When William Dwyer Joyce was a teenager, skinny jeans and Indie bands were what was cool. To be slim was fashionable. As a someone who didn’t fit into that stereotype, and who was always “plus-sized”, Dwyer Joyce turned to food as a coping mechanism.
The now 32-year-old was diagnosed with binge-eating disorder when he was 21, though he says he struggled with mental health difficulties long before that diagnosis.
“For me, my binge eating was very secretive. It was going to the shop, getting large amounts of things like chocolate, crisps, cookies, whatever. And going home and secretly eating it to the point where I could not eat it any more,” he says.
“It created a coping mechanism that was quite harmful because my body image was very poor. It was about numbing. In a sense it was self-harm. If you eat to the point of pain, it’s not a nice thing to go through.”
Compounding this difficulty, Dwyer Joyce also struggled with alcohol addiction and drug misuse issues. These challenges, he says, all came from the same place: a desire to be able to exert control. He is now five years sober.
“When I got sober, it was like I was in a house that was on fire. Sobriety put the fire out, but now I’m standing in rubble and I have to build the house again,” he says.That was when he seriously sought help for his eating disorder.
“In April 2020 I got sober for the last time. A year after that, in 2021, I had a year of sobriety under my belt. My 30s were knocking on my door and I thought, I cannot live like this forever and the only person who can change this was me.”
One difficulty he found when seeking help, he says, was the questioning attitude and scepticism he faced by some healthcare professionals because he doesn’t fit the common eating-disorder stereotype: a young woman or teenager with anorexia.
“I am the opposite of the stereotype in that I’m a man, I’m plus-sized, I wasn’t restricting food,” he adds.
“There is all this messaging around fatness or plus-sized people that if you’re fat it’s a moral failing or you’re lazy or you don’t care about how you look. But that’s just not true.”
This stereotype is beginning to change, according to Laura Casey, director of services at Lois Bridges, an eating disorder treatment centre in Sutton, north Co Dublin. The number of young men seeking help at the centre has increased in recent years, she notes.
Casey attributes this rise to the increasing gym culture seen online – in which men are constantly fed images of bodybuilders with very little body fat – combined with the masculine tendency of men to keep their feelings to themselves.
“But when they do go and reach out, they’re not heard the same. Their voices can be dismissed a bit easier,” she says.
Another changing trend is the prevalence of a condition known as avoidant/restrictive food intake disorder, or Arfid, which is often diagnosed among people who are neurodivergent.
“It’s sometimes called the beige diet; they eat a lot of chicken nuggets and chips. But we’re moving away now from language that describes these people as being a picky eater, and acknowledging in many cases they have a sensory aversion to something.”
According to Casey, Arfid can have a significant impact on an individual, particularly in a social setting.
“Sometimes a person’s diet is so restrictive they won’t eat. There is a lot of shame and stigma if all they are able to eat is a chicken fillet roll. So, nutritionally, they can be at the same risk as anorexia. It affects their vitamin intake and electrolytes,” she says.
When it comes to certain foods, some people with this diagnosiscan have a panic attack or feel like they’re choking. “They can only eat yoghurts and drinks,” she adds.
Awareness of eating disorders has increased since the Covid-19 pandemic, when there was a rise in the number of referrals for treatment to HSE eating-disorder teams, who provide specialist treatment.
HSE data shows there were 894 referrals to such teams last year, a 33 per cent increase on 2023. There was also a 24 per cent rise in accepted referrals, where patients proceed to treatment after an initial consultation.
A total of 562 patients were assessed last year, of which 90 per cent were female and 59 per cent were children under the age of 18. One-third were teenagers aged between 15 and 17. Still, the service also saw the number of adults accessing treatment increase by 51 per cent.
You’re either too sick for the psychiatric hospitals or you go into a general hospital and there’s no help there for these things
— ‘Rebecca’
Of those assessed, 503 had an eating disorder, 118 more diagnoses than in 2023.
