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Teenage Problems/Eating disorder or just low self-esteem??

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QUESTION: Hi Daryl,

I'm 21 and female.

I will start from the very beginning however relevant/irrelevant it may be...

So when i was about 15 (iím saying 15 but i donít really remember) i had big issues with eating in front of people. Mainly because i felt fat and didnít want to be judged (i donít remember if this started before or after a boy told me i was fat 100 times a day because i didnít see it as a problem and therefore doesnít stick in my mind). Anyway i would skip breakfast and not eat at school. I would throw away my packed lunch so my parents would think iíd eaten it and then just eat dinner at home. This continued through college and at uni iíd have problems cooking and eating as so many people lived in my flat but by second year it got a little better.

Then in third year of uni (last year) i went to Sweden for 4 months where things turned bad. I wouldnít cook in the kitchen because it was so dirty/disgusting and i wouldnít eat there because of too many people. I wouldnít eat breakfast, eat little for lunch at a nursery i worked at (it was provided) and then eat cereal for dinner. At the weekend i would eat only a tin of tuna or sweetcorn and maybe some cereal in a day. I realised i was losing weight, liked it so continued with it.

When i got home i had lost 13 lbs and became obsessed with my weight and continued as i did in Sweden. Then at Christmas i gained a few pounds and became angry with myself. So back at uni i refused to eat bread, rice, potato. I would only have skimmed milk and felt guilty if ever i had a bit of semi-skimmed. I also went through a phase where all iíd eat was cereal which had the lowest calorie content. I would read all the calorie labels in shops and choose the lowest. I stopped drinking squash and would only drink water to lower calorie consumption. I started exercising 4/5 times a week and became obsessed Ė if i missed one iíd feel guilty/fat. Then i bought some scales, became obsessed and virtually weighed myself every day.

I lost weight at uni then threw the scales away when i came home after graduation so my parents wouldnít know. At home i would take food from the fridge and bread, throw it in the bin, put crumbs on a plate and tell my parents iíd eaten it when i hadnít. Then in September 2012 i went to Africa for 2 months and ate really badly because so many people were in the house and a lot of the food provided was very unhealthy. People kept commenting on my eating which then made it harder to eat. I came home, weighed myself, lost weight but wasnít happy so bought new scales and hid them (i weigh the same on both). In total since before i went to Sweden in September 2011 i have lost 21 lbs. I now weigh 104 lbs at 5ft 2".. which i know is a healthy weight.

Basically, what is wrong with me?! Now i am back home from Africa i go through phases on eating LOTS when no one is around and then hiding the evidence. Is it just because of low confidence?? I really do not know.

Sorry the message is long, and thank you in advance.
Sophie

ANSWER: Hi there Sophie,

Thank you for taking the time to write to me and I hope that I can help.

Firstly, it is good that you are looking at your eating habits and are conscious that there may be an issue with the way in which you manage your diet; recognizing that there may be a problem is always the first step in getting appropriate help and helping yourself to feel better about who you are, so you have taken a huge leap forward, well done!

Secondly, there is a fine line between someone who takes an active interest in their diet to the point where they are aware of their calorie intake and someone who becomes infatuated with every calorie consumed. Monitoring your weight and diet is a positive way of maintaining a healthy lifestyle but having an obsession with it to the point where you skip meals or feel guilty if you eat the 'wrong' foods is not.

From what you have described to me, it does sound like you could have the symptoms of anorexia because you have been hiding your lack of eating and are secretive about your eating patterns. By the fact that you are clever about how you have been hiding this issue (hiding the scales, putting crumbs on the plate etc) tells me that you are perhaps too conscious about both what people think about you and the fact that you know that this behaviour is not healthy. Add to the fact that you are exercising too much and punishing yourself when you are eating 'normal' foods, again suggests that this is more than just an issue around your self esteem and you could be anorexic.

Eating disorders tend to take root in young, female teenagers more than they do in young, teenage boys and this is because girls are more susceptible to internalising what their peers are saying to them which means that a 'throw away' comment can have lasting effects and this could be what has happened to you. The uncomfort that you have had eating in public may stem from this experience with this idiot who called you fat and because you were eating when he made the comment, you have began a negative association with food; believing that all food will make you fat when it will not. We are at our most sensitive and vulnerable during our teens when we want to fit in and be liked and it is during this time that we begin to develop our habits and behaviours which shape our adult lives. Traumatic experiences or negative experiences have a long lasting effect upon us. Your aversion to eating in front of people may or may not be linked to what this idiot said to you but it reinforced the idea of your insecurity around food and eating; making you feel uncomfortable about food and eating in general. Whatever the trigger, it has set you on an unhealthy course with food and dietary management and this will have impacted not only your physical health but also, your psychological well being.

