THE RISE OF THE HIGHFUNCTIONING ANOREXIC Is the race for success fuelling an increase in eating disorders?
Is the race for success fuelling an increase in the deadly eating disorder? Julie McCaffrey investigates
in a corner of the BBC newsroom, Habiba Khanom listens intently through headphones as Andrew Marr and George Osborne, the former chancellor, of ‘sugar tax’ fame, verbally joust live on air in the studio two floors below.
She scrutinises each sentence and writes breaking news stories while the two political mights face off. It’s a high-pressure role. Khanom’s real-time reports must be wholly accurate, incisive and written at speed. She is one of a few young broadcast journalists with the skills and up-to-the-minute political knowledge to cut it.
Interview over and Khanom joins Osborne in a restaurant near the studio. Far from feeling intimidated as a 23-year-old among some of the nation’s most influential men, Khanom feels superior. It’s now 11am and she’s been up since 5am, when she began her day jogging on the spot for an hour. While the men around her tuck into hearty cooked breakfasts, she smiles as she sips black coffee.
“I feel powerful watching them eat because I can starve myself and they can’t,” Khanom says. “It’s like I get this pleasure that I can control myself by not eating. It’s as if I could conquer the world.”
Khanom inhabits the secretive world of high-functioning anorexics, where sufferers are fiercely driven, yet fuelled by little more than coffee and Diet Coke.
And their numbers are growing. Doctors in England report a steady rise in female eating-disorder patients over the age of 20, and the Renfrew Center (which has 17 eating-disorder clinics in the US) reported a 42% increase in women over 35 seeking help for eating disorders in 2011, too.
This rise in post-adolescents seeking treatment comes during a time in which women are under a huge amount of societal pressure to not only look amazing, but be successful – and do it all on a public platform. The University Of Pittsburgh School Of Medicine observed more than 1,700 adults between the ages of 19 and 32, and found those who checked social media frequently were 2.6 times more likely to report an eating disorder. Women in particular are drawn more to visual apps, such as Instagram or Pinterest, which are rife with opportunities for unhealthy comparisons.
“If women are increasingly pressurised to ‘have it all,’ then we predict a rise in the number of successful women suffering from anorexia,” explains Dr Ian Frampton, senior lecturer in development neuropsychology at Exeter University. “Our research has shown that some people are biologically predisposed to becoming complete perfectionists – they are really driven, have immensely high standards and work exceptionally hard. You’ll find that many of the men and women holding down today’s highest positions possess this unique brain wiring.”
Of course, we all strive to be excellent at something. And while not everyone with these qualities – which are clearly brilliant when used wisely – is vulnerable to an eating disorder, the risk arises when something triggers dieting. A recent 10-year study in America found women who struggled with body image or an eating disorder while growing up could be triggered to relapse later in life by the stress of a high-powered career.“If you do have an underlying personality that drives you to do well in everything you do, then you can become incredibly ‘good’ at dieting – which can lead to an eating disorder,” explains Dr Frampton.
Dr Pooky Knightsmith, 33, appears – on paper – to be superhuman. She is one of the UK’s leading experts in mental health and has authored three books, as well as being a frequent marathon runner. On top of all that, she also has two daughters. However, her relentless work schedule meant that those around her didn’t spot the signs of anorexia when she was suffering from it three years ago.
“I was one of the people producing the most work,” she says. “I was always chosen to speak first at presentations because I was so bubbly. I became a different person in the office.”
But while she was achieving so much professionally, she was also missing most meals. Her busy schedule allowed Knightsmith to mask her unhealthy habits. It’s not uncommon to hear a colleague say they’re “so snowed” that they’re missing lunch, or that they’re cutting out certain food groups; both have become signs of a modern high-powered life.
“We have also seen highly stressful jobs serve as a trigger to anorexia,” says Dr Joanna Silver, lead therapist for eating disorders at the Nightingale Hospital, London. “Someone with an underlying disposition might start skipping a few meals, lose a bit of weight – and get that adrenaline rush.” And Knightsmith agrees.“When I look back at what I counted as normal behaviour, I now see it wasn’t – I was really underweight and I was restricting the kind of foods I ate. But people didn’t notice,” she says. “My size wasn’t obvious under the trouser suits I wore for work – and I worked constantly.”
“There’s a certain type of woman who is idealised in our society,” notes Dr Silver.“She’s the one who always fits in exercise before work, looks impeccable and can turn down the doughnut at 4pm because she ‘doesn’t need sugar.’ They’re seen as being very much in control – but sticking to very rigid routines can be a way to manage stress, in the same way an alcoholic would turn to alcohol.”
It’s long been documented that successful men drink as a way to manage their stress levels (research
“Some people are biologically predisposed to perfectionism”
last year* found those who are better educated and of higher socioeconomic status are more likely to drink alcohol, with rich men being the worst offenders – and the drinking habits of young, successful women are quickly catching up). Now that more women are in the top jobs than ever before (the number of female directors on FTSE 100 boards has doubled in recent years), eating disorders could be a more subtle way women – who make up 85% of all anorexia and bulimia cases – are showing their stress.
Making matters worse? “The fact we reward slimness in women, and we don’t reward other forms of stress release – say, drinking. It’s a way for these women to keep giving out the impression that they are perfect.”
In Khanom’s case, all her colleagues see is that she’s on a fast track to promotion. And she works hard to keep it that way – her quest for perfection seeps into everything she does. Every morning she spends two hours getting ready, discarding scores of dresses before finally settling on one.
That’s quite common, as apparently high-functioning anorexics often make their illness a key part of a complicated routine. That’s why it can become wound up in their success. “It’s a trait common in all eating disorders,” says Dr Silver. “Those suffering identify so strongly with their anorexia that they often want to cling on to it. There is this fear that if they get better, they won’t be as successful.”
Knightsmith has recently undergone a spell in an eating-disorders unit; as has Khanom, who is still under its care. “I think anorexia will always be there in the back of my mind,” she says. “I don’t even know who I am without it, so I’m scared to let it go.”
If you’d spoken to one high-flying Oxford University academic researcher, 34-year-old Emily Troscianko (above), 10 years ago, she’d have agreed. “As a student I was convinced anorexia contributed to my success,” she says. It’s only now, years later, that she’s able to recognise that she gained her degree in modern languages, her master’s with distinction and her doctorate during her decade at the university of her anorexia, not because of it. “I felt that if I didn’t work that hard all the time, with the extreme and narrow focus anorexia made possible, I could never do well.” It cost Troscianko her physical health, and diminished her social life, too. “It was so incredibly isolating. Some days I didn’t see anyone at all, and as I got physically weaker, everything just got more unbearable.”
The roots of anorexia are complicated already – even more so when those suffering believe the illness is what makes them great. But escaping it is possible. For Troscianko, it was cognitive behavioural therapy that gave her the help she needed, and now she knows she can be successful without anorexia. “People thought I was ‘high-functioning’ because I was doing so well at work, but that’s buying into the idea that professional success is the only thing to be valued – and that it’s the be-all and end-all. Now I care about work and find it fulfilling, but can leave it behind and prioritise other things too.”
Towards the end of her doctorate, as the fog of starvation started to lift, Troscianko realised that being ill had, in fact, prevented her from being intellectually ambitious. “I didn’t have the mental energy,” she says. “Working in that way was always a dead-end strategy: exhausting and self-limiting. Real intellectual achievement isn’t possible when your body and brain are starving.” If you’ve been affected by the issues on this page, go to B-eat.co.uk