“WHEN YOU CAN’T eat with other people, you convince yourself these habits are normal. Nobody saw us and what we were doing. If we kept going like that, one of us would have probably died.”
Twin sisters Aislinn and Roisin Duggan have dealt with anorexia for years. After their illnesses worsened last winter, both were hospitalised to receive treatment.
The sisters – who are 23 and from Kilkenny – said the “isolation and loneliness” of the past year contributed to their eating disorders worsening.
They said they wanted to tell their story as a way of helping raise awareness of potential warning signs.
Roisin had been dealing with anorexia for around seven years before receiving hospital treatment, while Aislinn had experienced the disorder for around five years.
In the second half of last year, amid strict Covid-19 lockdown conditions and as both started new jobs, their illnesses deteriorated.
“Eating disorders thrive on isolation and the perfect storm for an eating disorder is a lot of time for yourself and a lot of negative emotions circulating,” Aislinn told The Journal.
“When you can’t eat with other people, you convince yourself these habits are normal. Nobody saw us and what we were doing. If we kept going like that, one of us would have probably died as [specialists] said we were really close to getting a heart attack.”
Eating disorders have the highest mortality and morbidity risk of all mental health issues, according to the HSE.
Mortality refers to death and morbidity refers to ill health.
Heart failure is one of the physical comorbidities (presence of two or more diseases or conditions in one person) associated with eating disorders.
The HSE said eating disorders affect a “relatively young section of the population”.
‘I didn’t know what anorexia was’
Roisin said she was 15 when she was first affected by disordered eating.
“I didn’t know what anorexia was, so there was no way I would recognise what was happening,” she said.
“You never think it will happen to you until you find yourself deep in it.”
She said hearing advice such as “just eat a bit more” made her feel “stupid, as if it was my own fault and I was just inept”.
According to Bodywhys, the eating disorders association of Ireland, some of the warning signs of an eating disorder include:
Aislinn said her eating disorder was mostly stable during secondary school and after starting university in 2016, with the anorexia worsening “in times of stress around exams”.
“Eating disorders have a very progressive way of isolating you from your friends and convincing you that skipping lunch to go to the gym is a good idea.
I thought eating disorders were a very specific thing that people were born with or something. Mine started entirely as a dieting thing, it never started as ‘I want to be thin beyond what is healthy’.
I wanted to be good at sports and attractive and popular and I thought being very fit was how to reach that.
She trained in sports like martial arts, and after a few years “had convinced myself that I couldn’t possibly have an eating disorder because nobody could keep this up”.
Somewhere along the line, it got ingrained in me that I needed to be as thin as I could be and as skinny as I could be to be successful, or enough.
Her illness got progressively worse in 2019 and she contacted a GP at the start of March in 2020. Roisin had consulted a doctor in late 2019.
Soon after Covid-19 restrictions were introduced in March of last year, Aislinn and Roisin moved back to Kilkenny to live with their family.
“We had sort of convinced ourselves that life would be better down here and we would start recovering and get better,” Aislinn said.
We didn’t really realise how categorically wrong we were and that this needs structured, long-term treatment. We both wish we had gotten help sooner… We’re both still in treatment and it’s going to be a long enough road ahead.
They were still trying to get help for their eating disorders during this time, but found it difficult to get conclusive solutions and faced long waits for consultations.
They were also job-hunting, after finishing their degrees in science.
Roisin said they were “hoping not to go back to Dublin”, but most of the jobs in their industry were based in the capital.
They found work in the autumn and because their workplaces were relatively close together, they moved into a shared room in the south of Dublin.
Roisin said it was “very isolating” as they couldn’t meet up with many friends outside work and they were living with strangers.
“The eating disorder crept in,” she said. “Between September and December, we both just went downhill a lot.
“My family would obviously notice if it got worse, but because we didn’t see them for eight weeks… Nobody was checking in on us and it just got worse.”
“Being at home with nothing to distract you from your thoughts, it just allows eating disorders to thrive.”
Aislinn said: “We were so ill at that stage, and we didn’t really realise it. Because of lockdowns, we didn’t really meet any of our friends much in Dublin at all. It has been a lot harder with the Level 5 lockdowns, they really, really add to it a lot.
“We were dangerously underweight and we didn’t realise how much the isolation and loneliness was getting to us.
We did go home finally in the last weekend in November and our mother just cried when she saw us because we really weren’t well by then.
