As told to the Sunday Sun newspaper ...

As a build up to the North East Skinny Dip 2013, I was interviewed by a reporter from local North East paper, the 'Sunday Sun.'  The article appeared in yesterday's paper (see photos below) ... this is the article as written by the reporter, Brian Daniel and printed in the Sunday Sun, 22nd September 2013.


"A NORTH woman will today notch up an important milestone in her recovery from eating disorders when she gets her kit off at a mass skinny dip.

Sharon Cox, 40, from North Shields, is taking part in the North East Skinny Dip 2013 at Druridge Bay Country Park in Northumberland.

The event, successfully held for the first time in 2012 and arranged to coincide with the autumn equinox, will see hundreds of men and women bare all and take a sunrise dip in the cold North Sea.

Participants will be raising money for the Mind mental health charity as well as event supporters, the National Trust, and could play their part in breaking the world record for the world's biggest skinny dip.

But for Sharon, [of North Shields], the event will be a key moment in her life - world record or not.

At the age of 15 she developed anorexia, a disorder she suffered from until she was 17.

"I probably got down to around 7 stone which, probably for my height at that age, was about two stone underweight."

Sharon then began to suffer from bulimia, a disorder which would plague her until she reached 30.

"Some periods I would be bingeing and vomitting quite often."

Sharon's weight would vary from to to 11-and-a-half stone.

In 1999, at the age of 27, Sharon began training to be become a counsellor, having attended counselling for her bulimia.

She eventually opened her own private practice, helping people principally with eating disorders and working at GP surgeries with those suffering from other mental health problems.

For the last six years, she has been studying a PhD at York St John University part time on the therapist's experiences of working with people with eating disorders.

The counsellor training and practice and the work she has done for the PhD, have helped Sharon - a steady 10 stone for the last few years - put her disorders behind her.

And today, enjoying life and her body unlike so many years when she did not, she will get her kit off at the skinny dip, the first time she - like most of us - will have done such a thing in public.

She said, "In the last 10 years I have not felt especially confident in my body.

It is only through my PhD that I have found a way to accept my own body and to feel that sense of body acceptance which allow me to do the skinny dip.

I would never have dreamed of doing it even a couple of years ago!

This is the pinnacle both of recovery and of my PhD - it feels a real high point in both of those."

Sharon is dreading feelings the icy water against her skin though, saying, "I am more worried about the cold than the nakedness!"

She is hoping to raise hundreds of pounds for Mind."

I still aim to find the time to write in more detail about my journey from eating disorders to skinny dipping ...

Mindful Eating & Eating Disorders ...

Taking mindful eating a step further & introducing the idea to people experiencing eating disorders ...

The concept of ‘mindful eating’ can be very difficult for people with eating disorders to appreciate.

Very often, such individuals have lost touch with their body, other than as something to hate or try to change.  They’re often unaware of physical sensations and emotions experienced in an embodied manner; as sensations within their body.

For them, food and eating have become so detached from physiological hunger that they are no longer aware of their body's physical sustenance needs.

The anorexic has  learned to control, ignore and deny their hungers, both physiological and emotional. The bulimic switches between trying to control and deny their hungers & feeling out of control around them. The individual with binge eating disorder tends to feel out of control around their hungers and needs.

Most people with eating disorders tend to be out of touch with their body’s  physiological signs of hunger, and so they’re no longer able to eat according to their body’s hunger sensations.  They tend to create, or look for ‘rules’ around what,  when, and how, they feel they should eat.

To eat according to their body’s needs can be a frightening concept.  They worry that they won’t know when to stop.  They’ve lost trust in their own inner sensations, in their own self, to be able to regulate and satisfy their hungers.

Mindfulness can be a step towards  rediscovering this trust in self and in one’s body, and learning to eat in response to physical hunger needs.

Teaching mindfulness to clients with eating disorders

Learning mindfulness skills around food and eating can be challenging for people with eating disorders.