Some people who develop eating disorders do so out of the need for control in their lives when they feel that this may have been taken away from them in another aspect; but some, develop something called body dysmorphia whereby what they see in the mirror is an extreme negative of the reality (for example, they think that they are fat when they are not). With you, it sounds like you had insecurity about eating in public that was reinforced by the experience you had with being called fat and from then on, you have developed a sense of identity through the ability to manage what you eat. The fact that you may have put yourself in danger through your over exercising and lack of eating is only part of the problem, the other part is the fact that you would continually push yourself further and further to see what else you could cut out of your diet to make you think that you are at a right weight. The good thing is that you are still young and can make the changes you need to be happy and healthy; as well as the fact that you think that there may be a problem. I cannot diagnose you through the internet but it does appear that whether or not this is low self-esteem or an eating disorder, it needs to be addressed.

At the moment you are at a healthy weight with a healthy BMI and this does not mean that you are fat; but that you are 'normal' and this is where you should aim to keep yourself. You can do this by eating a balanced diet and by going to the gym; but not by stopping yourself from eating nutritious food or nothing. There are several diets on the Internet that millions of people have tried but the fact is that they do not need to follow a specific diet. As long as you eat a balanced diet and exercise, there is no reason why you have to restrict your food intake or limit the foods that you eat. In fact, if you do limit your calorific intake you can begin to do your body damage and cause further complications because of vitamin deficiency. You will also begin to feel sluggish, tired and emotionally drained because you may never meet the expectations you set yourself in weight loss or you will keep beating yourself up when you should not be. This association with food and being fat, as well as the need to exercise a lot needs to stop if it has not done so already and I would always recommend that you get some form of help in case this goes too far.

Your friends, family and colleagues at Uni all care about you and they want you to succeed in life and be happy and healthy. You are deceiving them by hurting yourself and this is not fair on them or you. You have an incredible future ahead of you and you can achieve so much but if you focus all of you attention onto what you eat then you will miss out on so much of life's experiences and limit your potential.

I would recommend that regardless of whether or not this is low self-esteem or an eating disorder that you speak to your GP and ask to be referred to a CPN (Community Psychiatric Nurse). This will give you the opportunity to speak to someone who does not know you, identify key issues and through a course of CBT (cognitive behavioural therapy) change your coping strategies to be more positive. CBT may only take one session or several and it is something that has been proven to be effective in all sorts of psychological conditions including low confidence, depression, anxiety and stress and it may work well for you. Getting better will start with taking the second hardest step and speaking to your GP; but do not think that you are on your own or have to go through this alone, you do not.

There is a link below to the NHS Choices website and information on eating disorders. It is a good thing to look at because it talks you through treatment options, symptoms and possible causes and you can apply these to yourself and your current situation. Please do not do yourself an injustice of thinking that this is something that just happens or something that is just part of you; because it is not, it may be a condition.

http://www.nhs.uk/conditions/Eating-disorders/Pages/Introduction.aspx

There is also another link below to B-eat which can provide you information on support groups and talking to people who may feel the same.

http://www.b-eat.co.uk/

Sophie, I want you to be happy, healthy and safe and if you want this to and want to live your life to the full potential then you will speak to someone. Even if you are not diagnosed with an eating disorder, they can help you to improve your self-esteem and appreciate how wonderful you are.

I hope that this information finds you well and I wish you all of the best in the future, with love, life and health.

Good Luck.



---------- FOLLOW-UP ----------

QUESTION: Thank you for your amazing response!!

Just wondering, if i eat a proper meal a day and a snack or sometimes give in to chocolate or cake. Anorexics don't do this? I read somewhere that a disturbance like this doesn't occur with anorexics?

I eat proper meals when my parents are around because i feel pressured to do so. If i am alone then i avoid buying foods to stop myself eating it.

I don't know, i'm just so confused. I didn't think i had a problem, but then 2 people on separate occasions asked me if i have an eating disorder, which then got me thinking.

I'm scared of looking like an idiot at the doctors.
A completely different question - is seeing a CPN expensive? I live in the UK.

Thank you.

Answer
Hi there Sophie,

Thank you for getting back in touch.

As I mentioned before, there is a fine line between taking a positive approach to managing your diet and one that may be considered an eating disorder, it all depends on how you managing your eating.

