Every youth leader knows teenagers who have developed a complex relationship with food. But knowing how best to tackle it can be challenging.
Emma Scrivener describes some of her own experiences of this ‘good girl’ addiction, and provides helpful insights as to how youth workers can spot warnings signs and offer support to young people who are suffering with this life controlling issue.
I became a Christian when I was 13. Shortly afterwards I developed anorexia. Surprising? Well, yes and no. Eating disorders (EDs) affect everyone: young and old, male and female. But they’re especially attractive to ‘good’ girls and boys. These young people won’t go off the rails in spectacular fashion - but they might break down quietly instead. They’re in our churches and our youth groups – maybe even yours.
More than ‘fat’
EDs are about much more than feeling ‘fat’ or aspiring to size-zero perfection. They’re about communicating dangerous feelings: writing with my body what I can’t say with my mouth. They’re about getting rid of frightening emotions: anxiety, sadness, anger, despair. They’re a way of comforting – and also punishing - myself. EDs are about trying to take back control when everything else is chaos: hormones, relationships, life. They’re an attempt to make myself invisible and they’re a desperate cry for help.
For the sufferer, an ED is a solution rather than a problem. It might look like I’m pursuing death but in fact I’m trying to live. Food is how I deal with pain. By restricting it, I feel in control. By overeating I’m self-soothing. By getting rid of it (‘purging’), I’m flushing away the scary feelings that threaten to tear me apart.
There are different kinds of EDs, but the underlying issues are often the same. Perhaps you feel messy and ugly or ashamed. Well, here’s something you can control: your own body. Whether you starve it or stuff it, pound it on the treadmill or feed it laxatives, eat everything in sight or nothing at all - it’s your secret. It makes you special and it promises you life. But it takes everything from you.
My experience
Anorexia nearly killed me - but she felt like my best friend. We met when I became a teenager. My body, once so familiar, had suddenly become a riot of hormones and curves. Out of my pretty friends I was the brainy one but brains no longer counted. What mattered now were boys - but who would look at me? I was nothing like the women I saw on TV.
My new-found Christianity was also a struggle; another way of standing out when I was desperate to fit in. I pictured God as a headmaster – disapproving and far-off. Someone who wanted me to perform and keep his rules. Interested in my spirit but not my body.
At church, my youth group was full of veiled warnings about the dangers of teen pregnancies. Your body was like something separate; it would spiral out of control if you let it and sex could take you to hell! This confirmed my sense that my body was bad. Like me, it needed to be contained.
My brand of Christianity had space for ‘God’, but not for Jesus. It talked about sin and rules – but less about grace. It paid lip service to Christ’s work on my behalf. But, in practice, I felt like it was up to me. The gospel sets us free from performance and from masks. But stripped of Christ, Christianity becomes something else. It becomes slavery. And so I looked to another god for answers.
For three years, anorexia was my life: the good girl became a rebel and the dinner table a battle ground. With my parent’s help I received treatment. However, it focused on weight gain and, while this is a vital component of recovery, it wasn’t enough.
Aged 18 I seemed recovered. I won a place at a top university and was a healthy weight. In the glossy magazines, this would be the happy ending. But on the inside, nothing had changed. In fact, the way I’d recovered sowed the seeds for a terrible relapse.
Six years ago I stopped eating again – with near-fatal results. This time I was a student at Bible college, leading the children and youth work at my church and married to a vicar-in-training. I looked like a ministry ‘dynamo’ but I was committed to proving and to saving myself. What saved my life was not professional help. It was grasping the love of Christ through his word and a church who prayed for, and stood with me in my mess.
A spiritual issue
Even when I was at my weakest, my greatest need was for the gospel. I needed to know that Jesus came for the sick and that it was ok to make mistakes and be weak. I needed to know that Jesus was big enough to handle all my feelings, even the scary ones like anger and fear. I needed to know that other people struggled and were broken. I needed to face the consequences of my decisions and to say sorry – and most of all, I needed grace.
It’s easy to think that only experts can help but EDs are spiritual problems as well as medical ones. The Church has a vital role to play in ministering to the body and to the heart. This is not easy: EDs are threatening and hard to understand. But, while I knew about grace in my head, it was when others came alongside me that I believed it was true. So, as a youth worker, how can you spot the warning signs? And how can you help?
The basics: Around 1.6 million people in Britain are affected by EDs and 14-25 year-olds are most at risk (Beat). The best known examples are anorexia (restricting food intake because of an intense fear of becoming ‘fat’) and bulimia (eating large quantities of food and then getting rid of it by, for example, vomiting or using laxatives).
BUT remember: • EDs don’t necessarily fit into the categories above. When symptoms don’t fit a specific diagnosis they’re called an ‘eating disorder not otherwise specified’ (EDNOS). Up to 60% of recovering anorexics struggle with bulimia and binge-eating is also a widespread problem.
• Weight loss or gain is just one symptom; don’t assume that because someone looks ok that they really are. Bulimia is most common but those with the disorder are often of normal weight, making it difficult to spot.
• Around 5% of those with anorexia will die of associated complications. All EDs cause enormous emotional and psychological distress and should be taken seriously.
