She was skin and bone - more like a stick insect than a twenty-year-old student, Colm, who is a third-level lecturer, recalls. Colm had watched her struggling into class day after day, growing noticeably weaker and more emaciated. "It was death by slow suicide," he says. "She was very pale, her hair had begun to fall out and she had difficulty walking."
Colm was worried. He knew she was anorexic and that he had to do something. But what? Colleagues suggested some straight talking, but he feared that any direct intervention on his part would only increase the pressure on her. When he approached student services they told him that they were already on the case and were doing all they could. The problem had started way back in second-level and the girl - one of Colm's best students - was continuing to resist offers of help. Sadly, only a couple of days after she had last appeared at lectures she collapsed and died.
"As a lecturer you're put in a very difficult situation," Colm says. "You don't want to single people out and you're worried that you may be doing the wrong thing." It is a problem that an increasing number of third-level staff - and students -are having to face. Eating disorders among young people are on the increase. Statistics are hard to come by, but health board figures show that in 1995 some 76 young people between the ages of 15 and 24 years were admitted to hospital suffering from eating disorders. Up to 95 per cent of sufferers are female. More recently, a study conducted by DIT's Yvonne Ryan and Dr Mary Flynn found that two thirds of Dublin teenage schoolgirls have tried to lose weight - many of them using health damaging methods. One in five had smoked and one in six had induced vomiting. More than half skipped meals and others took diet pills and laxatives. British research shows that dieters are eight times more likely to develop eating disorders than are non-dieters.
Colm's student was anorexic - that is she avoided food in order to loose weight. "Anorexics have a totally distorted body image," explains Jennifer Kelly, secretary of Bodywhys, a support agency for victims of eating disorders and their families. "Even an emaciated person will see herself as fat." Usually the onset of anorexia takes place from puberty onwards, but nowadays even eight and ten-year-olds are not immune, Kelly notes. Anorexia is easily identified, but bulimia is more difficult. "Bulimia is much harder to identify because people don't lose weight," she explains. "They can have normal and even above-average body weight."
Bulimia sufferers are usually in their late teens or early twenties - hence the disorder is a huge issue for students. For bulimics, life is a round of rigid dieting followed by binge-eating, guilt and then self-induced purging - vomiting and the use of laxatives and diuretics. A major problem for people suffering from bulimia is that their lives totally revolve around food and dieting and their social lives become restricted, says Dr John Griffin, director of the Eating Disorder Unit at St Patrick's Hospital, Dublin. It's a dangerous lifestyle, which could kill you. Bulimia can lead to epilepsy or heart irregularities. At the least, you could lose all the enamel on your teeth, he notes.
Griffin traces the roots of the eating disorder syndrome back to the mid-Sixties when the strikingly skinny model Twiggy first paraded down London catwalks. From then on thin was in - and, for an increasing number of young women, the only way to look.
Looking back, it's hard to believe that in the Fifties, women like Marilyn Monroe, who wore size 16 clothes, were regarded as sexgodesses. Today, if Marilyn wasn't size 10, she'd hardly rate.
"Although Marilyn Monroe was a size 16, the average size for women at that time was size 12," according to Jennifer Kelly. "Nowadays thanks to better nutrition, the average size for a women is 14, yet the average model on the catwalk is only a size 10." This, she says, puts huge pressure on young women.
Obesity is one of the last prejudices to remain socially acceptable, Griffin argues. "Racism and ageism are frowned upon, but obesity is still openly condemned and people who are fat are often regarded as ugly or stupid." Griffin points to a study which reveals that one-third of people suffering from eating disorders have experienced childhood sexual abuse. He, however, disagrees. "I would put it at one in ten," he asserts. "Eating disorders are not just about food," notes Kelly. For some it's a way of coping with painful feelings or emotions. "There isn't a single cause. The reasons are different for each person. They can include family or school-related problems, for example. Sufferers tend to be ambitious and idealistic. They're often perfectionists and high achievers. They are people who put a lot of pressure on themselves."
While many sufferers do break down and admit they need help, others - like Colm's student - need to be identified, she says.
Anyone suffering from an eating disorder needs immediate help. When you approach someone with such a problem it's wise to avoid focusing on his or her appearance. Rather than talking about their weight loss, it's better to comment on their lack of appetite or their health, Kelly advises. It's important that you avoid condemnation. "You need to be compassionate and concerned. You can often get a negative reaction. Some people aren't ready to admit they have a problem. Suggest that they visit a GP. It's vital that they get a medical diagnosis. They could be developing damaging side effects." Since anorexics tend to be in the younger age group, they are usually living at home and are easier to treat. Bulimics, living away from home, pose a greater problem. And, unless a sufferer really wants to be helped, treatment won't work, says John Griffin.
While the family doctor can successfully treat most people - especially in the early stages - more serious cases need specialist treatment. Unfortunately only three public hospital beds are dedicated to eating disorder patients, according to Jennifer Kelly. Young people living in rural areas are often admitted to psychiatric hospitals where the treatment can be unsuitable. "People are often just fed up and then thrown out," she says. "They don't get the appropriate treatment." Griffin says he runs his programme on a contractual basis. Anorexics may require a spell in hospital to build them up but usually bulimics are treated as outpatients.
Anorexics are given weight targets while bulimics work on eating plans. Body image and mirror work are important features of the programme. Patients learn that it is acceptable to have a normal body shape or even be a little overweight.
"Check with your family doctor," Griffin advises. "He or she will tell you what your correct weight should be. Everybody differs. You have to take into account the overall size of your frame and your genetics." Bodywhys helpline:
Tuesday 12.30pm - 2.30 pm, Wednesday 7.30pm - 9.30pm ,Thursday 10am - 12.00 am
