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Katie Metcalfe, 21, is starting a creative writing degree at Cumbria University,
but seven years ago her life was very different.
"My battle with anorexia started when I was 14. My situation at the time was unusual:
I was at a Rudolf Steiner school in Botton Village, near Whitby, in a class with three
other boys. The pressure of being the only girl with hormone-raging teenagers was
enormous. I had no self-confidence, and my body became a focus of paranoia.
"Stress in my life multiplied when my parents told me there was trouble in their
marriage. In addition, we were about to move house.
"Nothing in my life seemed to be right. I started to think that perhaps if I lost some
weight and improved my fitness, things would change for the better. I assumed that
thin people had fantastic lives and I could too.
"I made a New Year's resolution to go on a diet, so I began to restrict my eating. I cut
out fats, carbs and dairy, and lived on rice cakes, apples and lettuce.
"As I began to lose weight I started to feel that life was worth living. At last I seemed
to be achieving something. A voice began to whisper in my ear and as I lost more
weight, it became louder. Eventually, it was all I could hear. Nothing mattered more
than satisfying the voice's need for weight loss and, ultimately, perfection.
"My weight dropped from 8.5st to under 5st. My hair fell out, my skin cracked and
bled, my bones ached and my periods stopped. I was also cycling between 13km (8
miles) and 24km (15 miles) a day to satisfy anorexia's need for exercise. But I still
didn't believe I was thin enough. When I looked in the mirror, a mound of blubber
stared back.
"My mum took me to the GP when my periods stopped, but they sent me home with
a diet sheet, which said I must try to eat more.
"Eventually, I collapsed and ended up in hospital after having a minor heart attack
while riding my bike. I was kept on a heart monitor for two days. I was sent home with
another diet plan and the simple instruction: 'eat'.
"Eventually, my GP realised I needed help. I was admitted to a psychiatric ward in a
hospital in Middlesbrough, where I stayed for the next nine months.
"I was put on bed rest for five months. My treatment involved cognitive therapy
sessions once a week, and I gradually started to eat small amounts of food again. My
recovery was slow. What really helped to pull me through was writing and the
consistent support from my family.
"I started to write about my experiences and realised that I wanted to recover so I
could help others who were battling with the same problem. I gradually got better and
went back home the day before my 16th birthday.
"I have had a couple of relapses, but five years on I am fully recovered, with few
long-lasting effects. Although I have been diagnosed with the early stages of
osteoporosis, my periods have come back, so I can have children.

"I still feel depressed at times, but writing about it helps me get over it. I eat healthily
and exercise for pleasure, not punishment. My book, A Stranger in the Family
(Accent Press), has been published and I'm about to start a university degree. A few
years ago I would never have imagined that.
"If you're going through what I went through, you must talk about how you are feeling
to your parents, friends or doctor, no matter how insignificant you believe your issue
might be. It's vital to express depressive feelings because things only get worse if
you bottle them up, and this can lead to major health problems.
"Aim to live every day as though it is your last and not submit to anorexia. Try to
defeat anorexia before it defeats you. Always remember that help is out there."

The rise of pro-ana/ pro-mia websites.
This is a gathering point for sentient individuals who are working to cause changes to
occur in body in conformity to will. There are no victims here. This is not a place for
the faint-hearted, weak, hysterical, or those looking to be rescued. This is not a place
for those who bow to consensus definitions of reality or who believe in the cancerous
fallacy that there is any other authority on earth besides their own incontrovertibly
self-evident, inherent birthright to govern themselves. This is a place for the elite
who, through personal success in their ongoing quest for perfection, demonstrate daily
the power and results of applying will, imagination, creativity and effort toward
meeting their goals.
(ana's underground grotto)

Type anorexia or bulimia into an Internet search engine and the results will
typically consist of help, information and support for people who are
suffering from or know someone who is suffering from an eating disorder.
Type in "pro-anorexia", or "pro-ana/pro-mia", and a very different picture
emerges. With titles like Starving For Perfection, Anorexic Nation, 2bThin and Totally in Control, pro-ana sites are the antithesis of self-help
websites for recovering anorexics. So much so that every site has a
disclaimer on the front page:
This site does not encourage that you develop an eating disorder. This is a site for
those who ALREADY have an eating disorder and do not wish to go into recovery.
If you do not already have an eating disorder, better it is that you do not develop one
now. You may wish to leave.

