Twenty-two people with an eating disorder have died in Northern Ireland within a decade, shocking figures reveal.
It has led to calls for more to be done to tackle an issue campaigners say is like a bully.
Debbie Howard wants the health service to refer those struggling with the condition to a support charity for carers, FightED, which she established after overcoming the problem.
The 37-year-old, from Bangor, Co Down, went to the Commonwealth Games as a teenage gymnast and endured years of counting calories and attempting to keep her weight down for sport.
She combated the natural tendency to gain weight after retiring from competing by vomiting or taking laxatives.
She said: “It is this punishing dictator in your head that rules everything that you do.
“It is like a bully, you are at its mercy a lot of the time and if you don’t do what it tells you, you get punished.”
A total of 20 women and two men with eating disorders died from 2008 to 2019.
A Freedom of Information request to the Northern Ireland Statistics and Research Agency unearthed the information from death certificates.
That included three women whose deaths were registered in 2018.
Ms Howard said eating an apple felt like “giving in”.
She added: “That is pathetic, why are you so weak, you are going to have to do better tomorrow, now you are going to have to go and do ‘X’ amount of sit-ups to get rid of that.
“It is really hard, a lot of your time is taken up thinking about this food, and calories and fat, and your size and what you look like, and weighing yourself, measuring yourself.
“Your whole world shrinks to just what you look like.”
Problems began with cutting out food aged 12. She went into therapy aged 22 and skeletally thin, undergoing four years of weekly therapy sessions.
She said: “Eating disorders are not actually about food, they don’t get solved with someone beginning to eat again and being put on a food plan, they are psychiatric disorders.”
Speaking of when she was a gymnast, she said: “The culture at the time was around having to lose weight and being weighed regularly, and having targets to get through, and being praised when you had lost weight.
“In that environment it was pretty much just restriction, and when all that was taken away I felt that now I don’t have to do that, I can eat whatever I want.
“But I could not cope with gaining weight because I felt fat when I was underweight.”
She said if treatment had to take place on an outpatient basis it made a lot of sense to train family members.
She wants GPs to refer people to the course, which she said was effective in improving the burden and distress that carers experience.
Last month the Belfast Telegraph reported how the number of people diagnosed with eating disorders in Northern Ireland has almost doubled in the last seven years.
In 2011/12, 272 people were diagnosed, but that had jumped to 518 in 2018/19 — up by 90%.
Emergency cases drastically increased from 225 seven years ago to 452 last year.
But campaigners fear the figures are “just the tip of the iceberg”.