, my mum pre-cooked food I am used to eating, and we put them in my freezer at uni, so I can sort meals easily when stressed.
My first term at university was stressful, but I am proud I have managed to cope with this dramatic change of environment. I still need to be careful when things become more stressful, but living at university often makes me feel like I am in a bubble away from the stresses of the world.
Overall, I am dealing with things much better than I once was. I have more of an objective view of my eating disorder and want to talk about my experiences publicly. Things are less raw than they were last year, and now I want to make sure that I can promote the help that is out there for people.
If people like me never talk about it, nothing will ever change.
This is an abridged version of an article at rcni.com/living-with-anorexia