Skin and bones

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The statistics are stark and horrifying. Male eating disorders are on the rise, from the anorexic teen to the bulimic middle-aged man.

What has led to the dramatic increase, and where does it leave the victims and their families?

THERE is a moment when, caught unaware, the human eye simply captures reality for what it is. It blinks like a camera shutter, before the brain has had the chance to filter the image and influence perception. There it is, the truth, imprinted like a photograph before the mind's airbrushing has been allowed its insidious influence. For Donald MacNaughton, that moment came climbing out of a bath. He was anorexic, but could never see himself as thin. Never thin enough. And then, unexpectedly, he caught a glimpse of his body in the mirror and saw the truth of his own emaciation. "I remember looking and seeing the equivalent of a Belsen refugee and just being so… the emotion broke through and I remember thinking… that's me."

SEX: MALE. Height: 5ft 8in. Weight: Six stone. Age: 21. Three Shape yoghurts a day. Discipline. All-Bran with water. Stomach curls. He doesn't see that Belsen refugee any more because low weight alters brain chemistry. Things get distorted. That's why anorexia has the highest mortality rate of any mental illness. MacNaughton runs on the beach, backpack weighed down with bricks. Heart rate: 32 beats a minute. It could stop at any moment. Tomorrow morning, he might simply not wake up.

But he did wake up. More than 20 years on, he sits opposite and when the human eye blinks on him, the photographic evidence is of a successful man. A sports psychologist and motivational coach, MacNaughton works with the British ski team, the Scottish shinty team, English rugby league and many top football clubs. It's hard to reconcile this man with his description of himself as David Bowie's gaunt Thin White Duke character, drowned in a long jacket, topped by his minister grandfather's hat, eyes that shut out the world. "Dead eyes. That's how you tell someone has anorexia. It's like all your emotions shut down. You can't feel anything. It's like a blanket. I became introverted, living in a different world inside my own head."

Back then, a down grows over his body. His hands turn blue, his body shutting down to protect vital organs. In hospital, doctors want to open a vein and inject adrenaline. But they change their minds, unsure that his heart will survive the shock. A nurse gives him tea. He takes a sip. "Is there sugar in this?" he asks. "I remember thinking, 'You're dying here and you would rather die than give in.' It's like there's this war inside you."

We associate that war with women: skinny models, the size-zero debate. While 1.1 million people in the UK now suffer from an eating disorder, traditionally only one in ten of these have been men. But as men's roles and expectations change in society, so too has their relationship with their bodies. Figures suggest an increase of at least 50% in male eating disorders in recent years, with both gay men and men who have suffered sexual abuse at greater risk. "In terms of the people we have seen," agrees Dr Chris Freeman, an Edinburgh-based consultant psychiatrist in eating disorders, "the numbers have doubled, though we start from a very low base."

There are historical precedents for male eating disorders. The 19th-century poet Lord Byron is believed to have been anorexic. Interestingly, he was also infamous for his sexual exploits, and sometimes addictive behaviour in one area can bleed into another. Byron took vinegar to curb his appetite and dosed himself with Epsom salts and strong laxatives.

In recent times, it is celebrity women who have most famously suffered. When Princess Diana publicly admitted to bulimia, a condition of binge eating and induced vomiting, it normalised female eating disorders: even royalty struggled. The same is now happening for men, with a string of celebrities admitting problems: Russell Brand, David Coulthard, Adam Rickett, Elton John. But is the psychology of male eating disorders any different to that of women?

What is clear is that in the last 20 years, society's increasing affluence has complicated both men and women's relationship with food. Britain's obesity problem is second only to America's, and alongside that are other spiralling disorders. We take too much, or too little, as if the collective thermostat governing our eating impulses is simply on the blink. In the West, we stuff and starve. Food has become our cri de coeur. "To starve yourself while being surrounded by the plenty of the Western world is a powerful message that you need help," says Freeman.

Bulimia is far more common than anorexia in the West. "You find anorexia everywhere," says Freeman, "but bulimia is the Western diet disease."

In Africa, there is not the luxury of affluence-induced eating disorders, but even there anorexia exists. Dr Jane Morris, consultant psychiatrist at Edinburgh's Young People's Unit, and chair of the Scottish Eating Disorders Interest Group, explains. "Even in countries where fat is regarded as very beautiful, there is still this minority of people who compulsively starve themselves. Some attach it to religious fasting, some almost to a party trick, the amazing freak person who can go for days without eating, and some are just tolerated – or not – as oddities. But there are people in every culture who do it."

