The essential features of anorexia nervosa are the refusal to keep a minimally normal body weight, intense fear of gaining weight, and a disturbance in the way one perceives the body shape.The essential features of anorexia nervosa are the refusal to keep a minimally normal body weight, intense fear of gaining weight, and a disturbance in the way one perceives the body shape.

Caroline’s* 12-year battle with eating disorders has been a long and harrowing one. Over the years, the illness has literally eaten away at her and her family’s peace of mind.

The 25-year-old went through various doctors, psychologists and psychiatrists without registering any significant improvement. But as anorexia continued to ravage her body, taking her down to a skeletal 31kg, Caroline’s mother Philomena turned to their final outlet of hope.

In 2011 she asked the Community Chest Fund to help fund her daughter’s trip to The Priory in the UK, renowned as Europe’s leading treatment provider for eating disorders. The exorbitant fee of £400 a day made it impossible for the family to financially support Caroline’s enrolment in a full programme.

However, after being investigated by a board which also comprised members from the Health Department, the family’s request was rejected.

The recent controversy regarding the offer of financial assistance for a Master’s degree programme for the sister of the President’s daughter-in-law, Darleen Zerafa, left Caroline’s family feeling angry and rejected.

“My daughter’s was a case of life and death and yet was not recognised as such by the Community Chest Fund,” Philomena, 57, told The Sunday Times of Malta.

My ultimate goal was one – that of not eating. I started losing grip of my sanity

“I hope the proposed Dar Kenn Għal Saħħtek [the therapeutic centre catering for eating disorders] is successful, but I must admit that for some, particularly my daughter, it may be too little, too late.”

Caroline first developed anorexia nervosa when she was barely 13. She radically cut down her intake of food, devising elaborate strategies of trashing her food when no one was looking.

She insists vanity and peer pressure had nothing to do with it.

“I was abused and I felt the only way of obtaining some semblance of control was to restrict food entering my body. I had no idea at the time that I was suffering from an illness.

“All I knew was that I was different from others. I felt profoundly unhappy in an unusual way,” she recalled, referring to the depression which slowly took over her mind.

She didn’t open up about the abuse until eight years later. When one of her sisters realised she was not eating, she took to sitting by Caroline’s side during meal times and would not budge until Caroline had swallowed every mouthful.

But things slowly spiralled out of control.

“The thought of food consumed me. It became a persisting obsession. My ultimate goal was not eating. I started losing grip of my sanity.”

Caroline describes the destructive chain wrought by the illness which crushed her mind and ravaged her body. Her anorexia caused her to suffer foot drop – a weakening of the muscles that causes an individual to drag the front of the foot – leading to frequent falls. She also turned to binge eating and purging, ballooning to 69kg. She abused the anti-depressants prescribed by her psychiatrist.

She also suffered severe depressive episodes and required hospitalisation on a number of occasions as she was highly suicidal – overdosing on two occasions.

“She went from being a happy, chubby girl to this,” Philomena said, tears streaming down her face.

Caroline was admitted to Mount Carmel Hospital after being transferred from the Psychiatric Unit at Mater Dei Hospital; however, there was little improvement.

Compiling Caroline’s medical history to be presented to the board in 2011, her psychiatrist at the time wrote:

“Various agencies were approached, seeking adequate therapeutic interventions for Caroline’s problems. However, none was suitable to deal with her eating disorder and co-morbid conditions.

“In my opinion, Caroline requires an urgent and appropriate programme which, unfortunately, is not available locally.”

Caroline feels her psychologists and psychiatrists were not specialised enough, despite their care and support which was always available.

All I knew was that I was different. I felt profoundly unhappy in an unusual way

“They’re oblivious to the illness and its inner workings. They are clueless about how our afflicted mind works and the ‘tricks’ we adopt to fool people into believing we’re coping.”

In the midst of all the turmoil, Caroline managed to graduate and obtain a degree in tourism. For a while, she had reached a healthy weight and seemed to be mastering her illness.

However, she has relapsed again and is rapidly shedding kilos – surviving on fruit and soups.

“It just gets so tiring. I’m existing, not living. I wish I could be treated by a specialist who can truly help me – I’d take any option which could lead to my recovery.”

When contacted, a spokesman from the Office of the President declined to comment on Caroline’s case, citing data protection.

However, the spokesman added that they were aware of the unfortunate plight of many people suffering from eating disorders, which is why Dar Kenn Għal Saħħtek was being set up to specifically address the illness. The centre should open later this year.

Questions sent to the Health Ministry remained unanswered by the time of going to print.

* Not her real name.

What are anorexia and bulimia nervosa?

The essential features of anorexia nervosa are the refusal to keep a minimally normal body weight, intense fear of gaining weight, and a disturbance in the way one perceives the body shape.

According to consultant psychiatrist Ethel Felice, the majority of the patients do not accept they have a problem and are commonly brought to professional attention by a family member.

Associated with anorexia, one frequently finds psychiatric symptoms which include depressive symptoms such as a depressed mood, social withdrawal, irritability and insomnia. Bulimia nervosa refers to binge eating and inappropriate compensatory behaviour such as fasting, vomiting, using laxatives or exercising to prevent weight gain.

“These are not purely vanity or image related disorders. The actual cause of these disorders appear to result from many factors, including cultural and family pressures and emotional and personality disorders. Genetics and biologic factors may also play a role.”

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