Some 63 per cent (318) presented with anorexia nervosa; 18 per cent (97) with an “other specified feeding or eating disorder” (OSFED); 8 per cent (42) with bulimia nervosa; 3 per cent (16) with Arfid; and 2 per cent (10) with binge-eating disorder.
Many eating disorders begin the teenage years. But disorders often don’t end there.
Rebecca, not her real name, was first brought to Child and Adolescent Mental Health Services (Camhs) at age 15. However, she believes this “did a lot more harm than good”.
Although she acknowledges there are many good people working in the service, she was unhappy with the attitudes she faced in relation to her anorexia. Then the coronavirus lockdown happened, shutting down vast swathes of regular life. “Everything was gone, and I deteriorated very rapidly.”
Following this, she underwent a “string of hospital admissions and A&E presentations” to help with her diagnosis, but she says it was like a “revolving door”.
“You’re either too sick for the psychiatric hospitals or you go into a general hospital and there’s no help there for these things. You’re stuck between nothing that will help,” she says.
“When you go into a general hospital, it’s really only for one thing: to be fed against your will. But it’s so important to get to the root cause of it. It was very difficult to find help that suited me. And then when people do offer you that help, it’s hard to accept it if you’ve had bad experiences. I’m still struggling a lot.”
The almost 21-year-old makes a comparison to alcoholism: relapse can be a common challenge for people, and oftentimes the difficulties of the illness are persistent.
“But there’s no AA meetings [for eating disorders] around the country that you can pop into. You’re kind of just left alone,” she adds.
Dr Art Malone, a consultant psychiatrist and chair of the eating disorder specialist interest group at the College of Psychiatrists, says one of the biggest challenges is that some areas of the State have inadequate access to the necessary specialist services.
“Not all areas that have a specialist service are fully resourced to deliver the sort of service they would need to do. The biggest one is probably the lack of higher-level care needed for severe cases, so the lack of inpatient treatment is something all teams have to contend with,” he says.
Dr Malone says that for the “very small minority of patients” who have very severe, acute illnesses there is “no higher-level care available in the way that it should be”.
“What ends up happening is there can be funding sought in other places such as private places or abroad but there can often be fairly lengthy delays in arranging that and then even when it is arranged – because it’s taking people out of their home environment – it can be quite tricky then to transfer their treatment back to their own home set-up,” he says.
Dr Malone says there’s a big push to try to make early intervention a priority, as this can prevent people from needing inpatient care.
He cites international research that found the relapse rate for people with severe illness who receive inpatient treatment is around 50 per cent in their first year.
“But it’s important to note that services where they do exist are extremely hardworking. Things have come on such a huge distance in a very short time, but it’s coming from such a low base in terms of service accessibility that there is still a way to go.”
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In recent years, the Government has taken steps to improve eating-disorder services. Currently, 14 of the 16 specialist eating disorder teams recommended in its internal plans are funded.
Minister of State for Mental Health Mary Butler says no patients have been treated abroad this year so far for specialist eating-disorder care.
“I’m very proud of the progress we are making in establishing a full suite of services to support people with eating disorders, from early intervention in the community to the development of specialist inpatient beds for acute care,” she says.
However, things are far from perfect, those working in the sector say. Figures from the HSE show that one-third of funded posts at eating disorder regional specialists teams are currently unfilled.
In the adult eating disorder team in the Sligo, Leitrim, South Donegal health area, there are more vacancies than people in post: 3.2 whole-time equivalent staff are in place, with seven unfilled posts in the area.
Furthermore, there are only three adult specialist eating disorder beds in the country, all of which are in St Vincent’s hospital, Dublin. The rules for these beds, which are for those who are acutely unwell, require patients to be within that hospital’s catchment area to be treated there.
As a result, people with eating disorders outside that area who go into public hospitals for treatment are typically referred to a general psychiatric unit. Often they are unable to access specialised care in such settings.
However, The Irish Times understands a plan has been devised by the HSE to increase the number of public eating-disorder beds nationally.
At least 20 new specialist beds will be established in the coming years, under proposals submitted by the HSE for Ms Butler’s approval. The beds will be spread between Dublin and the rest of the country, but all of them will have a national catchment area.
