It really worries me to think that if I need any treatment in the future, I will have to starve myself to 80lbs before even being considered for a referral to an adult unit (I have since turned 18).
SCOTLAND'S system for treating people with eating disorders has been condemned as "positively dangerous" by Britain's foremost expert on anorexia and bulimia.
Bryan Lask, professor of child and adolescent psychology at the University of London, claimed the NHS in Scotland was operating a "misguided policy" by basing its treatment decisions on how thin someone has become.
Experts say that without official guidelines the majority of Scottish GPs follow a rule of thumb based on body mass index (BMI). This means that those who have a BMI above 13.5 - the equivalent of 5st 7lb for a woman of average height - stand little chance of getting specialist care.
Prof Lask's criticism comes just weeks after a damning report into the death of Lindsay Weddell, 20, accused health boards across Scotland of failing to provide "vitally important" services for people with eating disorders.
And today The Scotsman can reveal how one young woman struggling to control her anorexia was forced to seek treatment in Canada at a cost of thousands of pounds after her doctor told her she would need to lose more weight if she wanted in-patient care in hospital.
Sally Cole-Hamilton, 21, was told by her own GP that unless her BMI was 13.5 or less she would be unlikely to receive in-patient treatment. The St Andrews University student, who has now achieved a remarkable recovery from her illness, said: "I was told in no uncertain terms that unless my BMI was 13.5 I would not be considered for referral. This was very upsetting and very counterproductive, but there was nothing I could do.
"I wanted to fight this illness here in Scotland with my family close, but I had no option but to go to Canada."
Although Sally, who is 5ft 9in, was just a dress size six when she went to her GP for help, using her doctor's criteria she would have needed to drop down in weight to 6st 7lbs in order to access treatment.
Using that criteria, a woman of average height in Scotland would need to weigh just five and a half stone before she could get treatment for anorexia.
About one in every 100 young persons aged between 12 and 25 in Britain has anorexia. The incidence of bulimia is at its worst among college-aged people, where 4 per cent of the population has the disease. And the age profile of anorexia sufferers is dropping dramatically. The youngest recorded case in Britain is in an eight-year-old girl.
Scotland trails behind England in its approach to treating people with eating disorders, experts say. The NHS in England must follow official guidelines for treating those with eating disorders, but north of the Border there are no official guidelines for GPs and only two centres operated by private companies to treat anorexics and bulimics.
Prof Lask said: "Scotland is woefully served for in-patient services for anorexia and bulimia. I cannot think of one other country in the western world that has worse facilities than Scotland.
"Stories such as that of the student at St Andrews make my blood pressure soar because basing treatment for anorexia on weight is positively dangerous.
"That sort of policy is misguided and based on a lack of understanding of eating disorders and is very dangerous indeed."
Prof Lask said that using a BMI of 13.5 as a guide showed little or no comprehension of how ill someone could be from anorexia. He said: "You could have a person with a BMI of 16 who is desperately ill and needs to be in hospital urgently while someone else could naturally have a BMI of 17 and be perfectly well.
"So basing what are in some cases life or death decisions on BMI means no attention at all is being paid to a patient's medical needs - in my opinion it's being driven by finances."
There are two independent centres in Scotland which can treat people with an eating disorder - the Huntercombe Hospital in West Lothian and the Priory in Glasgow. Diane Whiteoak, the manager of the Huntercombe Hospital, said:
"Sally, sadly, is typical of many. We get people like Sally into us all the time because the NHS support services can only refer them for inpatient treatment at a point where their BMI has fallen below 13.5."
The Eating Disorder Association runs a helpline for people struggling to cope with their illness. Mark Riley, the EDA's head of regional support, said that the majority of calls came from Wales and Scotland simply because both countries operate a woeful service for treating anorexia and bulimia.
The Scottish Executive set a taskforce to look into services for anorexics last year, however insiders say it has met only once and has yet to make any firm commitment to improve the system.
