Just a quick visual update of where the Insomnia cognitive disorder creature design is up to at the moment before we progress forwards. Moving onto the next set of cognitive disorder creatures, I started to look into categories that I had not previously looked into which includes some disorders of more sensitive subject matter (Bulimia Nervosa and Dysthymia). This sensitivity requires more delicate nature in the design choices to make a more meaningful impact and not to just appear preachy.
Starting with Bulimia and understanding how the disorder has forced the sufferer to have a distorted view of themselves which impacts their eating habits, forced purging which in turn forces the body to require more food and calories for maintenance creating a vicious cycle of over-eating or binging and repetitive purging causing sever harm to internal anatomy and organs.
Some of the triggers for this condition may include; Self dissatisfaction, Family problems, Emotional crises, and Educational or Work stresses.
Whats interesting as a design observation is how many physical symptoms there can be to this condition due to the effects it can have on the body compared to some of the more 'silent' disorders that have more mental implications.
Some of the more common symptoms can be;
- Often a normal or above average body weight.
- Repeated episodes of binge eating and fear of not being able to stop eating.
- Self-induced vomiting (often in secret) - this is only an occurrence for purging bulimia, non-purging sufferers regulate their disorder with exercise and/or restricted diet.
- Excessive exercise
- Excessive fasting
- Specific eating habits or rituals.
- Misuse of laxatives or diuretics.
- Irregular menstrual periods or no periods at all.
- Anxiety.
- Discouraged feelings about themselves and the way their body looks.
- Depression.
- Fixation on food, weight, and body shape.
- Inflamed oesophagus and swollen glands near the cheeks.
- Tiredness and less energy.
- Dental problems due to erosion of tooth enamel from vomiting.
- Stomach issues, holes can form or rupturing can occur.
- Kidney and heart issues due to lack of vital minerals and electrolytes being absorbed by the body such as potassium and sodium.
A lot of the physical symptoms can allow for creature designs that inhibit the sinister look I am aiming for when crafting these beasts so as to show the monsters that sufferers face on a daily basis but can also be heeded as a warning to those in the beginning stages of the disorder, whilst also giving visuals to individuals to look out for in their friends and family if they suspect one such individual may have the condition thus rising awareness and empathy in players/readers of this project.
Alongside just researching the symptoms the following webpage has real accounts from those that suffered from the condition or family members of sufferers where they give a real insight into the unique situations that can bring about the disorder and how the signs can be seen or felt as well as personal events that can give a deeper and stronger set of visuals during my design process I will copy a few of the stand out examples to highlight the effect of first hand resources, plus acknowledge how having such an open source of information from real survivors has the effect that I am aiming to achieve with this project so a lot of respect to Forward Thinking Birmingham the cities mental health partnership with the NHS.
https://forwardthinkingbirmingham.nhs.uk/eating-disorder-recovery-stories/
"It was just over two years ago when Evan’s eating disorder began. He was nine and a keen cross-country runner. He began to think about eating and thought that if he was lighter he would be able to go faster. And so began the voice in his head telling him to eat less.
At first, it was difficult for us to understand what was happening. He was generally anxious and depressed and said that he felt sick after every meal, and we really wondered if there was something physically wrong.
We initially accessed Forward Thinking Birmingham for treatment for anxiety and depression and he was diagnosed as being on the autistic spectrum. Throughout this time the voice saying ‘Eat less’ persisted and became increasingly problematic.
The lowest point came after a week during the summer holidays when he, his siblings and cousins were staying with his grandparents. When we went to pick him up, we were appalled by his skeletal frame – clearly worse after a further week of eating practically nothing.
The psychologist we were seeing was monitoring his weight and charted a steady decline, and we were referred to the Eating Disorders Service. That initial visit marked a turning point for us. It was a gruelling three-hour visit with the dietician and psychologists and Evan initially was very disheartened, feeling that it was going to be impossible to increase how much he ate.
Within a couple of weeks, Evan was managing to follow the meal plan and his weight stabilised. Things were OK at home but not at school, it was difficult for Evan to eat in this setting and there were many days that he would not eat lunch.
With the support of his psychologist advising us and school, we put a plan in place to tackle this and eventually, over a year after he initially developed his problems, he was consistently eating lunch. We had enormous help, support and advice from Evan’s psychologist and our family therapists, who dedicated many hours to Evan and our family. They gave us confidence and strategies to help Evan overcome his difficulties. Another key resource for us was a book by Eva Musby called ‘Anorexia and eating disorders: how to help you child eat well and be well’. Together, these sources of help enabled us to understand anorexia better and face many difficult eating battles.