For some people, recovery feels impossible. Aoife, which is not her real name, developed eating disorder behaviours when she was 12, after she sought to lose weight for her Confirmation.
“My family weren’t very nice about my body. But also society. You’d be in drama class and I was the biggest so I would have to try on the costume and if it didn’t fit me then nobody would get it. Then there were things like the Special K diet, or Kate Moss’s saying about skinny being better,” she says.
The 32-year-old Cork woman says she was diagnosed with anorexia at the age of 15, and went into hospital when she was 16, which she describes as “the worst point in my life ever”.
“I couldn’t control anything. I had a tube in my nose, I wasn’t allowed to walk anywhere. I basically just lay in bed. I soiled myself because it would expend too much energy to go to the bathroom. It was only about weight restoration, not about treating the eating disorder,” she says.
She struggled through college but was determined to continue her studies.
I’ve been told I’ll never recover. I have chronic anorexia. So you ask yourself, what’s the point in trying?
— ‘Aoife’
After graduating as a teacher, she realised she needed to get better before she could work full-time. In 2016, she returned to inpatient care. She improved somewhat, she says, but was not in recovery.
She was admitted again two years ago, but had to leave early due to panic attacks. For her, she says, a history of trauma is playing a role in her current condition: her sister died when she was very young.
“I overate when she died; that was soothing myself. My life felt out of control, I didn’t know who would die next. Food was something I could control,” she says.
But it is 20 years since the onset of those challenges. These days, she feels quite hopeless about her current trajectory.
“I’ve been told I’ll never recover. I have chronic anorexia. So you ask yourself, what’s the point in trying? Normal eating is no longer normal for me. This has become my normal and it’s very hard to see outside of it,” she says.
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“It’s pointless to be here every day. I keep wondering, how did things come to this? I’d love for someone to tell me what to do because I just don’t know where to go or what to do. I look inward wondering what I could do differently. What did I do to deserve this?”
Trying to find somewhere to go is something many patients experience. Alicia Woods, clinical nurse specialist at Lois Bridges, says the centre is a private facility, but they receive “phone calls everyday of the week from people who don’t have private health insurance”.
“We treat a range of eating disorders. And in terms of age, we’ve treated from 18 up to people in their early 70s,” she says.
“The majority of older people with eating disorders have had it their whole life but they just haven’t had the information, education or support to seek help. Some people do develop it later in life.”
Though Woods says the reasons why individuals develop eating disorders are complex and nuanced, she believes social media is playing a role.
“Body positivity was such a thing, but now we’ve gone back almost 20 years. The videos on social media, encouraging people to obsessively run 5K a day, or the ‘what I eat in a day’ videos [and the food quantity] is not enough to feed a toddler,” she says.
She is also concerned about the potential impact the widespread availability of weight loss jabs like Ozempic might have on vulnerable individuals.
“We know that people can put in fake weights and get these prescriptions. If someone already has a low [body mass index] … the potential of that is frightening,” she adds.
But even when people can access treatment, often recovery is not linear, according to 38-year-old Edel Higgins.
She was diagnosed with an eating disorder when she was around 25. She didn’t know much about such disorders at the time, but says she had “always tried to change my physical appearance”.
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It took four inpatient stays before she reached a point where she sees herself as being in recovery. She says: “It doesn’t just take one go. People often feel guilty when they have to go back. But it’s such a complex illness.”
The Tallaght woman is four years in “proper recovery”, but she says for her that doesn’t mean the eating disorder is “completely gone”, but just now she has the “resilience” to acknowledge and challenge those urges when they arise.
She writes poetry to help her cope. She looks at inspirational quotes hung up on her wall.
“Sometimes I wish I could wake up, go about the day, not having all of these overwhelming feelings – the eating disorder and mental health [difficulties]. But it doesn’t work that way. It can be frustrating. But it’s about findings ways to deal with it.”
Bodywhys (The Eating Disorders Association of Ireland) – bodywhys.ie – (01) 210 7906 – alex@bodywhys.ie