Causes: A combination of biological, psychological and environmental factors. If friends or relatives have an ED, this may make it more likely. They can also develop as a result of unintentional weight loss e.g. after sickness. Some young people may be particularly vulnerable: • Perfectionists with low self-esteem. • Those with difficulty expressing emotion. • Those who feel helpless or powerless. • The anxious. • People who think in black or white categories – e.g. ‘I’m terrible’, ‘everyone hates me’. • Those with a poor social support network. • People who may have history of physical or sexual abuse. • Those feeling out of control. • Youth who seem young for their age and fearful of growing up.
Possible warning signs: • Weight loss or unusual weight changes, wearing baggy clothes. • Missing meals, eating very little or in secret, avoiding ‘fattening’ foods. • Denying any problem and becoming very upset if confronted. • Large amounts of food disappearing, empty wrappers, stashes of high calorie foods (for binging). • Going to the toilet after meals, may use mouthwash or perfume etc. to disguise smell. • Sore throat or tooth decay, swollen cheeks or ankles, poor skin, bruising on knuckles (from making themself sick). • Personality changes (e.g. anxiety or depression, being secretive, loss of interest in normal activities). • Impulsive or obsessive behaviours (e.g. rituals with cutting up food, promiscuity, overspending). • Poor concentration, missing school, college or work. • Withdrawal from friends.
Some of these behaviours are a normal part of adolescence – but if you spot a number of them they may indicate a bigger problem.
Act early: EDs create a sense of being in control but then become very out of control. That’s because they are biologically and psychologically addictive, which makes them very hard to break. Here are some examples: 'Whirlpool effect': as weight is lost the person experiences a physical ‘high’. Thinking and reasoning is affected, so they become increasingly obsessed with losing weight, and less able to break the cycle of over-exercising, laxative dependence etc. Binge-purge cycle: sufferers feel relieved when they give in to these behaviours – and panic or depression when they resist them. They may fast for long periods, which restarts the ‘binge-purge’ cycle.
NB: If the person suffering is seriously underweight, depressed, self-harming or suicidal, then physical health should be a priority. Seek immediate help from a GP or hospital and work with the families of those affected: they too will need support.
Guidelines for talking to the young person: Where possible, work with families, relevant professionals and others on your team. Don’t try to address them alone: EDs are self-centred and it’s easy to get sucked in. Aim to draw sufferers out and invite them into healthy community. Make sure you have support and set clear boundaries.
Challenge the young person gently but firmly. Explain that you are concerned about them and their health, but don’t promise secrecy and be prepared for denial, tears or anger. Don’t comment on how they look or their weight - instead focus on feelings and relationships. Don’t demand that they change or try to guilt-trip them into eating but do let them know that you are listening and available.
Key teaching areas: • Teach the gospel – we’re all broken, but that’s ok. We don’t have the answers – but Jesus does. • Provide a safe place for the young person to talk about dangerous feelings. • Focus on the person, not just their behaviour – and look out for the quiet kids as well as the louder ones. • Explain the value scripture places on the whole person: body as well as soul. Talk about who we are in Christ and what that means in practice. • Discuss and challenge cultural notions of beauty, thinness etc. Invite speakers to come and talk about eating disorders or other addictions.
Guidelines for supporting affected families:Don’t • Think you’re unqualified to help because you’re not an EDs expert. By all means involve the professionals, but remember that praying and listening is vital. • Focus on weight or how the person looks. • Get drawn into their world, instead draw them gently out. • Assume that weight gain means the sufferer is better – this is when they will need more support rather than less. Do • Read up-to-date information on EDs (see links at end). • Allow families to make their own choices about treatment. • Be there for the long haul. Recovery can take months, or more usually, years - and relapse can be a part of it. • Be sensitive: don’t base all your activities around food. • Provide extra help during times of transition (e.g. from hospital to home). • Offer to stay with the sufferer so parents or carers can take a much needed break. • Help out with other children in the family, as they will need more attention during this time. • Treat the person with an eating disorder as you did before they got sick. They’re still in there and will come back as they recover. • Pray, pray and pray again. • Remember you are not the saviour: Jesus is. And no-one is beyond his help.
Emma Scrivener suffered from life-threatening anorexia as a child and as an adult. She now speaks and writes about her experiences at www.emmascrivener.net. Her new book A New Name can be ordered at the website above or at www.ivpbooks.com
Other Resources
My website: www.emmascrivener.net
My book: ‘A New Name’, Emma Scrivener, (IVP, 2012)
The Big house: www.thebighouse.org.uk Website includes talks on dealing with self-harm and eating disorders.
Helena Wilkinson: www.helenawilkinson.co.uk
ABC: Anorexia and Bulimia care: www.anorexiabulimiacare.co.uk
National Centre for Eating Disorders: http://www.eatingdisorders.org.uk
Royal College of Psychiatrists: http://www.rcpsych.ac.uk/campaigns/changingminds/mentaldisorders/anorexiabulimia.aspx
Beat: www.b-eat.co.uk
Men: http://mengetedstoo.co.uk
Parents and carer support: www.feast-ed.org
Further reading: J Treasure: Anorexia Nervosa: A Survival Guide for Families, Friends and Sufferers. R. L Palmer: Anorexia Nervosa: A Guide for Sufferers and Their Families.
