THE first thing you realise after talking to a few patients and staff at Cotswold House, Headington, is that the common perception of anorexia and bulimia being mostly driven by body image is untrue.
In fact, the need for control, to have their life dictated by order and routine is what motivates most of the people who attend as day and inpatients at the unit, at the Warneford Hospital, rather than seeing themselves as “fat”.
Consultant clinical psychologist Nicky Boughton, who helped set up the service in 1994, said: “It is completely over-egged in the way it is presented in the media. Many patients know they are thin.”
She said: “The kind of people who develop eating disorders are perfectionists. They are very much all or nothing.
“They are obsessed with getting the best results which becomes impossible and becomes their downfall.”
Adding that high achievers are particularly at risk, Mrs Boughton said: “Part of the therapy is helping them with their thinking. They focus on little details and don’t see the bigger picture.
“Although it is a severe mental disorder, people don’t see it like that. They think people are vain and concerned about what they look like.”
The lack of specialist care motivated her and colleagues to set up the unit – supported by another in Marlborough, Wiltshire – to tackle what she said is the mental illness with the highest death rate for the under 65s.
Before then, sufferers were sent to general psychiatric wards or specialist units far from home.
It was first hoped that by seeing people early on in their crisis without the need for overnight stays in hospital, they could stop the onset of a severe eating disorder.
She said: “Unfortunately that was not the case because there are patients who feel they can’t let go so they have very low weight and are on the edge of severe illness.”
This led to the opening of a seven-bed inpatient facility in 2003, now expanded to 14 beds, and still supported by day care for non-residents.
Today the service, run by Oxford Health NHS Foundation Trust, supports about 250 women from across the south of England.
Rather than delve deeply into the root causes of people’s problem, the service focuses on how people can change their behaviour with techniques like cognitive behaviour therapy, now widely used in the NHS to treat anxiety.
Mrs Boughton said: “It is very much about managing your mood by other means.
“It is about being aware of how you feel and finding a different way of managing it.
“For many people, to get things going, it is about being practical, getting them eating again and getting them to deal with their situation.
“You used to think you can just do therapy but the reality is nobody can make use of proper therapy while they are very starved.”
Ensuring people eat enough and regularly is therefore vital, she said, and staff hope to turn around outpatients’ disorder through 20 to 30 weekly sessions.
It’s not an easy challenge: “It is difficult nursing people with anorexia – they don’t want to be helped,” she said.
About 50 per cent of its patients – nine in ten are women – recover with a further 25 per cent finding a way of “living with their long-term illness” and the remainder struggling to overcome their disorder, she said.
“The main reason people tend to get better is actually when they realise they are sick of being ill and the restrictions that imposes on their life and they can have a different life and are brave enough to take that step.”
It works with Oxford University’s Department of Psychiatry on new treatments in what is still a complex and often misunderstood problem.
Mrs Boughton said: “We still haven’t got the definitive treatment for anorexia but we have spent a lot of energy in enabling those who live with it to live fuller lives.”
Looking back, she said: “It is fantastic, it makes you feel ‘wow, there is a reason’.
“Sometimes you see people come back and you tend to forget those who are successful.”
FROM PATIENT TO STAFF MEMBER
DR BECKY McKnight, below, said her 2004 to 2010 battle with her anorexia – including a seven-month inpatient stay – inspired her to tackle the issue in her professional life with a job at Cotswold House.
The psychiatrist, who studied medicine at Oxford University, said: “I feel I have a unique insight into what it’s like to have mental health problems compared to the average doctor.
“The things that led to it were probably intense pressure to perform really well academically. I put pressure on myself to do that.
“One thing I felt was out of my control was my weight and shape and if I thought if I can control that I will do well academically.
“People have different reasons they want to take control but, at the end of the day, it is that control.”
Asked how the unit helped, Dr Knight, 30, said: “I wouldn’t have finished medical school. It is hard to say whether I would be alive or not.
“I wouldn’t have a career or the relationship I have got. I wouldn’t have my son because I wouldn’t have been able to have a child.”
‘MY NEED FOR ACADEMIC SUCCESS LED TO ILLNESS’
ANNA King, 20, above, said the pressure to succeed academically contributed to her eating disorder and stay at the unit from March to July 2012.
The Nash, Buckinghamshire, resident said: “There was definitely a mould for life which was school, exams. An A was acceptable, a B was failure and an A* was what you should be getting.
“I have always been a bit of a perfectionist and had obsessive tendencies.
“You can become very controlling and eating comes quite high on that list.”
She began shunning food in her first year of a maths and philosophy degree at Edinburgh University and her weight fell from 9st to 5st. Daily exercise and only eating small portions like two pieces of melon saw her weight plummet.
She said of her stay at Cotswold House: “Once they got me on the right medication then everything changed.
“Without it I could quite possibly be dead rather than be very, very happy with my life.”
It also helped her realise that practical work as a hotel pastry chef was her path to happiness. She said: “I’m the happiest pastry chef in the world.”
‘I PUT A LOT OF PRESSURE ON MYSELF TO DO MY BEST’
MODEL Tiffany Saunders, 23, above, said her need for control and not her career in a body-conscious industry led to her dangerously low food consumption.
Miss Saunders – modelling from the age of four – was an inpatient from February to May 2012 when her weight dropped to a low of 5.5st.
She said: “My life was incredibly structured and rigid. My mind was all over the place and I didn’t necessarily have time for breakfast. If I ate, it was an apple.
“I just didn’t know how to manage everything. Being an inpatient forced me to stop and rest and eat.
“It was incredibly bad anxiety, I became very anxious about a lot of things. I was fearful of the big wide world and the reality of growing up.
“I put a lot of pressure on myself. I had to do everything the absolute best. It meant I was controlling what I ate. Eating became my coping.”
Despite commercial modelling in media like catalogues, she said low self-confidence led to her disorder and stay at Cotswold House.
She said: “When I got to the January I wanted to change and started to work with them rather than against them. That was when it worked.”
‘NOW I AM ABLE TO EAT FOOD WITHOUT FEELING GUILTY’
EATING disorders are harder to treat as people get older and Jane Donnelly, 52, above, finds it an ongoing battle.
She has struggled with her eating disorder since 11 at a time when such conditions were little understood, saying: “I just ate very little.”
She said: “I didn’t fit the mould, I’m not a young girl, I’m older.
“I used to run up and down the stairs as a teenager because I was worried about getting a big stomach.”
Her weight fell as low as 5.5st.
She said: “Now things are different because Cotswold House will take people of an older age.”
Undiagnosed until her 30s, she said 10 years ago she would have been “terrified” of the chocolate cake at the unit’s birthday party.
While doctors are encouraging her to raise her weight, she said: “I make sure that I can enjoy food now and not feel guilty afterwards.”