Pro-ana sites are emphatically not for those who are in recovery, regard
themselves as victims, or even regard themselves as ill. They are targeted
at those who "believe that the Ana way is the only way to live", who feel

that anorexia is the right lifestyle choice for them, and will allow them to
achieve happiness and perfection.
Statistically, eating disorders are most common in young women; sufferers
are often portrayed as hapless victims of a ruthless consumer
culture. Victim is the key word here; it is generally thought that
nobody wants to be anorexic, that anorexia is a disease, and that
sufferers want to get better. Pro-ana sites turn these preconceptions on
their heads. One site goes so far as to distinguish "anorexics" from "rexies",
the idea being that if you identify yourself as an "anorexic" then the site is
not for you:
"You may already know the difference between us rexies and anorexics! If u want
sympathy for your "disease", you are anorexic. If you want respect and admiration for
your lifestyle of choice, you are a rexie. Anorexics die. Rexies don't. Have we
understood the difference? This site is for us rexies, who are proud of our
accomplishments, and the accomplishments that lie ahead. we will never die."

The emphasis is moved from self-destruction to self-control; in the words of

one "rexie", "A good ana doesn't die". If you are using anorexia as a means of
self-destruction then, according to these girls, you simply aren't doing it
right. Key ideas are strength, will, achievement, fulfilment; eating disorders
are portrayed as a means of achieving perfection and of forming an elite, a
group of humans who have successfully "mastered" or "governed" their
Unsurprisingly, these claims to strength, independence and health fail to
ring true when a small but significant minority of sites are left unattended
because their controller is "having to take it easy for a bit" or "has gone into
recovery". In one case, an online journal, message board and support group
was being maintained from a hospital bed. In light of this, the
protestation "we will never die" sounds more like a cry of rebellion than a
While a number of sites claim to subscribe to the view that good anorexics
"don't go too far", some contain material that would suggest the opposite.
Almost all have a "thinspiration" picture gallery, displaying photographs of
stick-thin models and ana beauty ideals. Most feature Kate Moss at her
thinnest and a decidedly emaciated Jodie Kidd as examples of "perfection".
A significant minority go further, providing pictures of women in the last
stages of anorexia, hollow-cheeked and utterly fleshless. Pro-ana artwork is
similarly varied. One picture in particular, which appears on a number of
sites, features a fairy-like, unearthly creature amid a mass of psychedelic
blue swirls. Pro-ana websites are a mass of contradictions; with every

supportive post on a bulletin board about the dangers of excessive purging

("try washing your mouth out with bicarbonate of soda afterwards, it'll
protect your teeth from the acid in your puke"), there is another entitled
"Please somebody help me", "I really need to die" or "My parents are forcing
me to go to hospital and I'm scared I'll get fat".
Despite extensive media coverage, an air of mystery still hangs around proana/ pro-mia websites. This is perhaps because the most basic questions
about their existence are often ignored in favour of more sensational
material. The following questions and answers are an attempt to make
sense of the wealth of contradictory material that is the web based proana/pro-mia movement.


The families of two young people who died from an eating disorder
say sufferers do not realise the condition can be fatal.
It is hard to gauge how many people die from anorexia and bulimia as
death certificates normally record heart or kidney failure instead.
Laurence Nugent, 24, from Belfast, kept his eating disorder a secret for
years before confiding in his mother.
He died from a heart attack after suffering from bulimia.

His mother, Pamela, said at first his family did not realise how serious
the disorder was.
"We weren't in despair at the beginning. We thought we'll get him help,
we'll fix it as mummies and daddies do, but as time progressed we
realised this is very serious," she said.
"It was a mental health issue. His personality started to take the form of
someone who was depressed, who was very angry, very afraid and
"But we never thought in one million years that Laurence would die."
But Laurence did die, after years of bulimia and starvation began taking
their toll on his body.


