Agony of anorexia: It's hard to explain but by refusing food I felt good...I was in control

And she enjoyed the usual teenage diet of crisps and chocolate without having to worry about puppy fat. But by the time she was 18 Emily, now 23, had developed the slimming disease anorexia nervosa.

It all began when she was in the sixth form at a school near her Oxfordshire home. For several years her closest friend had been a girl called Jenny but, for no apparent reason, Jenny decided to end the friendship.

It left Emily feeling confused and isolated because she couldn't understand why Jenny had distanced herself.

Friendships among young people often end for no reason, but Emily found it hard to accept that it was over. She felt worthless and not in control of her life, and gradually began to stop eating.

Her dark brown eyes glaze over as she remembers the pain she went through in the early days of her condition.

She says: "I have always been shy and not the sort to make friends easily, so I was devastated when Jenny decided she didn't want to be friends with me any more. "It wasn't that I didn't want to get on with other people, but I just couldn't think of anything to say to them. My self-confidence just seemed to get less and less. I found everything so difficult.

"The anorexia started so gradually. I would simply refuse a crisp or a biscuit. It's hard to explain, but by refusing food I felt good - I felt in control."

The weight began to drop from her slight frame. After sitting her A-Levels she went away to a college in Berkshire, but found it difficult to make friends and became homesick and lonely.

The anorexia began to get out of hand so she decided to leave the course.

She transferred to a college nearer her home and hoped that things would improve, but they went from bad to worse.

Other students noticed how thin Emily was becoming, but she says it still made her feel good. She didn't want to hide herself away by wearing baggy clothes - on the contrary, she felt proud of what she had achieved.

"People commented on how much weight I was losing and that made me feel as if I was really interesting.

"I would think about food all the time. I would feel really pleased that I was disciplined enough to not eat it."

The recommended average daily calorie intake is between 1,500 and 2,000 for women, but Emily allowed herself only 200 calories a day. Her daily menu consisted of half an apple, a few carrots and half a slice of bread.

The recommended weight for a 5ft 6in woman is between 8st 12lb and 11st 1lb. But Emily's weight plunged from just under 8st to 5st 10lb. She became too weak to cope with the demands of the course and had to drop out.

Yet though she was obviously painfully slim, she still could not see it as a problem. She remembers: "I used to buy children's clothes because size eight was too big for me. I felt really clever that I had dieted so much that I didn't fit into adult clothes."

Emily's parents could not believe what was happening to their daughter. They were good parents to all three of their children and tried to support Emily in their own way.

Her mum cooked delicious meals and tried to tempt her to eat, coaxing her at the table to try the food - even if it was just a little.

But by this time the anorexia had taken such a hold that Emily began to miss mealtimes entirely because she wanted to avoid the confrontation.

Emily's problems were more far-reaching than the anorexia. People who suffer from eating disorders often also harm themselves externally by cutting or scratching their bodies.

If she was stressed, Emily used to mutilate herself five or six times a day by slashing herself with sharp stones or even razor blades.

"I was doing it for attention," she says. "I found it hard to make friends, but when I harmed myself I would get lots of sympathy and people would be nice to me." The situation spiralled out of control and in 1997 Emily tried to kill herself by taking an overdose.

That was when she was referred to the adult eating disorder service, based at the Warneford Hospital, in Oxford.

A special programme was designed to help Emily learn to eat a balanced diet and cope with her psychological problems.

And though it is taking time, it is clear that the regime is working. She now weighs 6st 5lb and feels well on the way to her target weight of 8st.

Her daily menu includes cornflakes for breakfast, beans on toast for lunch and an afternoon snack of yoghurt or a cereal bar. Evening meals are still a problem.

Emily says: "I wouldn't dream of eating something like lasagne. It's hard to know just how many calories it has in it. You have to be so careful."

As I look at her I suddenly feel very aware of my hulking great frame. I weigh in at 9st.

Meeting an anorexic is an sobering experience for someone like myself, who is constantly on a diet.

Being thin did not make Emily happy. There's a message in there somewhere. Having an eating disorder is an isolating experience. So much of society is centred around food, but if you don't eat, or if you vomit when you do, life can be difficult.

The true extent of eating disorders in this country is hard to quantify. Research by the Eating Disorder Association (EDA) shows that around 34 people per 100,000 in this country develop an eating disorder, with 40 per cent of them becoming anorexic and the rest bulimic.

The highest risk age group is between ten and 19.

Research published this week by Dr Philip Shoebridge, consultant child psychiatrist at the North Bristol NHS Trust, suggests that over-anxious mothers may contribute to the development of anoxeria in teenage years.

Medical history experts say they have found documentation of cases of apparent anorexia dating as far back as the 1600s, when young women took religious fasting to the extreme. However, it was not until the 1950s that the condition was given its name.

Stick-thin supermodels such as Jodie Kidd and Kate Moss come under fire for supposedly inciting girls to develop eating disorders in a bid to look thin.

But what the critics fail to understand is that people do not become anorexic or bulimic simply because they want to look like a model. Instead it is a manifestation of other, deep-rooted psychological problems. Steve Bloomfield, spokesman for the EDA, says: "Body image is not a trigger for an eating disorder - that is certainly a misconception.

"Pictures of models do not cause the condition, but they create a mindset that can develop into an eating disorder. It can be an influence, but certainly not a cause."

Mr Bloomfield says the key to understanding disorders is found in a person's lack of self-confidence or self-esteem.

Food becomes a means of communication for sufferers and they take control of their diet in a desperate bid to assert themselves and find a way to cope with their problems.

But starving a body of nourishment through anorexia inevitably takes its toll.

A lack of calcium leads to the brittling of bones and the possible development of osteoporosis in later life.

The condition can also lead to heart complications. Other short-term effects that women with anorexia often suffer include irregular or stopped periods, and the growth of a fine all-over body hair. However, it's not just the impact on the physical and mental health of the sufferer that takes it toll.

Parents who are heartbroken to see a child wasting away before their eyes are left wondering where they went wrong.

Their natural instinct is to nourish and protect their child and they are left feeling helpless.

Recovery from an eating disorder is a gradual process. Severe cases are generally referred by GPs for treatment at centres such as the Oxford adult eating disorders service, which is based at the Warneford Hospital.

There psychologists and psychiatrists work with patients to tackle the deep-rooted cause of the disease.

Story date: Wednesday 02 February

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