The road to recovery has been slow but sure. We can now go to a restaurant and enjoy a meal together rather than it be a horribly stressful experience, Evan can visit a friend and share a meal with them. And just this week he told us how he enjoyed a donut at school given to him to celebrate a friend’s birthday. Just six months ago, we could not envisage such a change. We are immensely grateful for the help and support from Forward Thinking Birmingham. We would also like to offer hope to others in the midst of similar struggles – seemingly impossible situations can change."
Highlighted are physical and mental attributes we have already seen as common symptoms, whats interesting is the misdiagnosis early on in the disorder which only showcases how more awareness of all cognitive disorders needs to occur so people can talk about them more freely and get the right help as soon as possible. I like the added inclusion of a helpful resource and naming the author, I would like to see individuals like this represented in the game either through actual NPC or have their works be a semi-readable source in the game like the countless tales you can read in Skyrim as you travel through the land adding depth through narrative lore, this would add informative documents to my world that could help players get an understanding of how to beat the symptoms.
"My eating disorder (anorexia) was me. It engulfed me for nine years of my life. It was my identity and all I knew. I was 11 when it all first started. It all stemmed from my core values of ‘I’m not good enough’, ‘I’m unlovable’ ‘Everybody’s going to leave me’, ‘I need to be small to be accepted’, ‘If I am sick people will stay’. I was scared of food, petrified in fact. I was scared to ever gain even a pound of weight. It became everything to me. I could not see a life without anorexia. I thought I would never recover. Until I landed myself in hospital struggling to breathe. When trying to fight for a breath, it hit me; 'I need to recover, I need to do this or the reality is, I won’t be here for much longer'. I knew in that moment that I needed to fight. I needed to fight this ED and get myself back. It was a long journey, rewiring nine years of thought patterns was hard. I remember refusing to comply with anything on my care plan when I first started therapy. But the truth couldn’t escape me, I was deteriorating. I would sit and stare at meals and cry and I would cry every time I was made to stand on a scale to get weighed. Recovery is not just one fight to a stage where you are healthy, it is a battle every day. It requires daily work, from meal choices, to controlling thoughts that may arise. Today it has been a few weeks since I have been discharged from all eating disorder therapy services and I am beyond proud of myself. I have not only gained weight, but I have gained my life back, my period back, my smile back and food freedom back."
"I have struggled with an eating disorder for 7 years. It’s been a long road to where I am today, but I am proud of the strong woman that I have become.
I was diagnosed with EDNOS at 16, with many symptoms typical of bulimia. I received treatment from CAHMS but unfortunately, the focus on gaining weight caused my illness to evolve into bingeing and purging.
I kept my new illness a secret because I was ashamed of being a failure. I was discharged 6 months later, and for many years I was stuck in a cycle where my self-worth was defined by my eating disorder. I had a very unhealthy relationship with food and suffered from low self-esteem, low confidence, and constant guilt.
Last year I decided that I wanted to be free from the control that my eating disorder has had over my life. Eating disorders thrive in silence, so the first step towards recovery, for me, was to talk to people about it. This included my family, friends, my GP, a counsellor, and the Forward Thinking Birmingham team.
Being open and honest allowed me to accept my illness and work towards getting better. When it’s so easy to be knocked down by setbacks, it’s crucial to remember how far you have come already. The Forward Thinking Birmingham team has helped me to understand that recovery is a process of self-discovery and self-acceptance. I am extremely proud of how far I have come. Regaining my sassiness and confidence means so much more to me now than the numbers on the scales or the calories in my food."
"As I step on those scales my minds screaming at me “you better have lost otherwise there’ll be problems”. I used to think weighing myself every day was ‘normal’. That counting calories was ‘healthy’. That seeing bones was ‘beautiful’. How wrong was I? Very.
My eating disorder consumed every single thought I had. It destroyed me. I couldn’t go out and do normal things due to collapsing and exhaustion. I couldn’t eat in front of people in case they thought “wow, look at how fat she is”. It was the scariest time of my life and still haunts me now. I would go days at a time without eating, and what did I achieve? Nothing but pain and discomfort. I still didn’t please the voices circulating in my head.
Food was the enemy! On some days I would cry over drinking a glass of water scared it was going to make me gain weight. I just got told “how stupid it’s only water” but to me, it was more than water, it was poison dripping through my veins.
But after all these years of self-neglect I can finally say with the help of my amazing team around me, I’ve overcome my eating disorder and am now weight restored.
It is so important to speak up about your eating disorder and get help. It can escalate so quickly and is a very dangerous disorder."
