Britain has the highest rate of eating disorders in Europe, with around 1.6 million people affected. Increasing numbers of young people are being admitted to hospital because of them, which in part is blamed on social media and its role in developing an obsession with image.
But while the connection between eating disorders, body image and the media is well-documented, obsessive thoughts and compulsive activity can play a major part of the problem. Eating disorders are often mistaken as a form of obsessive compulsive disorder, but while they are separate to OCD, some people suffer the debilitating consequences of both conditions.
Kate Winter, 29, from Warwickshire, has suffered with obsessive compulsive disorder for her whole life. Five years ago, her condition developed into an eating disorder. She was diagnosed with anorexia nervosa, a serious mental health condition that affects one in 250 women in the UK at some point in their lifetime.
"My diagnosis is anorexia nervosa and OCD, and I was in a therapy session when the therapist said she would describe it as atypical," she tells IBTimes UK. "It upset me initially because it reinforced a feeling that I wasn't a proper anorexic."
"At that time, I wasn't at my lowest weight," she says. "But by that point, I had been admitted to hospital several times and knew I had a problem, but I still thought - am I really anorexic? But as I began to think about what atypical anorexia means and started to articulate it in the context of OCD, I realised the therapist was spot on."
In atypical anorexia, the disorder fulfils some features of anorexia but lacks others. One of the key symptoms – such the dread of being overweight – may be absent in the presence of marked weight loss and weight-reducing behaviour. In group therapy sessions, there were aspects of the illness that others discussed that Winter could not relate to.
"At no stage of my life have I actually wanted to lose weight or be thinner," she says. "I haven't really looked in the mirror and thought I was fat – even in hospital, when I was forced to maintain a BMI of 20. Even then, I felt OK with my body and the way it changed."
Negative body image is known to be a factor that can lead to preoccupation with weight or body shape. But, as Winter explains, body image is not always the main factor in developing an eating disorder.
"Eating disorders are not just about body image," she says. "Obviously it plays a big part of the problem for others with the illness but, for me, it boils down to control. Control of food, patterns, numbers and checking. Eating disorders are about control, whether it is controlling intake of food or controlling your body. It always comes down to that word."
"In terms of negative body image, it is hard to know what is normal and what is disordered thinking. I do have days when I feel fat and other days when I feel good about myself, but everybody does. But that is the problem, it is so common you don't know when it turns into an obsession."
Dealing with OCD
Until the age of 24, Winter had a good relationship with food. But she has been aware of having OCD for as long as she can remember. "The OCD was only diagnosed with my anorexia, but I know that I have had it forever," she says. "I remember carrying out checking rituals in my bedroom as a child. Everything has always had to be just so."
Around one in 12 people – around 750,000 – suffer from obsessive compulsive disorder in the UK. The mental health condition causes unpleasant or unwanted thoughts, images or urges, leading to repetitive behaviour to relieve feelings of anxiety, fear or disgust. Typically, the condition starts to significantly interfere with a person's life during early adulthood – although problems can develop at any age.
"At 24, my OCD crossed into an eating disorder. I noticed one day that I had sat down to eat breakfast at exactly eight o'clock – and I thought it felt almost comforting. I thought it would be nice to eat at exactly 11 or 12, as I could make a pattern out of it," Winter explains.
"This got increasingly worse. I would be rigid, starving hungry, watching the clock and counting down the last ten seconds until I could take a bite out of something. Then it turned into counting. I could only eat five cherry tomatoes, no more and no less."
"OCD still affects my entire life and it always has. I am single and I live alone, as I find it difficult to share physical space with people," Winter continues. "It's not all about cleaning or tidying impulsively. I am at the point now where I feel quite sad about how much it impacts my life.
"But in terms of my anorexia, I have managed to control it to a point where I am not in hospital. I can go to work and see friends for dinner or coffee."
Raising awareness of the disorders
During Eating Disorder Awareness Week, which runs from 23 February to 1 March, Winter hopes to increase awareness and understanding of anorexia and OCD.
"It is hard to hear the term OCD being used so trivially," she says. "When people say they are 'OCD' about lining up tins of beans, I think, that's not the worst it can be. I don't want to upset people, but at the same time, you want people to be more aware of how difficult living with the condition is.
"I have also come across a gross misunderstanding of anorexia – to the point where it is almost daily. People commenting on what or how you eat can make you very self-conscious. People still think eating disorders are a lifestyle choice, not a mental illness."