They’re often so out of touch with their bodies and hunger sensations that the concept can be frightening.  It’s important to remember that some people with eating disorders experience extreme fear around food, and so it’s important not to rush the learning of these ideas.

It’s often easiest to start with mindfulness around food.  Encourage people to pay attention to what they’re eating.  To look at it, to touch it, & smell it before they eat it.  And as they eat it to pay attention to any tastes, textures, smells, thoughts & feelings they’re aware of.  This encourages them to start  becoming more aware of the food that they’re eating, and to start to enjoy food again.  It’s also the first step towards getting in touch with their body’s experience of eating.

As people become comfortable with  focusing their attention on food, it’s time to encourage them to become mindful of how their body feels as they experience the food.  Encourage them to pay  attention to their body as they relearn what physiological hunger and satisfaction feels like for them.  Enabling clients to get back in touch with their body’s hunger for food can be hugely empowering.

Mindfulness can help us recognise when we’re eating in response to our body’s physical needs or for other reasons; an important distinction for us all to make ... 

The Binge ...

The decorative biscuit tin has been sitting there on the side all week. Calling to me, drawing my attention to it. Even when I'm not looking at it, I can feel its presence; I know it's there. And I know it's full of those delicious cookies that I just love.

I've resisted it all week. After they were bought for me, by a well-meaning friend; they'd be horrified if they knew the conflicting emotions that tin of biscuits has instilled in me. I knew I should have given them away, or even binned them, but I couldn't. I couldn't bear the thought of those biscuits going in the bin, or of not getting to taste them.

I've resisted it all week. Until now ...

"I'll just have one," I tell myself knowing that I can't do that. Knowing that I'm just fooling myself ... but ignoring that sensible voice.

I open the tin and, holding the lid in one hand, I allow my gaze to wander over all of biscuits displayed there. Feeling my gaze caressing the crunchy sweetness of each individual temptation. I feel my heart rate increase slightly, my breathing becomes quicker and shallower as the anticipatory excitement and anxiety slowly begin to ignite.  My hand hovers over the selection. I'm only going to have one so I need to ensure I make the right choice. Knowing that if I regret my decision, I'll have to have another.

"Will I have the chocolate chip cookie? The chocolate covered one? Dark chocolate? Milk chocolate? White chocolate? The vanilla cream? The chocolate cream?"

Too many to choose from. And each has its own attraction. "I so don't want to get this wrong."

I finally decide on the chocolate cream. The combination of crunchy biscuit and rich soft filling areappealing to my eyes, my brain and the taste buds on my tongue.

"Crunch" as my teeth break through the biscuit. Crumbs crumbling around my lips.

"Mmm, delicious, " as the chocolate cream caresses my tongue. I try to savour each mouthful, knowing I'm allowing myself only one ...

But even as I know this, that other voice, the devilish voice at the back of my head, is telling me; "Go on, have another one. You know you want to experience the rich dark chocolate. You can stop after that one."

And this is where that infernal inner argument starts; "Am I strong enough to fight it today?"

And even as I ask myself that, or because I ask myself that, I know I'm going to succumb. I know I'm going to give in. I'm half heartedly fighting it, but the thought of more of those biscuits, those different textures, tastes, coverings and fillings is too tempting.

"I knew I shouldn't have had that first biscuit. That's where it all went wrong."

My heart is racing faster as the excitement builds, still quelled at this stage by my sensible inner voice; "One biscuit is fine. Just stop now. You don't need to have another one."

But my hand reaches into the tin again and I know my sensible inner voice has been drowned out ...again. I already feel angry with myself, but the enticement of more of those biscuits is too great to ignore. And anyway, I can get rid of them afterwards. It's easier to make myself sick with an overfull stomach than after just one or two biscuits ...

I eat that second biscuit … one this time covered in chocolate.

My heart is racing, excited, fearful, anticipation.

