I am in my mid-20s and suffer from some kind of eating phobia. I have been trying to diet for about four years, but since getting engaged to a wonderful man, I have been eating less and less. My fiance has tried to talk about my eating and gets very worried. I try to hide that I am not eating for much of the time. He wants me to see a doctor, but I laugh off his concerns and say I do not have a problem.

I have always "got by", despite not eating properly and, until now, had not given any thought to what damage this could be doing to my body. However, I can't bear the thought that this may have a knock-on effect on any future children's health. So far, I have avoided talking with my family and friends about any emotional issues I may have, as doing so would make the problem I have seem real. I used to be very overweight and cannot bear my BMI to be over 18.5 now.

I can't talk about this to anyone, but I am so worried that I may not be able to have children. I have no control over the eating. I don't feel any specialist could help, as I believe I would just say I do not have a problem.

It will not go away by itself

I would urge you to get help now. I developed anorexia in my early 20s - what began as a diet escalated into a full-blown eating disorder. I was also getting married to a wonderful man, who tried to get me to admit something was wrong. Like you, I laughed it off, denied I had a problem and reassured him I was fine.

This will not go away by itself. My BMI dropped to 15 before I could admit I needed help. I was a shell of my former self. But I was lucky and, through my GP, was given access to a team of specialists in eating disorders, who helped me on to the road to recovery.

Only after two years of cognitive therapy did I start to see the world in colour again. It was the hardest thing I have ever done but five years on I am healthy and happy.
Name and address withheld

I had anorexia and now eat normally

I was anorexic for six years in my late teens and early 20s. I comfort ate when I was nervous but most of the time I starved myself. When my body weight got very low, I had difficulty concentrating and had no periods for two years. I was getting my life together and eating more reasonably. Then I went to live with my French boyfriend in Paris. Eating and appreciating good food is so central to the French way of life that my former obsessions seemed ridiculous.

I am now my mid-50s and for many years have maintained a healthy weight. I love food and feel far happier with my body than when I was 20. You are right to fear that you may be damaging your health and fertility. Luckily, I got pregnant twice very easily after I had returned to a normal weight. Eating disorders are associated with low self-esteem, perfectionism and a fear of failure, which lead to a totally inaccurate body image.

I regret the time I wasted

I deeply regret that I wasted so much time continually thinking about food and fanatically counting calories. This only made me self-obsessed and unhappy. I thought eating was the one thing I could control but it diverted my energies from looking outwards and facing my fears about emotional issues, my future and enjoying life.
SW, London

Get the help you need

You need to act to stop this downward spiral. It is not only around food that your thinking and behaviour will become restricted, obsessive, fearful and rigid, but in everything. The sooner you make a start, the more chance you will have of a full, healthy and happy life.

What an incentive you have: you're engaged to a wonderful man and would like to have children. Grasp this opportunity and get the help you to need to allow you to embrace life.
Name and address withheld

• For further information and help, contact b-eat.co.uk (0845 634 1414) or eating-disorders.org.uk (0845 838 2040).

What the expert thinks - Linda Blair

It is not surprising that you are focusing on your food intake and BMI. These are things you can measure and control. Weight and body mass do not, however, lie at the heart of your dilemma. If you become ill or your weight drops to a dangerously low level, your physical health will become a priority. However, to overcome your anxieties in the long term, you must face up to your underlying fear - your fear of the demands others make on you. You will have to learn to please and value yourself at least as much as you wish to please your partner and others, and to value your own health as much as that of any children you may have in the future.

Your anxieties have, no doubt, deep roots. Perhaps as a child or young adult, you were repeatedly asked to assume more responsibility than you felt able to take. Perhaps you were praised only for accomplishments that others deemed important, rather than for what you were proud of. Whatever the reason, you may have felt overwhelmed or misunderstood - and thus out of control of your destiny. When this happens, an individual often decides to focus on something she can control - in your case, what you eat and what you weigh.

Try to step back and consider where this behaviour could lead. The "control" you are asserting over your appetite and body size is actually making it more likely you will feel unable to determine the direction of your life. In other words, if you continually malnourish yourself, you are likely to become ill, and then the opportunities available to you may well become more restricted.

The fact that your problem has worsened since you became engaged is significant. It is unlikely to have anything to do with the character of your fiance. It is most likely to be your way of indicating that you are not yet ready to commit fully to another person. The psychologist Erik Erikson writes of intimacy as the capacity to commit oneself to another, even when that commitment calls for significant sacrifice and compromise.

I suspect that, without realising it, you are reacting to the "demand" of an engagement as if it is no different from the overwhelming demands made on you in the past. Only when you are confident enough to put your needs on an equal footing with those of others will you be ready for true intimacy - ready, that is, to make compromises and sacrifices that are fair not just to your partner, but to you too. At that point, you won't need to seek other (inappropriate) ways to gain "control" in your life.

It is not easy to learn simply to value yourself, rather than your accomplishments or ability to please others - but it can be done. Gather your courage and find a therapist with a good reputation for treating eating disorders. He or she won't "make" you eat - or do anything you are not ready to do, but will help you learn to feel proud of yourself, and to recognise and stand up for your own needs. That is when you will begin to want to nourish yourself adequately and feel ready to commit fully to another person.

• Linda Blair is a clinical psychologist and an associate fellow of the British Psychological Society.

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