Mrs Nugent said: "We didn't know who to turn to for help because
Laurence wouldn't allow us.
"It was his secret - he was totally ashamed of himself and he hated
himself. He told us he hated the very look of himself."
Laurence kept his secret within his immediate family, but continued to
live what looked like a normal life to those outside the family circle.
His brother, Chris, said many of his friends were shocked to discover the truth.

I'm saying to every young man out there in Northern Ireland - this can
kill you. It killed my son, you need to get help
Pamela Nugent

"After he died we told a lot of his friends what we'd been hiding for so
long. They couldn't believe it. They said to me, 'why didn't he tell us?
We would have helped him. I can't believe we've known him all this time
and we didn't know'."
Mrs Nugent said she feels it is important to let young people know that
an eating disorder can be fatal.
She said: "I'm saying to every young man out there in Northern Ireland this can kill you. It killed my son, you need to get help."

Danielle O'Neill was also 24 when she died. The fashion designer from
Londonderry had only suffered from anorexia for several months.
Her mother, Adelaide, said she developed the condition after starting a
diet that went too far.
"She said to me she never meant to get so thin," she said.
"That's the thing I can't stress enough - how big a part your mind plays
in this, it's like it takes over and you can't stop."
Danielle had received treatment and was doing well, but her mother
said an attempt to eat a normal meal had a terrible effect on her.
"She ended up in hospital on a drip and it seems her stomach ruptured,
it just couldn't cope with the food after months of starvation," Mrs O'Neill
Mrs O'Neill said losing Danielle was like losing part of herself, but now
hopes to raise awareness about eating disorders.

"She's gone and we'll never bring her back, but if this can help
somebody else and raise awareness then that would be something
good," she said.
The Nugent family are setting up the Laurence Trust later this month to
highlight the dangers of eating disorders, and to offer support to young
men in particular.
Mrs Nugent said: "It's too late for Laurence, but young people need to
know the dangers."
Danielle suffered from anorexia and died after her stomach ruptured as it could not cope with
food any longer

Jacqui King, from the charity the Eating Disorders Association, said the
problem needed to be taken more seriously in Northern Ireland.
"In 12 years of being in EDA I have approached each of the health
ministers for a meeting about this and I've never had a meeting yet,"
she said.
"We do need something more like a day hospital where people could go
on a daily basis, where they could have different types of therapy and
we definitely do need some in-patient facility, because people are just
being put into general medical wards or psychiatric wards.
"There are two people that I know of who are seriously ill (due to eating
disorders) but are not being treated for their eating disorder in hospital,
only really being kept there to keep them safe."
A spokesperson for the Department of Health said the minister had not
received a meeting request from the Eating Disorders Association.
"There have been significant developments in eating disorder services
for young people and adults across Northern Ireland in recent years,"
they added.
"There are specialist community-based eating disorder teams in each
health and social care trust area, with the Belfast Trust providing these
services for the South Eastern Trust."


What is it?

An eating disorder is when we have a problem with food. And our weight.
You may think you're too fat, and as a result start restricting what you eat. You
may think your life will be better if you lost weight.
Most of us feel this way at some time or other, but it can get out of control. You
may start to obsess over every calorie, every bit of exercise, a kilo gained can
ruin your day. It starts taking over your life, and threatening your health and
happiness - that's when it's developed into something more serious.

The three most common types of eating disorder

Eating disorders can manifest themselves in different guises....
Anorexia Nervosa
This involves starving the body or taking measures to keep weight as low as
possible. It's an exremely miserable existence, and side effects include:

hair loss

thinning/weakening of the bones

brittle nails

downy hair on the arms or neck

Bulimia Nervosa
This is when someone is trapped in a cycle of binge eating and then
deliberately being sick or using laxatives to get rid of the food they've eaten. In
addition to the side effects of anorexia, teeth may start to rot and vision can
become affected.
Compulsive Eating
Like bulimia sufferers, compulsive eaters gorge on excessive quantities of food,
even when they're not hungry. However, they do not purge themselves.
People with eating disorders can become so ill they end up in hospital. Some
find they can't have babies when they're older. And occasionally, people die.
This is why you shouldn't ignore any worries you have about yourself or your

Why do people get eating disorders?