"I was 14 maybe 15 when I fully started becoming aware of my body. I had started puberty prior to that, but it was at this young age that I really started to feel like I was over weight. I wasn’t of course, and I perhaps carried a little bit of “puppy fat”, but I was by no means fat. But I can certainly remember feeling it. I felt as though people were looking at me, and thinking the same.
It was about this time that I started to feel uncomfortable eating around other people. I don’t know why, I just felt as though people were watching me when I ate. So I stopped eating at school. My Mum would give me dinner money and I would use it after school to buy cake or chocolate, when the hunger had got the better of me and I just wanted anything to numb it. But I did this secretly so no one could see me doing it. My friends commented about me not eating at school but I just shrugged it off, saying I wasn’t hungry.
I did have one friend in particular. She was super skinny. And I was super jealous. I desperately wanted to be like her, to be thin. And she would have a habit of commenting on my figure. If we went swimming she would mention my “large thighs”. Larger than hers, yes, but large? No. A comment in passing, nothing malicious about it. But I can remember this remark, even to this day, what we were doing when she said it, how it made me feel, what it made me think. I can’t remember what I had for tea last week, but this I can remember. It has sort of etched itself in my mind, and stayed there.
I started thinking, at this young age, that there must be something I could do about my weight. There must be a way of getting it down, I thought. Although this is hard for me to remember, I know that I did cut down on what I was eating a lot, but I found it too difficult and the hunger usually got the better of me. But I do remember doing some research about purging food. I stumbled across it on a website, I wasn’t actively looking for tips on how to purge, but I just sort of came across it. And I tried it... and failed!! I think there were more tears and snot than sick... I just could not get the hang of it! How on earth do people do this, I thought, it hurts, it isn’t very effective and everything is running! I think I tried it a couple more times, but gave up. But I did know this... that this wasn’t right.
I knew what I was thinking, what I was feeling wasn’t right. So I told a friend about it, and made an appointment to see the deputy head at my school. He sat me down in front of him and I told him how I felt. I opened up about it and told him that I felt as though I had an issue with food. And this was his response. “You don’t look as though you have an issue with food, in fact quite the opposite.” I cried, there in that office. I think I cried sufficiently enough for him as he made me an appointment with a nurse who came into school. My friend, a different one, came with me. She weighed me. I actually didn’t know my weight, but she told me, in front of my friend. 8 stone. My friend blurted out “blimey Tabby, that is a lot!” And the nurse took it no further. As far as she was concerned, I didn’t fit the idealistic weight, or fit the criteria for an eating disorder. And that was the end of that. I didn’t take it any further. Neither did she. And actually I didn’t pursue any more purging actively till a few years later.
So let’s fast forward a few years. I am now 19. I have done my GCSEs, finished college, and been to New Zealand travelling for 5 months. I have a boyfriend, I am reasonably happy, although not with myself. I hadn’t ever dealt with my thoughts about myself, so they haven’t ever gone away, and I am pretty care free. It was at this age I embarked on my career as a care assistant. I worked in a care home, for long hours and shifts, but I mostly loved the job. My boyfriend at the time ended up going to university a few hours away on the train and this led to a whole new set of insecurities for me. I already had an issue with him looking at or talking to other women. In my mind, if he was doing that, he obviously wanted to or would definitely have sex with her! Yep, crazy thoughts. But the fact that he would be so far away, I wouldn’t be able to see him as much and that he would be around other girls that I couldn’t see was quite difficult for me to bear.
The thing about this boy was that he was quite complimentary, and critical at the same time. He would compliment how I looked, but also tell me if I was a little overweight or that he didn’t like something I was wearing. But he would quite openly look at other girls in front of me, make comments about them, and watching a film with attractive ladies on could be unbearable for me. I made my feelings clear on this and actually over time he got a little better at it, but what was I expecting, he was 19, full of hormones and he still did it, even though he said he didn’t. The reason I felt like this was because I was so insecure about myself. So in the grand scheme of things, I was much more unfair to him than I should have been given his age.
However, all this leads me to how I would embark on the bulimia that would ultimately change my life completely. I had gone up to visit him at his uni, like I did every other weekend. We had decided to go out somewhere, where I can’t remember and we got on a bus. The bus stopped and an overwhelmingly attractive girl got on. And my boyfriend said out loud “Wow she is fucking fit.” The ground fell out for me, I felt as though I was sinking. Yes she was attractive, but he wasn’t saying that to me! I felt completely consumed by this feeling of jealousy, disgust for myself and absolute hatred of the body I was in. And I just thought, I will show you who is attractive, thin and beautiful. And I did...