I’m still eating that second biscuit, but I’m already thinking about the next one … a vanilla cream … and the next one … covered in dark chocolate … and the next one … and the next one .. and the next one . the next one next one next one next one …

All sensible thought had left me.  I’m eating faster and faster, trying to savour the taste, yet simultaneously, not tasting the taste.  Just eat them.  Now I’ve given myself permission; just eat them.  Eat as many as I can.  It’s okay now I’ve started … I might as well keep going until they’re finished.  It’s okay, I can get rid of them afterwards …

Keep eating them; tasting them, whilst not tasting them.  Savouring them, whilst not savouring them. Eat them, eat them … the sense of freedom and liberation … eat them, eat them all ……

And that’s exactly what I do.  I eat them all.

And suddenly, the tin is empty…

Regret.  Disgust.  Horror.

I have to get rid of them now.  I can’tlet them all stay inside of me.  I’ll have a drink of water … it’ll mix with the biscuits and make them easier to bring back up …

Fear.  Terror.  Dread.

I don’t want to do this.  I don’t want to make myself sick.  I’m terrified of the damage it might cause me … I’m well aware of the health risks.  I know I’m putting my life at risk every time I make myself sick…

But I have to do it.  I can’t let them stay inside me …  

Into the bathroom.  Head over the toilet.  Hair tied back. Two fingers down my throat …

Relief, release …

Remembering; and hopefully still understandinging ... to everyone who finds themselves caught in this painful, frightening, liberating, disgusting, terrifying, disempowering, empowering cycle …

Anorexia as an autism spectrum disorder?

After writing my blog earlier this week about Asperger’s Syndrome, I was intrigued when I opened my newly delivered copy of the European Eating Disorders Review journal on Thursday (Vol. 19, Issue 6, Nov-Dec 2011) to see the first article entitled; “Is anorexia nervosa a version of autism spectrum disorders?”  The research essentially highlights similarities in cognitive functioning between people diagnosed with anorexia and those with an autism spectrum disorder.

Reading this article has led me to see what other research I could find about this link so I could think about the possibility for myself.  My earlier blog was inspired by my thinking about someone close to me and my struggle to understand them.  This new angle has now made me revisit some of my understandings about myself; as someone who was once diagnosed with anorexia.  In my earlier blog, I noted that I saw some traits of Asperger’s within myself … where does this new information leave me with my understanding of myself?  And of my relationship with this other person?

There isn’t a great deal of research to be easily found, but what I have found, I’ve written about, under the heading of ‘So what has the research out there told me?’ below.  For people not interested in reading the details of the research or my reactions to it, I’ve written ‘My Own Thoughts’ on the possible link immediately below …

My Own Thoughts

Reading the research was initially another ‘light bulb’ moment of enlightenment for me.  I thought; “Yes, I can see the links; makes a lot of sense to me!”  Anorexia definitely shares some of its traits with autism spectrum disorders, and more specifically the Asperger’s end of the spectrum (see bullet-point list below for comparative examples).  When I was ‘anorexic’ I would have satisfied a lot of the Asperger’s traits to quite a high degree … as would most anorexics.  Strange to think that at that time, I could probably have satisfied an Asperger’s diagnosis … and yet, that definitely wasn’t my experience; I was Anorexic.

And now, no longer anorexic, I can still see my tendency towards those traits (as I’m sure many people who haven’t experienced eating difficulties can!) but my increased self-acceptance and self awareness enable me to use those traits in a constructive and life-enhancing way.  With anorexia, there is a way forward … helping the individual work through their need to control food and / or their body and enabling them to gain weight.  The physiological effects of starvation create and / or exacerbate these same traits, so someone with anorexia whose weight drops significantly will display them, but once their weight rises out of the ‘danger zone’ the traits diminish.   The individual with a diagnosis on the autism spectrum disorder does not ‘recover’ … they might learn ways of managing their life effectively to compensate for their autistic / aspergic traits, but they can’t recover in the same way as many people with anorexia can, and do.

