Intended for healthcare professionals

Practice What Your Patient is Thinking

I thought I wasn’t thin enough to be anorexic

BMJ 2017; 359 doi: (Published 06 December 2017) Cite this as: BMJ 2017;359:j5378

Caitlin, 17, and her mother, Sally, talk about what helped, and what didn’t help, when Caitlin developed anorexia

On 15 December 2015, two weeks after I was referred to CAMHS (Child and Adolescent Mental Health Services) and six months after my periods had stopped, I messaged my mum a random question: “Am I anorexic?” I expected my mum to reply: “No, of course you’re not.” Two minutes later, however, the answer came back. “Yes, I’m sorry darling, it’s true.” That was the first time I realised that I was ill.

I was 15, and I’d started dieting in April. By June, I’d stopped having periods. By September, I felt cold all the time and my mum was worried enough to involve my general practitioner. She saw the doctor and then took me separately. By November, my weight had dropped and I was urgently referred to CAMHS.

Struggling to accept my condition

Why did I find it so hard to accept I had an eating disorder? Partly it was because even though anorexia was being discussed in my CAMHS sessions, I hadn’t understood that this was because I had it. The doctors weren’t trying to deceive me, but because I was ill, things were foggy and I was less able to understand what they were trying to tell me. I needed to be spoken to directly. It might have helped to say “Caitlin, you have anorexia. Do you understand what I mean by that?”

Perhaps the main reason I didn’t believe I was anorexic was because I didn’t look that unwell. The stereotypical person with anorexia is incredibly skinny—so skinny that you can see their bones. It’s the image that’s used in schools for education on eating disorders.

But …

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