A spokesman for the Executive said that BMI was one of several indicators used to identify anorexia. He added: "Improvements have been made in eating disorders services and important work is currently under way.
"The role of the independent sector is key and we will continue to work with NHS Boards, and their partners, on the range of local and national initiatives underway or planned to ensure the best possible care and treatment for all.
"It is very important that we continue to raise awareness of the effect illnesses such as anorexia nervosa and bulimia can have on people's mental health and well being, particularly young people."
'They were telling me if I kept starving myself, they'd treat me'
IT ALL began when I went on a diet in my second year of university at St Andrews. I just thought one day that I really ought to go on a diet and, as everyone is on a diet at some stage in their lives, it didn't seem like a big thing. The anorexia took hold of me quite suddenly. I went from being a normal, happy and healthy girl to just being pretty miserable and very depressed and not eating much at all.
A year in, and I was not allowing myself to eat most food groups. In fact, it got so bad that eventually I was afraid of having anything that was a carbohydrate or anything with fat in it. I only felt really safe with eating grapes. I was living this horrible life where I could not eat, but I was starving and all I could think of was food. I could not get out of bed, I could not go to university, I could not even hold down a conversation. I just wanted to die.
What people need to understand is that, while anorexia is about weight loss, it is really an emotional illness. Weight loss is just an outcome, but the NHS only look at weight.
I have got an amazing body; it just hangs on, regardless of what I do to it. At one point, I was eating fewer than 400 calories a day and I did not lose a single pound.
When I spoke to my doctors, I kept telling them I felt so terrible that I wanted to kill myself, but because I wasn't losing weight, they didn't think I needed treatment. But even when weight is not coming off, anorexia is still doing your body incredible damage. When I was down to 300 calories a day, I used to get a lot of chest pains and I would faint, and that was when I knew it was time to eat.
People imagine anorexics do not want to eat - they do. But they also think they have to be thin to be loved and to be successful and to be cared about. Thin is so much more than a tiny, four-letter word to anorexics. It means love, caring, success, popularity, intelligence - it means all these things. It is like holding on to a truth, but when you start starving yourself, you start to become confused and you give yourself your own rules because these are the only things you can hold on to.
I would get up every day but not until I had lain in bed for as long as possible, so that more of the day was gone when I would not be near the kitchen. Once I had got out of bed, I would have to go to the bathroom where I would weigh myself. I would then try and hold on as long as possible before eating something. I would probably have a bath - having a shower was out of the question as standing in the heat for any length of time made me feel light-headed - then I'd do my make-up and my hair and go to the shop and get the local paper.
You see, if I ate before 3pm I would feel bad. The only proper meal I would allow myself was the same small salad every day. I would eat from the same bowl, using the same knife and fork, and it would always look exactly the same. If I couldn't do that, [wait until 3pm] I found it incredibly distressing. The eating disorder had become my life and, if I deviated from it, I felt hopeless and upset.
What people, especially the NHS, don't seem to understand is that the eating disorder is about your life - not about weight.
When I went to the NHS for help, they used to weigh me. They essentially told me I had a body mass index higher than 13.5, so I was OK. I could hardly believe it - they were telling me if I kept dieting, kept starving myself, and got down to a BMI of 13.5, they would treat me. What kind of thing is that to say to someone with anorexia? Inside, I was screaming for help, but because I wasn't losing weight, the NHS wouldn't help me.
If the doctors could have looked inside me, they would have seen this tiny, emaciated person just desperate for help.
It was the Westwind centre in Canada that saved my life. I was never weighed the entire time I was there. There were people there who were emaciated, but they weren't weighed either. Westwind helped me to start connecting with what was going on in my life and all I was throwing away by having an eating disorder that controlled my life. I realised I didn't want my life achievements to be summed up on my headstone as: "She looked good in skinny jeans".
Reading it makes me want to go and set up my own unit here!
Are there any other Scots here that have recieved bad treatment? Or from anywhere else for that matter?