Seeing the similarities, has helped me understand how easily I related to, & connected so deeply with, someone in my life with Asperger’s … I was seeing parts of myself there.  I could understand that other person’s way of thinking, their way of being in the world … because I’d been there myself.  And although I’m no longer there to a significant extent, I do still have the understanding I gathered as a result of my time spent in that anorexic-aspergic world, making it so much easier for me to effectively relate to, and with, someone with Asperger’s.

If there are links between anorexia and autism spectrum disorders, it opens a lot of questions as to how we currently help people with anorexia.  Most treatment currently focuses on challenging the anorexic thinking and behaviour, exploring reasons behind the behaviour to find what purpose it serves for the individual and either resolving those underlying issues or helping them find more effective coping strategies, and exploring their relationship with food and their bodies to encourage a healthier way of relating.  However, if it was the case that anorexia had a neurobiological component, like autism spectrum disorders, therapy wouldn’t improve the condition to any significant degree.

And like myself, many people who have been anorexic move into Bulimia, which encompasses many different personality traits.  The individual with bulimia loses some of their perfectionism, their ability to maintain control or to focus on the minutia.  They often feel at the mercy of their emotions whereas anorexics and those on the autism spectrum are less able to experience or recognise such swings in emotion.

I’m not sure … there may be links, but I’d like to see some more definitive research before I wholeheartedly endorse the idea.  Yes, I think the two ‘conditions’ display a number of similarities, but I’m not convinced they’re part of the same ‘disorder’ … I’d be happy to be proved wrong though!  

The research does seem to indicate a higher than normal prevalence of autism spectrum disorders within diagnosed anorexics than in the general population, but for me, this doesn’t prove the link.  Instead it makes sense to me that females on the  autism spectrum (diagnosed or not), because of the cultural imperative to be thin in modern Western society and hence control eating and body weight / shape, are probably more likely to turn to anorexic behaviour as a coping mechanism.

As someone currently working with people with anorexia, and with a past anorexic diagnosis, I think the recognition of these links is important in that it has helped me gain yet again, a deeper understanding of Anorexia and also of Asperger’s, which can only be a good thing…

So what has the research out there told me?

In previous research in 2007, Professor Janet Treasure (professor of psychiatry at the Institute of Psychiatry, King’s College, London, and a recognised ‘authority’ on eating disorders) suggested two aspects of the link between anorexia and autistic spectrum traits.  The first is that because of their propensity for black and white thinking, needing to feel in control and an obsession with rules and systematic thinking, girls on the autism spectrum are more likely to be drawn into the controlled world of anorexia.  Having rules to follow around eating affords them the safety and control they enjoy.  The second link comes from the physiological changes brought about as a result of the effects of starvation on the body, which echo and exaggerate the autistic traits.  The effects of starvation on the brain include impaired cognitive functioning, a tendency to think in black and white terms, a focus on themselves and an increasing difficulty in reading other people … all common traits of those on the autism spectrum.

There seems to be a higher prevalence of autism spectrum disorder in those diagnosed with Anorexia Nervosa than in the general public; a study reported by Janet Treasure in 2007 claimed 1 in 5 anorexics met the criteria for an autism spectrum disorder and Tony Atwood (a recognised ‘expert’ on Asperger’s), also in 2007, reported between 18% & 23% of anorexic teenage girls meeting some or all of the criteria for Asperger’s Syndrome.  The prevalence rate for all autistic spectrum disorders in the general population is estimated to be around 1%.  For me, as written above, this simply indicates that females with an autism spectrum disorder are more likely than the general population to use anorexia as a way of attempting to deal with their personality traits.  Or that girls who develop anorexia typically share many of the autism spectrum disorder traits and their anorexic behaviour and physiological changes it brings about exacerbates these same traits.

One area in which Janet Treasure links anorexia with autism spectrum disorders is from a neurobiological basis.  It has been established that autism spectrum disorders result from atypical neurological processing (the brain processing information in a different way from the person not on the autism spectrum) and Treasure has proposed that anorexia results in part from this neurobiological level.  This is an interesting concept as it impacts on the current understanding of eating disorders being more socio-culturally influenced.  It consequently has huge implications for how we work with people presenting with anorexia.  There appears to be, as yet, no definitive research to confirm or disprove this theory.

