John Prescott is the latest well-known figure to admit to having bulimia. One local sufferer tells Judith Cole why she sympathises with the former Deputy Prime Minister - and applauds his courage for speaking out
I was surprised to hear that John Prescott had spoken out about having bulimia - it's rare for a man to come forward and it's just not something I'd have thought he would have had.
However, there's not a typical sufferer so it's good that he has revealed what he went through as it might encourage more men and people in general to get help. And a dangerous thing about bulimia is that it can be kept hidden from the world - outwardly you can appear normal, but inside you're in torment.
I know exactly what he went through. From the age of 16 I had anorexia, and some years later as I tried to recover from it I began to eat more to please other people. But, as I did so, I binged and developed bulimia. I felt disgusted with myself. Making myself sick and using laxatives was a way of getting rid of the food without people knowing about it, I thought.
At age 16 I was a very normal weight, eight-and-a-half stone and dress size 10. I remember as far back as primary school looking at thinner people and thinking they were prettier and better than me. I got the notion in my head that if I was thinner I'd be a better person.
I was in my final year at school when I started a diet that just went too far. The first stage of an eating disorder is denial - your family or friends tell you that you must put on some weight but when you look in the mirror you don't see why they should say that. You focus on the parts of your body you don't like. With me it was my tummy and legs.
Back then, about 20 years ago, doctors didn't understand eating disorders. My mum, dad and sisters all wanted me to put on weight, and it got to the stage when I had to do something to pacify them. I began binge eating, which I hated. John Prescott mentioned the amount of things he ate, and that's how I was — I would eat a whole loaf of bread, a packet of cereal, tin of custard, packet of biscuits, always high carbohydrate things. One of the problems with bulimia is you don't actually lose weight.
While you're making yourself sick your metabolism slows down to conserve energy, and your weight stays much the same. At my lowest ebb when I had anorexia I was just over five stone, but when I had bulimia I was around eight stone. The binging and vomiting does so much damage — it can cause kidney damage and heart problems. You're also bringing up stomach acid which causes burning of your gullet, throat, mouth and teeth. I had stomach problems, gastric reflux and bowel problems because I used laxatives. Damage is also caused to your mind. I became depressed.
When I was in my early 20s there wasn't any real help available. I felt very alone. You're hiding really awful things from family and friends — my family didn't realise what was going on for many years. Throughout it all I worked in the civil service — nobody knew I was ill there, either.
Eventually, I said to myself that I had to get help otherwise I'd die. I just couldn't cope. I was very fortunate to be seen by the only specialist doctor in Northern Ireland at that stage. It was enormously helpful and over three years I made a recovery — it takes a long time. I had cognitive behavioural therapy, trying to get me to focus on more positive things, as well as keeping a check on weight and general health.
It's five years now since I finally reached recovery and I would urge other sufferers to get help right away. No matter how alone you feel, tell someone you can trust. And visit your GP — the earlier you are diagnosed and treated the more successful recovery will be."
* Not her real name
How to spot bulimia — and the help available in NI
Consultant psychiatrist Dr Ken Yeow is one of only two specialists in eating disorders in Northern Ireland. He is based at the Belfast Trust Eating Disorder Service on the Woodstock Road, which serves about 40% of the population here, and tends to deal with the more severe and complex cases.
This service is entirely out-patient, and there is currently no dedicated in-patient unit in Northern Ireland.
In very serious cases, however, patients are sent to England or Dublin for hospitalisation, says Dr Yeow.
Alternatively, patients are sent to local psychiatric or medical wards, although there are concerns some staff there may not be adequately trained in eating disorders.
Plus, people suffering from an eating disorder are often placed beside very disturbed patients — something that Dr Yeow says doesn't contribute to a therapeutic recovery.
"The need for specialist in-patient beds has been an ongoing issue in Northern Ireland, because it takes time to develop both resources and staff adequately trained in eating disorders," says Dr Yeow.
Eating disorders are illnesses that need outside help to overcome, he says.
Like most psychological conditions there are a number of factors involved — common themes are low self-esteem, poor self image, lack of identity, unhappiness with one's self to the point that they believe that they're not good enough. External factors such as stress, trauma or troubled relationships can also contribute.
Sufferers aim to control what they eat, what they weigh and how they can appear in the belief this will give them the sense of identity and self-esteem that they're looking for. The use of food to comfort oneself and bury difficult emotions is another reason bulimia can develop.
"At a very simplistic level, bulimia could be called an extreme extension of comfort eating, as concentration on food can temporarily put these emotions aside," says Dr Yeow. "After binge eating, intense negative emotions of disgust and self loathing lead to the drastic measure of purging themselves. This is a means of control.
"The issue of weight is very much in there as well. It's the belief that in order to be a better person and feel better about themselves, they must control their weight and their appearance. While not always the main factor to the conditions, this would always be an underlying factor."
Though John Prescott has admitted to having bulimia and Sir Elton John is another high profile sufferer, significantly fewer men than women have eating disorders.
Official statistics show only one in 10 of those with an eating disorder is male, but Dr Yeow says that the way the disease presents in men and women is similar, with the same issues of control and low self-esteem.
However, in some male cases, instead of aiming for a very low weight, they want to achieve a perfectly sculpted body. The idea is the same as they are still trying to feel better about themselves by achieving a perfect physical state.
To sit back and watch someone suffer is a hard thing for families and friends to do, but Dr Yeow advises that to maintain an open relationship is key.
"To begin with, you need to make it safe to open up and share difficulties, share worries about exams or relationships, before the person can go on to talk about their eating disorder," he says.
"When family and friends feel the need to be more confrontational and direct, it is helpful to discuss behaviour, sharing the things you have noticed without apportioning blame."
But Dr Yeow stresses that it is only in the most severe cases — usually when the disease becomes life-threatening — that patients may receive treatment against their will.
"It's a very rare circumstance that people are sectioned under the Mental Health Act," he adds.
"It's important to acknowledge that it's the nature of bulimia that eating and purging becomes a very vicious circle and difficult to get out of. At the same time, it is treatable, there is a way out, and it is possible for someone to get treatment."