Seventeen year old art student Mia has been struggling with anorexia nervosa for around 5 years. In actual fact, although formally identified 5 years ago, she now realises that the problem started much earlier on. It would seem that even as young as 5 she was using not eating to feel more in control. When she had her first session on video earlier this year, she was at a particularly low point with the anorexia. She was on the verge of hospitalisation to undergo force-feeding and her family were desperate. It had got to the point where the damage she had sustained from anorexia was in danger of becoming irreparable. 



Anorexia and Trauma 


Mia had a plan in place where she was gradually increasing her food intake, with some minimal exercise. We spent a small amount of the first few sessions discussing ways that would support this eating plan. However, the anorexic behaviour itself was not the main focus of the early sessions. Mia has experienced a lot of trauma in her young life. What was immediately apparent was that at the points where the anorexia worsened it always followed a traumatic experience. The earlier traumas all concerned bullying and preceding this recent low point she was sexually assaulted whilst on holiday. The assault led her to have dreadful nightmares and to constantly fear for her life. 

In life, we often react to the experiences we have by adopting certain behaviours to cope with them. When we experience any kind of trauma, we store the pattern of it in our brain. When we experience a similar trauma, e.g. more bullying, we reinstate the coping behaviour. In the sessions I helped Mia to process several major traumatic experiences and detach the emotion from them. This meant that the coping behaviour that had been put in place – the anorexia – was not an automatic response for her. 

However, she had a lot of body image issues and we would need to tackle these before she would be able to begin to control the anorexia. 



Anorexia and Bullying 


Mia’s particular bullying centred on her appearance with so called friends telling her she was fat. Trauma from this bullying led to extreme negative self-image and body-dysmorphia. From her early teens she believed that she was fat and also that she was ugly. For the record here, I’d just like to point out that Mia has never been fat and is beautiful. So it’s incredibly sad that this belief persisted, and the dysmorphia became so serious that even when she only weighed 6 stone, she still believed that she was fat. She is also unable to believe that she is pretty. 

We look to our peers in our teens and their opinions can affect our sense of identity. In this case it was extremely negative. Mia’s parents also added to this, completely without meaning to. Both of her parents are very fitness conscious with past issues around body image. Out of concern for her health and wellbeing they often warned her against certain foods in case she got fat. This has created an obsession with calories, and the sugar and fat content of foods that she is finding hard to let go of. 



Tackling the anorexic behaviours 


From the first session we looked at ways that would help Mia to eat more easily. She finds meal times highly pressured and as such dislikes eating in front of people. These methods changed as she progressed. In the early sessions they centred on distraction. Basically trying to eat without being too consciously aware of it! In this way she would be able to quieten the voice telling her she shouldn’t be eating it. This worked well but is not really a sustainable solution.  

As we progressed with the sessions, we were able to start to change these methods, creating a healthier longterm approach. This focused more on becoming more aware of the taste and flavours of food and beginning to enjoy it. We would use hypnotherapy to rehearse these methods in the sessions so that she could practice them at home. 



Getting her emotional needs met 


With all the bullying trauma in her past, friends have always been an issue for Mia. She has had many instances where people who were meant to be her friends subtly (and often not so subtly)  bullied her about her appearance. She has been quite isolated over the years and this has meant that her emotional needs were very poorly met. Our emotional needs, such as a sense of community, intimacy, status and control, help us to be emotionally resilient. Trauma often prevents us from getting these needs met well. Having dealt with the traumas, she’s not only been able to make friends but also make better choices in friends. She also has had the courage to remove toxic friends from her life, that were harming her self-worth. 

From this point she has been able to move forward much more positively. Currently she still struggles sometimes to physically eat food, although she does eat it. She is working on widening her taste for different foods and to work on her body image. We are continuing to work together around once a month for the time being. In the sessions we work on any issues that have arisen and come up with ways that help her to deal with them. 



We all need to be shown trust 


Mia says that she finds it hardest when other people judge her eating. Despite eating better than she ever has, by most people’s standards it is still less than average. If friends or family criticise her for not eating enough or for being thin, she finds that it can set her back. She says that she wishes people would understand that for her she is eating a lot and that it is a work in progress. It is important that the people around someone with an eating disorder, trust them to manage their own progress. Nagging and moaning at them will raise their emotional levels surrounding food and this definitely will not help. 

Although Mia is still working with me on her anorexia, this is what she has said about her treatment: 

“This therapy has saved me in so many ways and helped me to explore my own mind. It helped me learn more about my eating disorder and find out where it came from. Using the techniques helped me clear old patterns and heal from them.”

I am delighted to see the progress that Mia is making. She has worked hard to make the progress she has and her dreams of travelling, pursuing her art career and having a family  are all on track.

This is just an insight into how we might treat an eating disorder. The process of course varies with each client, as do the causes. As always, please share if you know someone who would benefit from reading it. For more information and useful downloads, head over to our website.


With very best wishes


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