For myself, the following similarities when they were first highlighted to me were what excited me and made me think that maybe a link between the two ‘conditions could be possible. Common symptoms shared between people with a diagnosis of anorexia and those on the autism spectrum include…

• Obsessive or compulsive behaviour
• A tendency towards perfectionism with the individual having a need to do things perfectly or completely
• Reduced ability to see, and think about, self-identity and connections with others
• Difficult empathising
• A tendency towards focusing on minute details, and therefore, an inability to see the bigger picture 
• Difficulty with multi-tasking or switching between ideas and tasks
• A lack of flexibility in their thinking, which makes coping with changes in plans or routines very difficult and stressful
• A like of routine
• Difficulty in negotiating, and coping with, life changes
• Ritualised eating, food preparation, or exercise routines
• Increased incidence of anxiety and depression

However, as discussed above, people diagnosed with anorexia are able to move away from these rigid patterns as they ‘recover’ … unlike those with an autism spectrum diagnosis … unless, the individual experiencing anorexia actually has a co-morbid autism spectrum diagnosis.

Another similarity which intrigued me, because I wasn’t aware of it, and which again, highlights a physiological element to anorexia is that both individuals diagnosed with anorexia and those on the autism spectrum have lower levels of Oxytocin. Oxytocin is a hormone involved in social recognition, the ability to empathise, bonding and sexual arousal; all of which may be impaired in these two categories of people. 

Anorexia has been called the female Asperger’s … Professor Christopher Gillberg, writing in 2005 suggested that autism spectrum disorders may be overlooked in girls as they present in different ways than with males; for example, anorexia, and it may be easy to overlook the possibility of an autism spectrum diagnosis when the presenting symptoms are indicating anorexia.  As I wrote above, for me it seems likely that females on the  autism spectrum (diagnosed or not), because of the cultural imperative to be thin in modern Western society and hence control eating and body weight / shape, are probably more likely to turn to anorexic behaviour as a coping mechanism.

I’m always happy to have my current ways of thinking challenged (doesn’t that statement itself ‘prove’ how far I’ve moved away from an anorexic / aspergic way of thinking!?!) and for me, challenging my beliefs, allows me to question them and to look around them and decide if I really do still believe them as they stand.  It allows me to adapt and expand my understandings and ways of thinking about things and to see a bigger picture as more relevant research emerges. I suspect that this will be an area of research I keep a close eye on …

Spirituality and Eating Disorders

I’ve just read an article; “The Role of Spirituality in the Treatment of Trauma and Eating Disorders: Recommendations for Clinical Practice” (Berrett, Hardman, O’Grady and Richards, 2007) and it includes what is for me, a nice description of what spirituality encompasses ….”Spirituality includes experiences such as feeling compassion for someone, loving, accepting love, being able to feel hope, receiving inspiration, feeling enlightened, being honest and congruent, feeling gratitude, and feeling a sense of life meaning and purpose.”

Spirituality in any therapy room can be important … experiencing the things listed above, can help a client begin to feel accepted and worthy of the love of others …an often important step on the road to beginning to accept themselves.

Especially though, for people with eating disorders, who tend to have lost touch with themselves, or disconnected from themselves and their ability to connect to others, rediscovering a sense of spirituality can be an important element of recovery. Eating disorders are often about a denial of appetite, a denial of neediness, a denial of the importance of connection to others…. a denial of spirituality.

These clients develop eating disorder symptomatology as a coping mechanism, as a way of living in the most effective way they can with the emotions and experiences which have made up their lives. As a result of this, they tend to lose touch with their inner lives, their inner self, and begin to ‘worship at the altar of eating distress.’ Their whole life and emotional capability becomes focused on food, eating or not eating, and their weight or body shape; they don’t have space to make deep connections with themselves or anyone else. The person with an eating disorder thus becomes completely detached from both themselves and any sense of spirituality.

