In the couch queue

I've had an eating disorder for several years, although I didn't speak to my GP about it until about a year ago. He was extremely supportive; he prescribed Fluoxetine (Prozac) and referred me for cognitive behavioural therapy. Even though I had the initial assessment about six months ago, I still haven't received an appointment yet. As a result, I currently feel very down and disillusioned. My eating behaviour has become increasingly erratic, and sometimes I feel so ugly that I feel guilty about other people having to look at me. This self-disgust, along with frustration over my eating problem, has led to me cutting my arms and legs with kitchen knives and burning my wrists. I've also had suicidal thoughts.

I know that I should be telling my GP all this, but the thought of telling anyone makes me feel physically sick. I really like and respect my GP, but I do usually downplay things when I go to see him, so he doesn't know how bad things really are. I feel that to offload all this to him all of sudden would make me seem melodramatic. What should I do?

It sounds like things have been difficult for you over the past few years. It's good to hear that you've found the courage to talk about your eating difficulties and have been receiving support from your doctor (GP). Waiting so long for therapy sounds frustrating and it's understandable you're feeling so down and disillusioned. The thoughts and feelings you describe sound very upsetting, as does your erratic eating behaviour. Although life may seem bleak right now, you do have some options that may be of help, which are outlined below.

Feeling suicidal can be a very isolating experience, even if close friends and family are around. Sometimes, people find it hard to talk to people they know about feeling this way, as they fear that others may not understand or don't deserve the 'burden' of their problems. Sometimes, it may feel like people simply do not care, even if they do. However, you may find it helps to share your feelings with someone close to you. Talking to someone you know may help them understand you better, enabling them to support you more effectively.

If you feel that speaking to friends or relatives may not be an option for you at the moment, but you'd still like to talk through your feelings with somebody, you could call Saneline on 0845 767 8000. This is a helpline for anyone affected by mental health problems - all advice is provided on a non-judgmental and confidential basis. If you're feeling suicidal, you may also like to consider calling Samaritans on 08457 90 90 90. If you'd prefer not to speak to someone on the phone, Befrienders International offers further support and information via email.

As you may know, unhealthy relationships with food can begin when food is used to cope with difficult feelings. Some people use food to ease painful situations or to relieve stress, perhaps without even realising it. When food begins to rule a person's life, whether in the form of compulsive or binge eating, or excessive dieting, a person's relationship with it can become dangerously unstable. This may develop into an eating disorder.

You can receive treatment from a clinic or therapist to help you overcome an eating disorder, so it's good to hear you've already been referred for cognitive behavioural therapy (CBT) and been given an initial assessment. Unfortunately, there are often long waiting lists and this may be why you've had to wait so long for an appointment. It's worth re-contacting your GP about this, as he may be able to find out about the status of your referral.

With the right support and treatment, it is possible to manage and overcome eating disorders. For extra support and information, you might like to contact the Eating Disorders Association helpline on 0845 634 7650. They also have an extensive website, offering information, advice and a support  network, including a message board.

Sometimes people self harm to cope with (and get through) difficult emotions or situations. Doing this can also ease what cannot put into words or even into thoughts, and be a way of releasing painful emotions such as rage, sadness, emptiness, guilt or fear. Since it is generally a private coping mechanism, some people may feel too ashamed or unable to admit to anyone what they are doing; therefore it's understandable you're finding it difficult to talk to your GP about it.

You might like to consider contacting the National Self Harm Network, which provides support to people who self-harm. Their website features a range of resources and also includes a message board.

If you find talking helpful, perhaps counselling, would benefit you further whilst you are waiting for your CBT to begin. A trained counsellor will be able to assist you in identifying any underlying issues you may have which could be contributing to your situation. These may include elements of control, low self-esteem, depression, family or relationship problems. The Eating Disorders Association or your GP will be able to provide you with further details of local services. You could also try contacting Youth Access if you wish to seek this form of support independently.

Updated: 03/06/2011

Question answered by SANE