Some people are just naturally more prone to eating problems, others develop
a mixed-up attitude to food as they get older.
Stress or bad experiences can also make us more likely to suffer.
If someone in our family is funny about food, we're more likely to be too.
Often we begin by dieting to lose weight. Then we feel better about ourselves.
We feel in control, and better looking, so we keep going. We may find it difficult
to stop, even if we know we're harming ourselves.

I think I've got an eating disorder...

Ask yourself whether you:

Feel guilty when eating certain foods.

Sneak food or eat large amounts on the spur of the moment

Prefer not to eat in front of other people

Stop going to fun events because there might be fattening foods

Weigh yourself a lot and feel fat even though you're smaller than
other people

Often count calories and/or fat grams and worry about what
you'll eat next

Try not to eat for a while, and then overeat and feel guilty

Make yourself vomit, use laxatives, or over-exercise

If you said yes to any of the above, talk to someone you trust and see your GP.
Don't waste any time. The sooner you start getting proper help, the better your
chances are of beating it. Don't spend another day being miserable about food
- there's so much more to life.


A new study warns parents that childhood eating problems could predict
underlying psychological issues.
Researchers at the University of Montreal found that eating disorders can appear
before puberty.
Many researchers believe thatbulimia only appears at adolescence, but our
studies indicate that the problem can arise much earlier. It is possible that it is
currently under-diagnosed due to a lack of awareness and investigation, said
clinical psychologist Dr. Dominique Meilleur.
The findings raise questions about the way eating disorders develop and are
Meilleur and colleagues Olivier Jamoulle, Danielle Taddeo, and Jean-Yves Frappier
came to their conclusions by studying 215 eight to 12 year olds with eating
The children were assessed for psychological, sociodemographic, and
physiological characteristics that may be associated with disordered eating.
Children with physical issues that could cause eating problems, such as diabetes
or cystic fibrosis, were excluded from the study.
Researchers found that In addition to the eating problem, many children suffered
from other problems including anxiety, mood disorders and attention deficits.

More than 15.5 percent of the children in the study made themselves vomit
occasionally and 13.3 percent presented bulimic behaviors. These results are
very concerning but they may help clinicians reach a diagnosis earlier by enabling
them to investigate these aspects, Meilleur said.
Treatment of these conditions should start as early as possible.
Across the study, 52 percent of the children had been hospitalized at least once
due to their eating problem and 48 percent had been treated as outpatients.
The fact that most children had been hospitalized upon contact with medical
services suggests that the childrens physical health was precarious.
It is also worth noting that psychiatric issues were present in the families of 36.3
percent of the study participants, Meilleur explained.
The presence of multiple mental health issues in association with an eating
disorder is not a surprise.
Many factors are associated with the development and persistence of eating
disorders, Meilleur said.
The results of this study indicate that 22.7 percent of the children identify having
been mocked or insulted for his or her appearance as a trigger event to the
modification of their behaviors.
For some children, bullying can initiate or reinforce boy image preoccupations
and possibly lead to a change in eating behavior.
Indeed, 95 percent of the children in the study had restrictive eating behaviors,
69.4 percent were afraid of putting on weight, and 46.6 percent described
themselves as fat.
These behaviors reflect the clinical presentations we observe in adolescents and
support findings that body image is a preoccupation for some children as early as
elementary school, Meilleur explained.
The study also proves that eating disorders are not a girl problem as boys in the
same age group were found to be similar to girls in most cases.
The one exception to the similarity between boys and girls is that social isolation
was more prevalent and lasted longer among boys.
The profound similarity between boys and girls supports, in our opinion, the
hypothesis that common psychological and physical factors linked, amongst other
things, to the developmental period, are involved in the development of an eating
disorder, Meilleur said.