Warning: This article discusses mental illness and eating disorders.
OPINION: Eating disorders are highly complex mental illnesses. Notice I said "mental illness" - anorexia, for example, has the highest mortality rate of any mental disorder. It may surprise you how many people disregard anorexia as simply "not eating enough".
Anorexia holds a certain societal stigma. It carries a strong visual association, an image that disturbs people. Protruding hip bones, skin stretched over jutting ribs. People see the pictures, but they distance themselves. Whether it be depression, bipolar or anorexia - society has a habit of retreating from things it just doesn't understand.
Of course, some progress has been made. The glamorisation of size zero models in the fashion industry has been replaced by a movement of body positivity and acceptance of all shapes and sizes.
As someone who has suffered with - and recovered from - anorexia nervosa as a teenager, it's apparent that although society may understand what anorexia is in its most skeletal form, the reality of living with the illness is still largely misunderstood.
Anorexia is a mental illness
Anorexia is easy to see as just a 'physical' illness. Starving oneself is a form of self-harm, and many fail to see the internal, mental scars. It is not simply "I'm trying to lose a few pounds". It is not "I was too busy to eat today". It is an intensely visceral desire to be thin by any means necessary. It is a deep-seated fear of food. It is body dysmorphia - seeing imagined fat to lose where there is nothing but bone.
If someone asked me what it's like to live with anorexia, I would say it is an all-consuming, daily battle against yourself. It's a cycle of self-punishment and self-loathing. Living with anorexia is feeling like an empty shell, numb to everything - except numbers on the scale.
Anorexia is not always properly treated
The sad truth is, anorexia is frequently misunderstood by the very people who are meant to be helping with recovery. General practitioners can be woefully ignorant to its complexities. There is a reason why anorexia has the highest mortality rate of any mental illness. In many cases, the patient doesn't want to get better.
"GPs often have very limited training in terms of eating disorder awareness," Kellie Lavender, an eating disorder specialist from the New Zealand Eating Disorder Clinic, told Newshub.
"Treatment options have changed significantly over the last 15 years. Many doctors aren't up to date with evidence-based treatments. GPs will understand aspects of mental health as part of their medical training but often won't know what treatment and support options should follow their diagnosis.
"Eating disorders are a fast-paced, dynamic field - it's hard to keep up with the research."
When I was diagnosed with anorexia at 17, I was referred to a specialist by my GP. I remember the specialist told me I was "too bony" and therefore "didn't look good.'' This has stuck with me ever since.
If I had been a "less bony" anorexic, would I have looked good? For me, comments like this demonstrate a total disregard for the intense, dysmorphic insecurities that underpin anorexia in the first place. If a person is anorexic, they already are deeply ashamed about their bodies. To tell a patient they "don't look good" is a new level of incompetence.
Although it is likely unintentional, I encountered this flippant use of language multiple times from professionals who should know better. Appearing to a check-up a few kilos heavier should not warrant the exclamation, 'Wow, you're looking good!" or "You're looking better!"
GPs need to understand that for an anorexic person, gaining weight is traumatic. It is their worst nightmare. Their body is the very thing they resent the most. Comments may have good intentions, but anorexics often don't want to get better. Telling them they look "better" reiterates they have visibly gained weight and can drastically set back recovery.
"New people to the field may not receive the necessary mentoring or supervision, meaning the depth needed to administer treatments in an individualised way becomes compromised. Things can be delivered bluntly without that level of understanding," says Lavender.
Outdated methods are still commonly used
Reaching a certain body mass index towards the end of treatment does not indicate total recovery. A huge misconception surrounding anorexia is that its diagnosis is dependent on a patients' body mass index (BMI). BMI is an outdated method of deducing a person's healthy weight range based on their weight, height and age.
The problem with BMI is that weight is so subjective. Fluid retention, bone density and muscle mass can all influence weight. Continued reliance on the BMI model as a form of diagnosis means legitimate patients are often written off because they are not technically 'underweight'.
"Someone can be very healthy and have a BMI of 30. It's a very unhelpful diagnostic tool. Healthy weight ranges do have to be considered within treatment, but that is much more complex than BMI alone," says Lavender.
"Eating disorder patients don't just have to look 'underweight'. Diagnosis and recovery can't always be detected by looking."
Treatment should be flexible and multifaceted
Back then, I felt the only treatment presented to me was to gain weight - and fast. I couldn't understand how the controlling, all-consuming OCD, anxiety and self-hatred in my head could be fixed by eating - the very thing I didn't want to do.
"Eating disorders are very much related to anxiety, depression, mood disorders - comorbidity is very high," says Lavender.
"Although traditional rehabilitation [gaining weight] is very important, specialists need to understand the neurobiology of the brain and why it's so difficult for anorexia patients to eat.
"Although it's a vital component, treatment should never just be 'you have to eat more' - the thing that is so distressing to patients."
Amidst the misunderstanding, misrepresentation and mental illness, my eating disorder was the hardest thing I have had to conquer.
With the plethora of new information and research becoming available, there should be no excuse for anyone in the medical field to trivialise anorexia.
Lana Andelane is a Newshub digital news producer.
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