When Sarah was three years old, she looked in the mirror and told herself that she was "fat and ugly". At the age of 14, she was diagnosed as diabetic and shortly afterwards began suffering eating distress - starving, bingeing, vomiting and abusing laxatives. By the age of 19, she had been hospitalised in psychiatric units nine times and had attempted suicide 15 times.
She sometimes deliberately burned holes in her skin with cigarettes. And when she was so thin and weak that she could hardly walk, she felt "happy" because she was losing weight.
Psychiatrists prescribed so many mood-controlling drugs that, at one stage, Sarah was taking 23 tablets a day. Their approach, says Sarah, was to sedate her to the level of a zombie and then to feed her until she reached a "target weight". But this treatment did nothing to alleviate Sarah's self-hatred and, once out of hospital, she would inevitably continue her self-destructive behaviour.
As a last resort, psychiatrists gave her ECT to "boost" her mood. Three weeks later, she was so depressed she took an overdose and ended up in casualty. At the psychiatric hospital, Sarah's parents were told that their daughter was incurable. So, at the age of 20, "incurable" Sarah was repeating fifth year at school for the fourth time. She had never been able to last beyond Christmas before being hospitalised for eating distress.
Sarah was, quite literally, at death's door, as the functioning of her heart, liver and kidneys became seriously impaired. Because her periods had stopped, thus depriving her body of female hormones, she now has the brittle bones of a 60-year-old woman and is at risk of a life-threatening fracture (see below).
Sarah's parents refused to give up and their search for help led them to Marie Campion, a recovered sufferer from eating distress who has become a psychotherapist. She is the founder of the Marino Clinic in Clontarf, Dublin, which specialises in treating eating distress. "If I hadn't met Marie, I'd be dead or in hospital," Sarah says now.
"Eating distress has absolutely nothing to do with food," says Campion, who was born in Czechoslovakia and moved to the Republic 20 years ago. "It is a mental illness, not a physical shape issue. Sufferers try to control food because their lives are out of control."
Eating distress can involve self-starvation, over-eating, self-induced vomiting and laxative abuse. It tends to occur in sensitive, anxious people who are intelligent, perfectionist and attractive.
At the core of this type of personality is an extremely negative mind-set. People with eating distress see the world and themselves in almost exclusively negative terms. This can lead to the behaviour which most of us know as "eating disorders" but which Campion prefers to call "eating distress".
As the organiser of the Republic's first Eating Distress Awareness Day tomorrow, Campion is keen to address the "shameful stigma" attached to the condition, as shame and ignorance prevent many people from receiving the treatment they need. Campion uses a psycholinguistic motivational model to "coach" her clients into seeing themselves and the world around them in a realistic, positive way. She teaches them to replace negative thought patterns with positive statements about themselves that they can repeat whenever they are feeling anxious and out of control.
In therapy with Campion, Sarah, for example, is learning that her behaviour with food was rooted in such extreme self-loathing that it was impossible for her to see what was obvious to anyone else: that she is a thin, beautiful young woman. "Another person who hated themselves as much as I do might become an alcoholic or drug addict. For me, it was food," says Sarah, now 23 and doing a science degree as a mature student at Trinity College, Dublin.
Campion sees children as young as three years of age who refuse to eat or who force themselves to vomit. Often, these children have mothers who are in denial about their own problems with eating distress. Her oldest clients are in their 60s, having suffered eating distress all their lives, and one in 10 clients is male.
Georgette, a 45-year-old mother of six whose youngest child is four months old, suffered all her life from secret over-eating before she got help from the Marino Clinic two years ago. Even as a slim teenager, she was lonely and felt "big, heavy and stupid with very little confidence".
She dieted so much that she slowed down her metabolism. (A recent medical study proved that teenagers who diet are more likely to be overweight adults.) Consequently, Georgette ballooned to 18 stone during her pregnancies and was afraid to be seen outside the house. It was a vicious circle as her poor self-image made her overeat even more. Twice she lost eight stone through Weight Watchers and then Unislim, but always put the weight back on because she was superficially changing her eating habits, while not addressing the fundamental cause of her over-eating.
"When I met Marie almost three years ago, I felt like I was speaking to a like-minded person for the first time in my life," says Georgette. "She did not judge me and gave me the freedom to be myself with her. I started to like myself as I learned positive affirmations and positive self-talking to overcome the negative messages that had been going on in my head all my life."
Learning to love yourself is a simple message, but a complex task which may take years. Campion shies away from the word "recovery", preferring to see a life liberated of eating distress as one in which "there is no euphoria, just the normal ups and downs of the real world".
An open talk to mark Eating Distress Awareness Day will take place in Trinity College Dublin's Ussher Theatre tomorrow at 7 p.m. For further information, phone 01-8333126.
Marino Clinic helpline: Monday, Wednesday, Friday and Sunday, 6-8pm: 01-8333063.