People with eating disorders tend to dislike themselves and can often only accept themselves if and when they’re happy with their current weight or weight-loss. When someone’s self-esteem is so dependent upon numbers on the bathroom scales, they tend not to hear any positive comments made about themselves by anyone. And if someone can’t, or won’t, allow positive feedback from others to touch their heart, their capacity for spiritual connection is severely limited.

In the counselling room, one of the most important things we can enable our clients to feel is that sense of connection … to us, and, more importantly, to themselves. Quite often, the person with Anorexia simply won’t take on board anything which is said, or will push away any attempt at connection, in the same way as s/he does with food. The person with Bulimia may appear to be taking in everything that is said, connecting on the surface, but they often find it difficult to hold onto, or digest the words and the relationship; casting it all aside (expelling it like a bulimic purge) once the session is over. The person with Binge Eating Disorder may simply interject everything that is said, but without the digestion or assimilation needed to make it their own.

It can therefore be difficult, and at times frustrating, to engage someone with an eating disorder, but once that trust is gained, the rewards for both the therapist and the client can be immense.

Reflections on Eating Distress

I’ve spent most of this weekend transcribing interviews I’ve conducted with experienced therapists who work solely with clients presenting with eating disorders. Listening to their experiences and reflecting on my own, both with clients I’ve worked with, and my own history, has left me feeling really sad at the depths of despair that some people using eating disordered behaviour are experiencing.

As someone with past experience of both Anorexia and Bulimia, I’m also left feeling full of gratitude, that although I did spend many years lost in the despair associated with disordered eating, I was one of the lucky ones. Psychologically, and emotionally, I suffered deeply for a number of years, but my physical health was never compromised to any dangerous extent. When I hear, or read about, some of the extreme practices that some people with eating distress are driven to use, I feel thankful, that although I did self-starve, I did binge and purge, I never did so to a point where my life was in imminent danger … many people do. Indeed, many people lose their lives to eating distress; how sad that the very substance that nurtures us and keeps us alive, can, when an individual develops a complex relationship with it, lead to some peoples’ death.

I find it desperately sad to reflect on the individual with Anorexia, who, although she is starving, feels she has to deny herself food, has to deny her own bodily hunger, because she feels unworthy of food. Because she feels so worthless that her bodily needs don’t deserve to be satisfied. Because she feels so worthless, she feels that she doesn’t deserve to exist. I remember the absolute terror and fear associated with food and eating … of being hungry, of wanting to eat, but of an overwhelming fear, a sense of terror, that wouldn’t allow me to.

And then I read and hear about some of the extremes some people with Bulimia go to, the huge amounts of food they can binge on, stealing to get that food, eating raw, or frozen food because they’re so desperate. And again, yes, I binged, but never to those extremes. It makes me reflect though on the absolute despair, self-disgust, shame and fear I used to experience before, during and after a binge / purge. And the inability to control it … not wanting to binge, knowing it would just lead to me feeling bad about myself, to feeling disgusted, and knowing I’d have to ‘get rid’ of that food before it became visible on my body as increased weight. Not wanting to purge and make myself sick, because I was aware of the disgust and shame I’d feel afterwards, and the fear (again, sometimes terror) as to the potential damage I was doing to my body and my health.

And yet, although eating distress seems to focus on food, that’s not what it’s really about. Eating Disorders are coping mechanisms individuals develop in order to survive. They are complex conditions with many factors leading to their development and maintenance … and consequently, this makes them so difficult to treat. Every individual experiencing eating distress has their own individual story … and hence every individual needs help to understand their own unique and personal meaning behind, and need for, their behaviour. Everyone’s path through, and out of an eating disorder will be different. It won’t always be easy, but for many people (sadly not all), there is a way out. And it’s about understanding the symbolic meaning of their use of food, and their behaviour. What purpose is it serving? What more effective ways can they find of coping with life, coping with their Self and their feelings, so that they now longer need to rely on food …

And speaking from personal experience … there is a way forward, free from eating distress…