Eating my heart out

How Anna Maxted beat her bulimia No one ever heard me. My gagging reflex was so developed I could vomit quietly and at will As I gulped down chocolate I could feel my cheekbones disappear under bulges of facial flesh

THE SUMMER of my 15th birthday we went to Portugal for two weeks. I had a crush on a boy named Trad, and when our hotel organised a disco I did my best to attract his attention. Ten years on I retain this image of my teenage self: a porky red-faced girl in a frilly white blouse, a too-tight pink ra-ra skirt, and - as was the short-lived fashion - a hairband sprouting a pair of antennae at the end of which bounced two glittery pink polystyrene hearts. No wonder he ignored me. I looked like a fat pink slug.

I despised my ugliness and myself. I wanted to be thin and pretty and kiss boys like the other girls at school. At the same time I didn't want to upset my mother by refusing food. Making myself sick after meals seemed the perfect compromise. I didn't give it a second thought. I didn't regard throwing up as an illness. I'd never heard of bulimia. Vomiting was a practical measure which I kept secret because it wasn't exactly etiquette. I didn't want to arouse suspicions by always rushing to the toilet after dinner, so I would go to my bedroom and be sick into rubbish bags, which I threw away later. No one ever heard. My gagging reflex was so developed that I could vomit quietly and at will.

I lost weight, but not enough (I was nine-and-a-half stone). I was the textbook candidate for an eating disorder: ambitious, intelligent, terrified of failure. I wanted to be perfect and when my dear father told me "we're proud of you whatever" I didn't listen. I worked obsessively to get into university.

There, I was in charge of what I ate. So I ate next to nothing. Breakfast was four crispbread with a scrape of low fat spread, and a black coffee. Lunch was an apple and maybe some nuts and raisins. Dinner was a salad, cottage cheese and vegetables. I thought I was eating a lot. I bought a pair of scales and watched my weight plummet. The less I ate, the less I needed to eat. I was very happy. I had friends, boyfriends, and sticky- out ribs. Excellent. Then my hair started falling out.

That was the only reason I went to the doctor. Not because I thought there was anything wrong in dropping from nine-and-a-half stone to seven in five weeks. I visited home, immune to my parents' distress at the sight of their emaciated daughter. I sought medical help because when I washed my hair, I saw hundreds of hairs floating in the bathwater and it frightened me. The doctor was kind. I confessed, as if it wasn't obvious; I was a stringbean swamped in an oversized jumper and long skirt. He told me I was doing serious damage to my body and that my hair would only stop falling out if I ate more. He recommended I see a counsellor. I left the surgery feeling liberated. I went straight to the petrol station across the road, bought a packet of Rolos, a Twix and a Snickers bar and wolfed them. Then I ate lasagne for dinner.

The counsellor was useful to a point. She was like a friend with pertinent theories about why I believed I was such a useless specimen of humanity - and why I was worth so much more than I thought. She opened my mind to new ways of thinking. She helped me rationalise why I shifted all my emotions and anxieties about life into body image and food. I now had a clearer understanding of my problem, but I still had the problem. Having followed the doctor's advice - I had, as they say, "piled on the pounds" - I felt out of control. I was miserable with guilt and shame. I resented the fact that other women could lose weight and their hair didn't fall out. Typical: I even failed at dieting. I started vomiting again.

No longer could I plead ignorance. In my teens I had been calm and determined about being sick: after ridding myself of a meal I'd feel elated and would skip happily downstairs to help with the washing up. My second relapse into bulimia, in my final year at college, was like leaping from the occasional cigarette to crack addiction. An imagined slight from a shopkeeper was enough to trigger a binge. I'd feel the unhappiness and tension well up. I'd feel empty and alone. I'd try to resist the craving but I couldn't stop myself. I'd buy bars of chocolate and sneak them back to my room.

Do I want to do this? I'd ask myself. No. Yes. I'd start to eat fast. It was like breaking the first commandment: don't eat more than a small bird because it's unladylike and you'll get fat and no one will like you. A few mouthfuls and I'd reach the point of no return. I'd flick through the newspaper without reading it. My consciousness was preoccupied with what to eat next. As I gulped down hunks of chocolate I could feel my cheekbones disappearing beneath bulges of facial flesh. I was a monomaniac. I'd drop the ``incidental eating while reading paper'' charade. I had to get as much as possible into my mouth. That greedy little hole. Chew. Swallow. More. And more. Until I was sated.

Disgusting. I loathed myself for my weakness and for what I had to do next: walk to the bathroom, stick two fingers down my throat and throw up. Again. Again, again, againagain. When all the chocolate was out, I'd brush my teeth and wash my hands. I'd be trembling. My heart would be hammering in shock at my self-abuse. I could still feel the calories lurking inside my stomach. I'd look in the mirror. I'd feel my body swelling as the excess energy was converted into fat. I'd pinch the flab on my waist. Oh God, help me. I was wretched and without hope. I was punished and now I wanted to annihilate myself. I'd cry great shuddering sobs into my pillow until I escaped into sleep.

My friends knew. They offered comfort and advice and I grasped at their wisdom. I'd ring Laura and tell her. Not the details, just that "I - I made myself sick". I'd tense and wait for her reaction. I flinched from the rebuke, yet I needed to hear it. Please tell me what to do. "It's like being on drugs," she'd say. "You must break the habit. Think of the anguish afterwards. It's not worth it. Think of your hair falling out. The enamel on your teeth [worn away by stomach acid in the vomit]. You have so many friends, so much going for you and you're not fat." Her words floated around me like straws as I sank.