Things started to spiral pretty rapidly for me actually. I started restricting my food pretty heavily and also buying a lot of my own food. I still lived with my parents and my mum would still cook for me in the evenings, but apart from that I was quite in control of what food I was eating. I was buying a lot of low calorie foods, salad and low calorie soup. I started off eating the whole tin of soup but I gradually cut it down to half a tin a day. At breakfast though I was eating a fair amount of food and this gave me energy for a lot of the day. Typically I would have a big bowl of cereal and 2 slices of toast, but lunch was minimal. As I said my mum cooked for me and if I was working the late shift at work I would take a small box of salad with me. But after a few weeks I began to get a bit funny about the food my mum was cooking for me. Was it healthy? Was it making me fat? Was it going to affect me?
Due to the amount of physical activity and serious decrease in food, I was actually losing quite a lot of weight quite quickly. But I still had these thoughts about myself. Even though I could see that I was losing weight, and I was happy about it, I still thought I should lose more. I didn’t have a target weight in mind. We didn’t have scales at home, so I wasn’t able to weigh myself. But something happened. At work they got a set of scales for the residents of the care home I worked in. And inwardly I was excited! I could finally weigh myself! And I did. The scales said 7 stone and I thought that was awful. I had been 8 stone that time at school and I was only 1 stone less than that. They thought that was big, being 8 stone, so people would think that I was big now. I got home from that shift at 10pm and of course my mum had cooked me tea. I ate it and felt disgusting. I remember crying and not knowing what to do.
And then I remembered. I had tried purging before. Maybe it would work this time. Maybe, just maybe if I tried again it would happen. So I went to the bathroom and lent over the toilet. I stuck my fingers down my throat and gagged, but it wouldn’t come up. So I just stood there and moved my stomach in a way to try and push the food out. And after a few minutes I managed to induce vomiting. I couldn’t believe my luck. But what I had just learnt to do, what I didn’t realise would actually be my downfall, was to purge hands free. I didn’t need to use my hands to make myself sick, I could just do it. I felt amazing. And this cycle of purging my evening meal continued for a little while. But then I realised something. If I could eat this meal and purge it, I could eat more food and purge it too! I could basically eat what I wanted, when I wanted and not gain any weight! And this is when my binge purge cycle started... I was 20 years old.
Where am I now?
Everything changed for me in November 2017 when I discovered weightlifting. I have been able to overcome my bulimia through fitness. I no longer have the feelings of self-hatred and the feelings of guilt around food. I am able to eat without hating myself. I am able to eat with freedom. I am able to eat because I want to. I am able to eat because I now see and use food as fuel. Weightlifting has become my passion and without food I would not be able to sustain it. I feel truly blessed to be here, telling my story. To be able to eat without guilt and restriction is a wonderful feeling."
This final account is very detailed and telling of not only some of the internal symptoms and reasonings an individual may give themselves for why they should listen to the disorder but also of the binge purge cycle. There are even more horrifying accounts where individuals have found themselves rummaging through rubbish to find something to eat to feed the hunger, it is this behaviour that I would want to lean into when looking at real world animals for anatomy and behaviour to base my designs off of to craft a more realistic feel to them. It would be far too obvious to utilise mirrors and reflections in the design as so many others have - citing the malformed view of themselves that sufferers may have as a reason for the design choice, but I believe this places too much blame upon the individual and doesn't have the separation in the design I argue is necessary when looking to hunt the symptoms down and not the individual. The symptoms are this insatiable hunger brought on by the purging, an animalistic need to eat even succumbing to scavenging for food to fix the urge only to immediately purge it back up - and in the real animal world we have plenty of scavengers to incorporate into the design.
Scavenging functionally makes sense for the creature design as well, similar to how the Insomnia creature worked with other disorders the Bulimia Nervosa would have to scavenge the remains from wild variants of generalised anxiety disorder and depression disorders to sustain itself since those are often disorders that can start an individual down the path to bulimia. Or perhaps even having the bulimia picking at the scraps of a corpse of a domesticated variant of generalised anxiety to really hammer home the message of the disorder feeding off of an individuals anxiety.
Working through the iterative art process, starting from silhouettes then thumbnails before refining the designs whilst constantly making observations and asking questions along the way. Conclusions are made by the end of the process with some important questions left to answer that could help with composition of final images, colouration, and even some more definitive creature design features. (Four-legged with traits of vulture/hyena/goat aesthetics, does it hunt in a pack or just one dominant creature, how bulky/skinny do we feel the creature should be, horns forward pointing or very curved like a fetal position). I can continue to answer these questions in the second part of this blogpost whilst designing the Dysthymia creature.
