Marriam Abou-El-Haj doesn’t remember exactly how her decade-long battle with anorexia began.
What she does recall is a “perfect storm” of events — puberty, moving across the U.S. from California to New York, junior high school, the many compliments on her thinness. That, combined with her low self-esteem, anxiety and perfectionism, drew Marriam into what she now calls a prison.
“I just remember thinking I have to be thin. And perfect.”
Today, 43, she’s the co-ordinator of counselling services at Mount Saint Vincent University’s department of student services, a registered psychologist with 16 years’ experience who works with many young women battling their own eating disorders.
For 10 long years, however, lasting right into university, anorexia was a younger Marriam’s trusted companion. When she didn’t eat, her anxiety would almost magically subside. That’s a common perception among those battling the illness.
Her road to recovery began only after she decided the trade-off just wasn’t worth the cost.
“I realized I was never going to be thin enough … that I was living half of a life. I was in a prison and couldn’t ever truly feel happy, and I remember thinking, ‘This just isn’t good enough. I cannot spend the rest of my life like this.’”
After a decade of living with anorexia, it took Marriam five years to fully recover. That’s the normal pattern, she said. If you suffer from an eating disorder for 10 years, recovery will likely take five, if you suffer for two years, recovery will take one, etc.
Her struggles with anxiety and anorexia “absolutely” played a big role in her decision to study psychology.
I’m sharing Marriam’s story, much as she shared it with more than 70 people who came out for Eating Disorders Nova Scotia’s Supporting a Loved One event earlier this month at the new Halifax Central Library.
She was one of five panellists, along with Eating Disorders Nova Scotia co-ordinator Shaleen Jones, there to talk — each introduced by first name only — about their own experiences and how best to support someone with an eating disorder, regardless of whether that person is ready to confront their disease.
A big part is understanding how those with eating disorders view their condition. (These are often deadly mental illnesses, not choices.)
Anne Marie Coolen, a Nova Scotia-based director of the Eating Disorders Foundation of Canada whose daughter went through a four-year ordeal with anorexia, said sufferers often grow very attached to their eating disorders.
Anne Marie said her daughter often called the disease “her best friend.” It was a place to turn, a place to feel better, a place to be understood.
Until they decide they need help, sufferers are “completely blind” to the self-harm of their actions, added Anne Marie.
Though those who love them are trying to help, said Marriam, arguing with young adults with an eating disorder to try to change their behaviour usually doesn’t work. They’ll win those power struggles.
Even when someone with an eating disorder thinks about getting well, said Brad Holley, an occupational therapist with the QEII eating disorders program, “ambivalence is part of the process” — they want to get well, but they also don’t want to change the way they look.
So what can loved ones do?
Be supportive was one unanimous message.
Sarah, a young Halifax university student on the panel who’s recovering from an eating disorder, said such illnesses “blow up under isolation.”
Knowing friends and family are there if they need to talk is critical. Don’t pester them about what they’re eating, or comment on their appearance, good or bad, Sarah said. Just let them know you care about their well-being, even that you’re worried about them.
“It’s important not to try to solve that person’s problem for them,” added Sarah’s partner, Keith, another local university student.
Another strong message from the panel was to educate yourself about eating disorders because, sadly, too many front-line professionals, including doctors, nurses, social workers and others, still lack both training and up-to-date information on these mental illnesses.
One question from the audience underlined that point.
A woman explained her daughter had an eating disorder where she constantly purged the food she’d just eaten. Her health deteriorated to the point she was hospitalized. But then the mother learned nurses on her daughter’s ward — whose only experience with eating disorders was anorexia — had been congratulating her daughter for eating, which was useless under the circumstances.
That’s one of the biggest challenges now: improving training and increasing public awareness.
Eating disorders (despite mortality rates higher than any other mental illness) are a specialty of perhaps only a dozen psychiatrists in the entire country, Anne Marie said.
The good news? Eating disorders — in a majority of cases, caused by genetics, science has shown — are finally getting increased recognition.
Let’s keep that going.
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