It is often argued that airbrushed media images create unrealistic expectations of body shape, contributing to eating disorders. But if anorexia has always existed, perhaps media images are irrelevant. Not at all, argues Morris. Anorexia may have been around for centuries, but not at current levels. "We're doing more cosmetic surgery, more dieting – we are a society obsessed with appearance. And those are the perfect conditions for body-image disorders to grow in."

The island of Fiji makes a fascinating example. Academics were keen to study the island after the arrival of television in 1995. Traditionally, the island's people revered fuller figures. What impact would the importation of US television have? Anne Becker, a Harvard anthropologist, discovered a marked increase in eating disorders. "One could speculate," she says, "that television is another pathogen exporting Western images and values."

Doctors stress that eating disorders are very individual. But certain themes recur for both sexes. For women, disorders may more often be appearance-driven, while men, who commonly develop eating disorders through the route of excessive exercise, often latch on to goal-setting and targets. Dieting is a trigger and certain sportsmen, such as jockeys, are considered to be at high risk. Psychologically, two things are prevalent for men and women: low self-esteem and the need for control.

For MacNaughton, control issues were very important. Brought up in Brora, his adoptive parents meant everything to him. (Later, he would discover his birth mother lived just 15 miles away.) He was a sporty child and loved football. His computer screensaver is a picture of him at three with a football at his feet, his dad in the background. It says everything important there is to say about him. But when he was 12, his dad died. It had a huge impact on him. He internalised the grief but became very rebellious.

His teenage years were spent playing sport and drinking with the lads. "I was the last person you'd think would get anorexia. I was captain of the under-18s, well built, confident, not shy or retiring in any way." But he did, perhaps, lack direction then. He left school, joined the marines, but lasted only three months. He travelled to Israel and hitchhiked through Turkey, before returning to Scotland and deciding to study his two great interests: sports psychology and business.

In 1984, he went to America to coach football, and he and his friends were involved in a car crash on the way home from a nightclub. The car caught fire but luckily landed in a swamp, which doused the flames. MacNaughton regards that crash as the pinnacle of his out-of-control years. Things changed after that. When he came home, he began dieting. He set targets and loved his success. He was good at this. "I can be very disciplined, quite extreme. I always had focus and determination." For women, the ideal may be slenderness. But for men, isn't the ideal muscular? What was he aiming for? "My model for the ultimate in athleticism was Bruce Lee – muscular but very slim."

It was hard for his mother to watch, he says. She provided great support but he was living in London when he finally sought help. He spent three months in hospital, forced to lie in bed to conserve energy, all control over meals removed. As he gained weight, his brain chemistry changed and he began to see things differently. But even after leaving hospital, his weight fluctuated for a while. When it steadied, he swapped one addiction for another, becoming an alcoholic.

Sometimes, the mind and the body are simply at war with one another. His conscious, rational mind urged recovery. His unconscious mind whispered a different message. "It's like this," he explains. "Imagine there's a medicine man talking to Indian braves and he is explaining that all of them have internal conflict. It's like two wolves fighting, a black wolf and a white wolf. They will fight to the death. Which wolf, the braves ask, will win? And the medicine man replies, 'Whichever one you feed.'"

THE WORDS ARE haunting and lonely, written in the round, neat hand of a 16-year-old boy. Let's call him Steve, because he has been bullied at school and identifying him would make life too difficult. He writes to his eating disorder, like some bizarre companion inside his head. "Hate you but love you… You crawled into my eyes as I gazed over the smudge which was staring back at me in the mirror."

He welcomes his disorder until he realises this secret friend wants to destroy his identity. "Cutting down my size, me, my life. Till nothing. I was nothing… You lead me astray, lead me away from myself. I was becoming something I never wanted. I was becoming you."

Steve is friendly, bubbly, articulate. His hair is dyed blond, cut in a swept, spiky fringe, and he likes alternative clothes. Slightly punk, slightly goth. There is something instantly likeable about him, but somehow he has always had a hard time where he lives, never quite fitting in. Adults have always 'got' Steve but other kids don't. He was different, and this led him to long periods alone during school lunchtimes, drawing in the art department. In those periods of isolation, he began thinking about cutting back on food, creating a person he wanted to be.