‘Strange to give up your freedom like that’
During the summer, Roisin said she was given an appointment in December with St Patrick’s University Hospital. She rang the hospital in November, three weeks before the booking, to ask for an earlier appointment due to her worsening illness.
The hospital had an online consultation slot free. At this, she was advised to receive hospital treatment within the week.
“The next day, St Patrick’s rang and said there’s a bed available tomorrow,” she said.
“Checking yourself into a psychiatric ward is very strange. They search your possessions and you can’t leave the ward for the first few days at least.
“It’s very strange to give up your freedom like that. It was very scary.”
Shortly after this, Aislinn attended an appointment at St John of God Hospital in Stillorgan where they also advised her to receive hospital treatment.
She said they told her she would have to take time off work and “invest at least a year of my life to recovery”.
“I had just graduated, just started my first job in early November,” she said.
I thought that maybe it is more important to take time out, even though it would be bad for my career.
She agreed to receive treatment, and entered hospital in December. She was there for a total period of over seven weeks.
The day before being admitted, she had a busy day and went for a 10km run.
“The next morning I got up and got the bus to the hospital. When I got there, they took my bags and said ‘don’t walk too quickly up the stairs at your weight’.
“I had an awful few weeks in hospital – the first few weeks are the hardest. You go from being an independent adult working and living in your own house to giving up all your freedom to someone supervising all your meals.
We’re both extremely lucky to have private health insurance. We wouldn’t have been able to receive treatment if we didn’t and I don’t like to think about what could have happened if we didn’t.
Since leaving hospital in January, they continue to attend outpatient online appointments and sessions.
“It’s a long-term recovery to deal with,” Roisin said.
It’s been very hard. It’s a bit of a battle every day. It’s easy to lose focus in recovery and feel like now that you’re home, that you’re better, but then when you can’t feed yourself you’re really in no place to be out by yourself on your own.
Private treatment
Only 5-15% of people with eating disorders seek help, according to the HSE.
Aislinn and Roisin had not told anyone outside their immediate family about their experience until they left hospital.
“If you feel you can’t talk about it, it kind of has more power,” Aislinn said.
We told a lot of our friends about it even though it’s a very hard thing to tell people because it is hard and a bit depressing and grim, and it’s not something people like talking about.
Roisin added: “When people hear you have anorexia, they can write you off as dysfunctional.
“Being able to talk about it is very liberating.
“It’s hard to talk about it, but I’d rather talk about it… I might as well try and save other people from ending up in the same situation.”
They have since left their full-time jobs to focus on art.
“Art is a backup career and a passion for both of us,” Aislinn said. “It gives you a bit of an escape route.”
“Eating disorders are very much about control… With the pressure of living in the city and work, we felt we had to be more than we were and an eating disorder was how we thought we could achieve that.
“Recovery is possible, and even though it is hard to get treatment here, it is possible.”
It was reported in February that people with all types of eating disorders have been presenting “more unwell than previously seen” to HSE mental health and other services.
An article published in January’s Irish Medical Journal also said there was a 66% increase in hospital admissions for eating disorders in 2020 compared to 2019.
The authors of the article said there are a number of contributory factors including distress, anxiety relating to the pandemic, pre-existing morbidity, social and economic factors, the impact of restrictions and losses of protective factors.
Tough year
Barry Murphy, communications officer for Bodywhys, said it has been “an incredibly tough 12 months” for people with eating disorders.
“Unfortunately, the pandemic has heightened the risk factors while simultaneously stripping away the protective factors,” he said.
People with eating disorders, he said, have a “need for predictability” and the pandemic has “thrown that completely out the window”.
“It’s kind of like having headlights on your car. The storm of the pandemic has taken those headlights away, so you can’t see the road ahead now.”
“Certainly, parents are noticing that their children or their adult children are more entrenched in the eating disorder experience and clinicians are seeing more and more people being medically unstable and therefore needing hospitalisation.”
He said the lack of social contact has not helped the situation.
“Just the need to keep the social distancing and the isolation that comes with that, and the feeling that you’re very much on your own with an eating disorder. It’s very exhausting.”
Roisin said disorders like anorexia needed to be thought of like any other illness:
“Nobody chooses to get cancer and it doesn’t go away when you ignore it, and that’s how eating disorders should be viewed.
It can strike anyone down, as can any illness, which is not how it’s viewed in Ireland. It’s viewed as something dramatised that young girls go through when they take dieting too far.
This may be what triggers it in the beginning for some people, but it’s very much an illness and a disorder and it’s very much not something you can think your way out of.
If you need to speak to someone, contact:
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