I was in despair long before the arrival of the superwaif. I hated women's magazines, which reassured me that he'd love me whatever my shape - and then illustrated the article with a size 10 model; which printed recipes for chocolate cake beside advertisements for surgical fat removal. Who can exaggerate the pressure on women to be slim? How noble of the media to make an exception for Dawn French. The prejudice against overweight women remains utterly overwhelming.

Eventually I tired of self-pity. Bulimia was mentally and physically exhausting. My bingeing waned, and depression filled the gap. My friends were supportive but weary - they'd been buoying me up with stout-hearted words for five years and I was still a snivelling wreck.

I owed it to them and myself to sort out my problem for good. I asked my doctor to recommend a good psychotherapist. Fortunately I had a job, by this time, which started mid-morning, so I didn't have to ask my boss for time off to see my shrink. I visited this woman every two or three weeks. What a pointless exercise that was. I was aware of why I had my eating disorder, and didn't need to be coaxed into admitting things that I'd never said before. I was an expert on introspection. What I wanted from her was help on how I could change my behaviour. She allowed me to talk but she did nothing. When I told her things that I thought might benefit from informed interpretation I met with a blank. The few suggestions she made were either wrong, or I'd already considered them. Our conversations over the months had no bearing on my wildly veering state of mind. I was aware that therapists weren't meant to be judgmental, but they were supposed to build up a trusting rapport with their patient. I felt that I was boring a stranger with my self-obsession.

When I was particularly depressed one week, she suggested Prozac. Oh why not. I took the prescription to the chemist and paid for a packet of green and white pills. Medication. Now I was certified insane. I took them for a month, probably not long enough for them to take effect. Prozac was supposed to transform you into a shiny, happy person, yet I had read that in exceptional cases they made you feel suicidal. My brief flirtation with feeling suicidal was more likely thanks to the immature twit with whom I was then having a fling, but in those four weeks I was certain that I had never felt unhappier. I dumped the Prozac, and continued my futile visits to the therapist. She told me that we'd miss a session because she was going on holiday, and I politely enquired where. She affected not to hear. Ooh, I can't reveal any personal details to the nutter, I thought bitterly. Of course if you're unhappy with your counsellor, it's recommended that you tell her. As if. My self esteem was so low I could hardly get up in the mornings. I wasn't about to confront anyone.

Then I received a letter from another hospital detailing my appointment with another thera- pist. That was unexpected, but I went along. I told the young woman about the events contributing to my eating disorders and depression, and why I wanted to change but didn't know how. After listening for about 90 minutes she said: "Do you ever see or hear things that other people don't hear or see?" I was silent with shock. She thought I was mad. "Er . . . no." After further questions from the Ladybird Book of Psychiatry, she became fidgety. I thought oh no, she's going to ask me to draw a picture. Sure enough, she said nervously: "I'd like you to draw a picture of how you see yourself." She tactfully left the room. I was tempted to draw a huge fat pig, but instead sketched a proportioned impression of myself.

The she returned and it all went horribly wrong. I mentioned that I was seeing another therapist. She looked dumbstruck and asked me to excuse her. She then summoned me to another room where I was subjected to a hostile interrogation by her male superior. Why was I here if I was attending another hospital? What did I think I was doing? She stood by looking disapproving. I stammered my defence (it turned out that there had been an administrative error). I felt like a criminal. These people were professionals, aware that bulimia is not a "slimming disease" but a psychological disorder based on lack of self-worth. Yet through ignorance and bullying, they had reduced me to a worm.

I had one last shot at seeking medical help. I called a private clinic - on a friend's advice - and asked for an assessment. It had taken me two months to drum up the courage. "You have to be referred through your doctor," snapped the receptionist. "Are you anorexic?" she added sharply. "I - I used to be," I said. I didn't want to tell her who had suggested I ring, but she forced it out of me. When I put down the phone I was almost in tears. That was it. I gave up on the so-called specialists.

I'll never be normal about food. God forbid I should be offered a cake. And I'll always be too sensitive for my own good. But thanks to family and friends I have built up strength, confidence and shaken off bulimia and anorexia. They forced me to see sense. They pointed out that I was, despite myself, doing OK in life. They encouraged and bullied me but, most importantly, they made me feel loved.

I'm not proud of this story, and I accept my share of the blame. I defy anyone to sneer at it, and I despise those who propagate the look of a stick insect as the feminine ideal. I also thank heaven that, according to statistics, the majority of women with eating disorders are of high intelligence. They'll be lucky to get much sense out of anyone else.

FACTS OF A SICKNESS

o Between 2 and 3 per cent of women in Britain suffer from bulimia nervosa. In London an estimated 71,000 have the full syndrome or several of its features

o Between 1 and 5 per cent of sufferers are men

o Bulimics come from all types of social background

o Characteristics are binge eating, vomiting and purging, low self-esteem, secretive behaviour, depression o Bulimia causes hormone imbalance and nutrient deficiency. Laxative abuse may cause dehydration, increasing risk of kidney failure and cardiac arrest. Vomiting may cause tooth decay. Other dangers include hair loss, ulcers, stomach and bowel disorders