He liked the fact he was slight, but as he grew older he began to develop muscle and it unnerved him. He was desperate to be an adult because then he could leave school and follow his dreams of studying art and fashion. But he didn't want an adult body. "I wanted to grow up being the same size," he explains. He had become a vegetarian at 13 but two years later began cutting down on food. "I felt extremely in control. That's what gave me the urge to go further. I felt as if this was the first time I had done things for myself. I was achieving something."

Even as his weight dropped, he didn't think he was thin. "I never looked in the mirror and saw the same thing. Sometimes I was a wee bit satisfied but never fully. I would think there could be a wee bit less here or there." He became withdrawn, refusing to go out, spending time alone in his room, often staring into the mirror. "It turned me upside down. I had always been happy, smiley, energetic, but I became the opposite. I felt happy, but it was like a hollow happy, a false happiness. Something else was missing and I thought I had to go further to get that happiness. But it never, ever came."

Steve's comfortable house in a village near Edinburgh is very definitely a home. His parents, Sally and Jim, clearly adore their children, and even outsiders sense an exceptional atmosphere of love and support in a family traumatised by destructive illness. Sally and Jim watched impotently as their son shrivelled both physically and emotionally. "He was cold all the time, sitting at the radiator with big, baggy clothes, his dad's jumper and a bathrobe," explains Sally. "You are helpless in every way because this isn't your child any more. It's somebody else. He didn't even look like himself. He wouldn't make eye contact. I think he knew he had to hide. He would put the hood up on his robe and it was just not Steve any more."

Steve used to look at magazines because he liked fashion. He wondered why the models – men and women – looked so skinny. Sally found a few lines scribbled in his room one day: 'Sitting here on my own, in a magazine world. Hungry. Hungry all the time. Drinking water.' "I looked at it, thinking, what on earth is going on?" She felt immense relief when he suddenly started eating again. Pizza. Ice-cream. Biscuits. Anything he could lay his hands on. Thank God, she thought. But alarm bells rang as the quantities became vast and unhealthy. Unable to stand the hunger, Steve had become bulimic.

Every instinct as a parent is to protect your child. But parents of anorexic children have to watch them self-destruct on the most basic level. Sally is composed, capable, but ask her about that parental instinct and her eyes swim. "It was absolutely terrible. You're a mum. I said to him one day, 'Darlin', I didn't get a book when you were born. I can only feed you and love you and care for you, and now I'm watching you go the other way.' It was so upsetting. At one point I thought I wasn't going to get through it. I would be out in my car and I just wanted to drive past the house and never come back. I would go out shopping round Asda, putting things in the trolley without even knowing what they were. I felt everybody was looking at me, that everybody knew something was wrong."

Jim is more private, less talkative than his wife. His instinct was to tell no one. But Sally needed support. She told Jim about a notice she saw in the surgery: 'Mental health is everybody's business.' "I was sinking, absolutely sinking. I was Mum in the morning with the smile and the breakfast. Was he eating it? Was he swallowing it? Listening at the toilet door to see if it was coming back up. During the day, I was being scraped off the floor by my husband and sisters, and after school I was Mum again with a smile. Steve would come in and say, 'Have you been crying, Mum?' I'd have to say no."

Eventually, Jim, who had been so strong and supportive, cracked too. He called Sally one day from his car. "He had pulled into the side and was crying uncontrollably, which just isn't like him. He said, 'I can't do this, I can't drive, I can't see for tears.'" Sally persuaded him to call his family, to confide in others, and when they were offered the chance of a parents' support group, they jumped at it. It made them feel less alone. They had each blamed themselves, but resented any suggestion from the other that they were to blame. "It opened up a gap between us," explains Jim, "but once we were over that stage, it brought us closer."

The crisis had come when Jim had found Steve being sick. The boy claimed he had simply eaten too much. "The first thing I said," explains Jim, "was, 'We're going to do this together. We're going to beat it. It's not your fault.'"

Sally watched as her husband physically scooped their son up in his arms. It touched her – because her own instinctive reaction had been a fear-induced anger. "I was looking at Jim holding Steve, thinking, 'Why are you doing this? We love you. Everybody loves you.' Then it triggered: this isn't him. He said, 'I'm sorry,' and I said, 'No, you've not to be sorry, Steve. This is something that is happening to you, son, not something you are doing.'"

Steve can hardly put into words what he felt at that moment. "It was really scary that night. So many emotions. Reality checks." He was partly relieved that they knew and partly angry he had been found out. "A bit of me thought, 'That's it. I'm going to get fat now.'" Perhaps he explains it best in his writing. "Stay away from me, you screamed," he writes of his addiction, "while I was whispering help."

