'She manipulated me, she starved me and she nearly killed me,' says Anorexia survivor.

"In January, I was diagnosed with an eating disorder called Anorexia Nervosa. I was detrimentally underweight, had dangerously low blood pressure, critically low heart rate, no iron, protein, calcium, magnesium, or vitamin D, low bone density, I had no energy, I was pale, my hair was falling out in clumps, I constantly felt faint, I felt bloated after every mouthful, I stopped menstruating, I cried at every meal time, I was put on every kind of vitamin supplement, I never drank water, I lied, I cried, I collapsed… I was taken out of school. I was bedridden. I cried even more, and I had never before hated my life that much. To this day, I am in a rehabilitation process on an out-patient basis."

This is an excerpt from a blog post titled 'Revealing who A is' by South African blogger and psychology honours graduate, Sarah-Kate Bergstedt.

Parent24 spoke to Bergstedt to find out more about this disorder and her experience with it.

Anorexia Nervosa, more commonly referred to as Anorexia, is an eating disorder characterised by weight loss, difficulties maintaining an appropriate body weight (based on height, age and stature), and a distorted body image.

Anorexia sufferers generally place restrictions on their food consumption by way of regulating their calorie intake and limiting the kinds of food they eat. Others also exercise compulsively, adopt purging strategies and/or binge eat.

While the mental health community has eroded some stigmas regarding eating disorders, they can commonly be misunderstood as the focus is drawn to the physical aspects of the disorders and as a result, anorexia has been painted as an affliction of privilege and vanity when this is untrue.

Anorexia can affect people of all ages, social statuses, ethnic backgrounds and genders, however, a 2019 study revealed that adolescent South Africans are increasingly struggling with eating disorders, unhealthy eating habits and body image issues that present a cause for concern.

Why not just eat?

Anorexia sufferers use their restrictive eating habits and strained exercise routines as a way of gaining control of an aspect of their lives for various reasons. Extreme weight loss of this nature can lead to various health complications including bloating, dizziness, dehydration, hair loss, muscle weakness, impaired immune and organ function, and even death.

In understanding that one of the first steps to recovery from Anorexia is weight restoration, the solution to the problem seems quite simply to eat right?

Wrong.

'Why don't they just eat?' surfaces as a commonly asked question surrounding anorexia, but this stems from the oversimplification of the eating disorder as strictly being a fear of weight gain.

"It more often than not does not start out as an eating disorder," said Bergstedt explaining that the "silent killer" shows physical signs as a manifestation of deeper mental health struggles.

Many Anorexia patients have described an 'eating disorder voice': a voice in their head, feeding them lies about their body and food, and encouraging self-starvation tactics to feel a sense of self-worth, value and self-control.

Instead of a straight line, recovery then becomes a push and pull of the mind and body, making the decision to 'just eat' an anxiety-inducing battle - a back and forth between the will to survive and the need to quieten their eating disorder voice.

"Rehabiliation is a push and pull process. It's a struggle. One day, you're conquering the world, and the next day, you're losing the war," Bergstedt described.

"I've gotten to a safe weight as of now, but that does not mean I have recovered."

'A mental disorder with physical side effects'

When personifying the eating disorder, Bergstedt describes in a blog post: "All she had to do was wave a hand for me to dance around for her. She manipulated me, she starved me, and she nearly killed me."

"They are mental illnesses before they are physical illnesses," Bergstedt told Parent24.

"You can be of a healthy weight and still have an eating disorder – you can look just like everyone else and have an eating disorder – you can love food and think about food all the time and still have an eating disorder."

"Anorexia is not a physical disorder with mental side effects. It is a mental disorder with physical side effects," Bergstedt also writes in her blog. "This means that the anxiety and the controlling voice inside my head takes out its frustration on my body."

Forewarning signs and symptoms

Individuals with Anorexia hyper-fixate on their body weight and calorie content, but this is only scraping the surface of mechanisms and behaviours they adopt.

Common behaviours, signs and symptoms are characterised as follows:

• Rapid weight loss over several weeks or months

• Sudden interest in weight-loss and fad diets

• Compulsive exercising as a form of punishment for eating, or a way to rid oneself of the guilt of eating by burning the calories

• Body checking to constantly seek information about one's weight, size or shape by means of comparison.

• Restrictions on food: This can include restrictions on eating times, calorie and portion restrictions, and sudden pickiness and obsessive and compulsive behaviours surrounding food and eating habits

• Inability to assess one's own weight or body dysmorphia

• Social withdrawal due to heightened social anxiety, self-criticism and low self-esteem

• Anxiety, irritability and/or depression

Seeking help

Parents and teachers should be aware of the influence and impact of their words and should be vigilant about the way in which they talk about body image, food and exercise in their households and classes.

With the rise of social media and influencer culture, unattainably high body standards are constantly being set, more pressure is being put on the youth to reach unrealistic body goals, making it increasingly imperative to be conscious of the way food is framed in conversation and in the classroom.

"Food needs to be framed in the home as a source of nourishment and as a form of bringing people together," Bergstedt told Parent24.

If you suspect that an individual is secretively struggling with an eating disorder, it is important to take the steps to intervene early by seeking professional help, educating yourself about the eating disorders that exist and learning to be aware of their triggers.

"Talk to someone," Bergstedt advises children struggling with disordered eating patterns. "Even if you don't know what it is or why you're feeling the way you're feeling about food and your body – talk. Talk about what you're going through – talk about what you're feeling to someone you trust," she stresses.

First published on Parent24.