If you are eating balanced meals when your parents are around (and this is frequent), then chances are the problems you have with your eating behaviour is down to self-consciousness and not down to an eating disorder, but if you are purposefully skipping meals or reducing your calorie intake to lose weight when you do not need to (which you don't#, then, again, this could be symptomatic of an eating disorder.

Studies have shown that if you buy products #like sweets,cakes and biscuits etc# and they are visible in your house then you are more likely to consume them and eat a large quantity in one sitting. So if you are not buying fatty foods so that they are not available in your home to eat, this is a health conscious approach and just means that you are more aware of your psychology and tendency to snack than most people are, so you are just doing what is right for you. Similarly, other studies have found that even if you buy the same snacks but put them out of sight #for example, in a non-transparent caddy or container in the kitchen# then you are far less likely to snack because you are not physically seeing temptation everytime you enter the room. This means that it is ok to buy snacks for when you want them but just make sure that they are out of your line of vision when you enter the room. Snacking is something we all do and as long as it is in moderation, it is a good way to stave off hunger.

Anorexics do not usually eat cake or biscuits; it is a more bulimic type of behaviour, where they binge #over-eat# and then purge #make themselves sick#, so you are right, it is not a typical anorexic association.

One thing I would say is to take what people say with a pinch of salt; unless a lot of people are saying the same thing. People may think you have an eating disorder because you do not gorge on unhealthy portions of food or eat processed sandwiches everyday, but in reality, you may not have an eating disorder just a conscious awareness of healthy eating. So what they may consider to be unhealthy #to them), may actually be healthy to you; they are just looking at it through their own eyes and making judgements based on their own expectations and themselves. That said, if a lot of people are asking you the same questions then it may be cause to have a think about it. You know what is healthy for you and what make you feel comfortable to eat; nobody else can make that decision for you and should not judge you for it and nor should you let the concerns about your possible eating disorder replace the concerns that you had about what that guy said to you. You have to be happy and healthy; and this comes with knowing yourself, your body and how you feel; and only you know that, nobody else.

I still think it may be advisable to go and speak to your GP and tell them that you are becoming anxious about your eating and other people are starting to notice. Ask him to refer you to a CPN which is available for free on the NHS. It may take a couple of weeks for the referral but from personal experience, it is worth it. Doctors would rather you told them how you were feeling now than have to deal with the consequences of you becoming psychologically or emotionally ill, so you should not feel stupid at all. You have a genuine concern about your health and it is the doctor's job to make sure that you are reassured that you are fit and healthy. A couple of minutes of feeling uncomfortable explaining how you feel may mean the World of difference if it leads to you seeing a CPN or getting the help you need. Worst case scenario, the doctor says that you are fine and does not refer you; this is a good result and something that you should point out to anyone who dares to make a passing comment.

I hope that helps and genuinely, I hope you get yourself sorted.  

Teenage Problems

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Daryl Taylor, BSc (Hons) Psychology, PGDip (pending certification)

Expertise

My expertise covers everything and anything to do with growing up, being a teenager or a young adult or being the parent of one of the pre-described. I can cover issues on identity, sexuality, love, relationships, families, drug/alcohol abuse and anything and everything in between.

Experience

I have volunteered for AllExperts.com for over ten years now, but even before that I was trying to use my experience to help others by working with Advice4teens.co.uk, Teenadviceonline.org and even Lycos and Ask Jeeves. My experience comes from being a teenager primarily but this lead me to work with young people from the age of 13. I have worked front line, face to face and over the telephone, e-mail and webchat for a government department called Connexions UK (aimed at young people aged 13-19); as well as being student counselor in New York, a Peer Mentor, a student teacher and working for my school, college and University to help raise the aspirations of young people. My life has not been easy and I have been through my fair share of issues; so there is little that I haven't been through in reality opposed to just reading it from a book or from my academic studies. I have been featured as a case study as achieving through adversity for a number of magazines and I have featured in a couple of books on both sides of the Atlantic; even though I am UK based.

Organizations
The Albert Kennedy Trust

Publications
Relationships: Cathy Senker, 2012, Raintree The Dean and Chapter Positive Nation GTEN Television Aim Higher

Education/Credentials
BSc(Hons) Psychology Post Graduate Diploma in Multidisciplinary Design Innovation Basic Counselling Skills Effective Listening Skills Mental Health First Aid

Awards and Honors
Outstanding Student achievement Adult learner's Award

Past/Present Clients
Allexperts.com Advice4teensuk.org Teenadviceonline.org lycos.co.uk askjeeves.com Connexions Direct

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