He is a year into outpatient treatment and doing well. Recovery from eating disorders is not instant; it often takes four or five years to turn thinking around. Steve had to overcome the fear that food would instantly make him fat. "It felt like I was letting myself down. Like I'd been running a race for ages, reached the finishing line, only to be told I'd run the wrong way." Unusually, he was allowed to stay in control of what he ate, snacking on small quantities. It worked for him, and that was all that mattered.

Steve is realistic. He knows he is not fully well yet. "I don't know if I want it totally away…" he admits. But the perfectionist child who always thought his artwork was not good enough has a new self-awareness. "Now I think I know what kind of person I am, what I can and can't deal with, what I am and am not good at. I used to think I wasn't good at anything." He writes to his addiction: "You are not a friend. You made me think I wouldn't come back. But now I'm finding me again."

EATING DISORDERS are an internal panic button. The truth is that sometimes the mind destroys the body and the patient dies. But that is not usually the intention. "I don't think anyone with this illness wants to die," explains 33-year-old Mark, from Perth. "I certainly didn't. It was the last thing I wanted. But I was pushing myself to the limit." He was 6ft 4in, weighed eight stone, and took a perverse satisfaction in being told how awful he looked. It was evidence of his success. "Then, when you start collapsing, you do get really scared and think you have pushed it too far."

Mark is complex, artistic, quirky – as sufferers often are. He was 25 when he became ill but says nothing in his past indicated he was at risk. At the time he was unhappy in his job and overweight, and his long-term relationship was breaking up. In some strange way, he thinks starving himself was an outward sign to the world of the inward pain he was feeling. "I really didn't like myself much," he says.

Sometimes, sufferers show signs in childhood of obsessive-compulsive disorder but Mark's desire for control only began with his anorexia.

"The control thing is absolutely insane. If you were going to eat something, it would have to be at 12 on the dot. It would have to be a specific thing, on a specific plate, arranged in a specific way, and if anything got in the way, it was frightening how you would react."

Mark lived in London when he became ill, but a friend came down from Scotland, got him drunk, and basically kidnapped him, bringing him home to seek help. But while support from friends and family has been very important to him, he says there is nothing anyone can say or do until you are ready to be helped. Mark took off travelling, managing a caf-bar in Russia and existing almost entirely on alcohol and no food. When he came back to Scotland, his potassium levels were so low he began collapsing. There is not yet any inpatient NHS treatment in Scotland and patients have to be referred to private clinics: the Priory in Glasgow and the Huntercombe hospital in Edinburgh. Mark spent a year in the Priory.

"If anyone had said a year, I would never have agreed. But it was one of the most amazing experiences I've had. You're not in there sitting on a bed. You're working on yourself constantly. In the end, I thought of it like travelling, meeting extraordinary new people and learning about myself."

For the first seven months, he was the only man in his group – a common problem for male anorexics. But only when he began to recover did it even occur to him. Low body weight affects sexuality and libido. "Initially, I didn't think of myself as male or female."

Mark is about to go travelling again but wants to make sure he's not running away from life. He acknowledges that whatever made him anorexic may still be part of his personality. Donald MacNaughton, on the other hand, says that for him, nothing remains of the anorexic or alcoholic. "If I say I am a former anorexic, that's an identity statement. I am this. And I am not. I am far bigger than that as a person. That's something I did for a period of my life and I choose not to do now. I watch myself but I eat what I want. Is there anything of the anorexic left? No. Do I want to be fat? No."

MacNaughton has taken almost every personality trait that made him anorexic and alcoholic, and turned it into its positive alter-ego. The negative obsession became positive focus. The destructive targets became motivational goals. Everyone, he says, has things that inspire them in life. He took his passion for sport and created his own business. What he has been through nearly destroyed him, but it also created who he is. "There's a depth of experience that I bring to what I do because of what I've been through. When I work with people, there are not many things that phase me. I've learned that having a spectrum of emotion is human. It's sadness that tells me I am alive. I love to be happy, but I am not scared of the other things."

When he coached tennis and football, people used to look at him and say, "There's a man who has taken care of himself." It made him smile, because anorexia meant he knew what it was like to be wrecked: mentally, physically and emotionally. "Spiritually, anorexia is an emptiness." And yet MacNaughton is an example of that touching tenacity that marks out the survival instinct of the human spirit. "When I went to bed at night, what kept me going was the thought that tomorrow would be different. Every night. A lot of the time it wasn't, but I still held that thought in my mind. Tomorrow will be different."

Going public on a weighty issue

Dennis Quaid developed 'manorexia', as he called it, after losing nearly three stone to play Doc Holliday in the film Wyatt Earp in the mid-1990s. "For many years, I was obsessed about what I was eating, how many calories it had, and how much exercise I'd have to do to burn it off," he later said.

Elton John entered rehab for drug and alcohol abuse and bulimia after the collapse of his marriage in the 1980s. The singer has since gone public about his struggles. In an interview in 2002, he discussed his battle with the eating disorder – and that of his friend, the late Princess Diana.

David Coulthard has admitted he became bulimic in his teens, while trying to break into racing. In his autobiography, the Formula One star stated frankly: "I stopped eating fattening food and, before I knew what had happened, I was bulimic. In my mind, the only way I could keep my weight down was by making myself vomit. I became skin and bone but I weighed myself morning, noon and night. In the evening, if I was half a pound heavier, I would get in the pool and swim."

Matthew Perry has come under intense scrutiny for his yoyoing weight in recent years. After he shed a considerable number of pounds post-Friends, he admitted to suffering from pancreatitis, a painful illness that can be triggered by alcohol abuse or prescription drugs. Rumours ensued that an eating disorder continued to haunt him as he tried to deal with his fluctuating weight.

Billy Bob Thornton (below) dropped a staggering four stone during the filming of Oliver Stone's U-Turn, and ended up less than ten stone for Pushing Tin. The Oscar-winning actor later referred to that period of his life as "mental". Observers, though, have noted that Thornton still looks worryingly thin.

Richard Dunwoody, like many jockeys, has had problems with his weight. In his autobiography, Obsessed, he wrote: "Concern with my weight became an obsession. The less I ate, the less I wanted to eat. I hated what anorexia had done to me and hated feeling so helpless. Basically, I had starved myself to be a jockey but in doing so had lost the strength necessary to ride horses."

"I was a fat little kid," Russell Brand has said. "I wanted to lose weight, and I would make myself sick on a daily basis. I remember my stepdad asking me to stop puking up in the sink because it was blocking the drain.

"I stopped by the time I was 17 as by then I was a drug addict so I had other self-destructive behaviour to be getting on with."

Adam Rickett used food "to escape depression". "After just five months my bulimia had taken over my life," the former Coronation Street star has admitted. "My weight had plummeted from 11 stone to six stone, so at 5ft 11in I looked absolutely awful. I constantly wore a scarf to try and cover up my gaunt face."

Eating disorders: The warning signs

MANY people don't realise they or someone close to them has an eating disorder until it already has a hold of their lives. After all, most of us have been on a diet at some point.

But there are warning signs that can indicate someone is in trouble. These include regularly skipping meals, or only ever eating tiny portions. Perhaps the person refuses to eat in front of others, or has specific obsessive rituals they must go through at mealtimes.

They may always have an excuse ready as to why they can't eat: they're not hungry, they've just eaten, they're not feeling well, they're too upset about something.

Some people become disgusted by foods they used to enjoy, while others might claim to have become a vegetarian, but they don't eat the necessary fats, oils and grains to keep them healthy.

They may never go anywhere without a diet cola in their hands and they read food labels obsessively.

Bulimics tend to gorge on high-calorie foods in secret, then make themselves sick. But sometimes they leave behind clues – such as empty crisp packets and chocolate wrappers – indicating a need to be discovered. Look out for the tell-tale smell of vomit in the bathroom, running the taps to cover up the retching noise, stale breath or the excessive use of mints or mouthwash.

Often the person will start wearing baggy clothes – to conceal their body shape or to keep warm – and they'll complain about being fat even though everyone says they are not.

Watch out, too, for compulsive exercising and mood swings. The person could become snappy, have trouble concentrating and tire easily. They become increasingly withdrawn and self-critical. In extreme cases, they may self-harm.

The longer the signs of an eating disorder are ignored, the longer recovery can take, so it is important to act on any concerns. Consult your GP, who can refer you to a specialist clinic (though there may be a waiting list). If you're not ready to speak to someone face to face, websites such as feature a vast range of information on the illness, message boards to compare notes with others in a similar situation, and details on where to get help.