Catherine was aged 14, and an apparently happy-go-lucky outgoing child and keen footballer when she suddenly decided she wanted to lose weight. “I got it into my head that I was fat.” The teenager dramatically upped her exercise regime and the first meal she cut was lunch, as her parents would not realise she was fasting all day at school .

“At the back of my mind I knew they would disapprove.” Catherine comes from a family of good eaters. “I loved my food.” After a few short months, “I was eating nothing.” There were battles at every family meal. When her family confronted her, Catherine says she got worse. “Once they knew, I did not have to hide it any more.” When she dropped to six stone, Catherine, who is five feet six inches tall, knew something was wrong. “My mother had to buy me new clothes – in the children’s department. It was awful”.

“It was a runaway train,” said Catherine’s mother who says the helplessness she felt at the time is hard to describe. “I felt I was losing my child in front of my eyes and I could not do anything,” she explained.

Catherine’s mother had read about anorexia nervosa but did not know anyone who had been through it, and felt lost. She brought her daughter to their GP and soon Catherine was referred to Aisling Lafferty, one of 10 eating disorder therapists currently working on a Co-operation & Working Together (CAWT) programme in the Border counties.

Over two years the project has worked with 500 clients, including Catherine, now 16, who proudly reveals that she has no idea what her weight is today and has no intention of checking. She does know that it is way above six stone.

Of the 500 people treated so far in this EU-funded- project, which continues until December 2014, 92 per cent are female. Some 40 per cent are aged 17 to 25. Lafferty is the only therapist working with children and adolescents aged 12 to 18. “I do have some as young as 12 and indeed we get referrals who are even younger.” She sees six girls for every boy.

The figures show that 6 per cent of those referred to the CAWT programme are aged 16 and under, 26 per cent are aged 26 to 35, and 28 per cent are 36 or older.

It has been estimated that there are 200,000 people with eating disorders in Ireland with 400 new cases every year.

Catherine and her family were plunged into this nightmare at the end of 2010. A few months after her weight started to plummet Catherine collapsed with unbearable chest pain and was taken to hospital. “I wasn’t at home at the time. I was actually in Knock praying for her,” said her mother, who after researching the subject decided that she wanted her daughter admitted to St Patrick’s hospital in Dublin.

“I was in hospital for four days and then I was in St Pat’s for seven weeks. [The experience] was horrible – but there were other girls there with eating disorders and it was good to see that others were going through the same stuff.”

Catherine had put on a stone and a half by the time she left St Pat’s and she was to spend about another year seeing Lafferty.” Even now I sometimes get that thought in my head ‘oh my God, I am so fat’ but they teach you how to cope and not act on it. I was told that the feeling never goes away for some people but you do learn how to cope.”

Catherine associates her eating disorder with stresses she faced when she went to post-primary school. New friendships did not work out and she felt isolated. “Catherine was always really outgoing and she did not really open up to us or let us know she was struggling,” said her mother. “I feel so sorry for other parents who are going through this. It is an awful illness and some sufferers don’t want to let it go because they can’t face the underlying cause. I feel we have been given a gift. We got Catherine back,” said her mother.

Lafferty who has clients in Donegal, Sligo, Leitrim and Cavan points out that there are different eating disorders. The well-known anorexia nervosa is characterised by an obsession with body image and losing weight and sufferers restrict food intake to cut calories. A few purge but that practice is more associated with bulimia where sufferers over-eat and then try and compensate through vomiting, use of slimming pills or laxatives, and by excessive exercise.

EDNOS (eating disorder not specified) does not fit exactly into either category and is becoming increasingly common.

Those who are referred to the CAWT programme are in the mild to moderate range. Early intervention is regarded as crucial given that eating orders are life-threatening.

“It is a mental health issue” said Lafferty who can have 40 young clients aged from 12 to 18 at any given time. She says some clients may have a genetic pre-disposition or in some cases it can be sparked in childhood by a trauma such as bullying or sexual abuse. While the problem can be exacerbated by the media focus on body image, Lafferty does not believe this is the root cause.

Cognitive behaviour therapy is part of the treatment and sufferers are encouraged to examine past traumas or problems. “Low self-esteem is core to the negative mind-set of the eating disorder, “ said Lafferty.

“Tell-tale signs include frequently avoiding meals, hiding or hoarding food, lying about having eaten or just pushing the food around the plate, throwing food in the bin and delaying meals,” explains Lafferty. She pointed out that it can be tricky to diagnose eating disorders in boys who tend to wear baggy clothes, and who are perceived as “healthy” if they focus on shape and weight.

John Meehan, a mental health specialist with the HSE West, said liaising with and educating GPs is a crucial part of the programme. “We have to let GPs know that they have to dig deeper when teenagers are losing weight as it may be more than onset of puberty.” He said carers and families are put under huge strain but get invaluable support from advocacy bodies such as BodyWhys.

Catherine feels lucky that she did not damage her health as eating disorders can cause a range of complications from cardiac, liver or kidney failure, to dehydration, anaemia, and osteoporosis. Constant vomiting can damage the stomach and cause acid erosion of the teeth and infertility can occur in severe cases. The teenager said people should not be afraid to seek help. “I was petrified because I thought people would judge me for having an eating disorder. Once you take that step it is okay. But you have to want to be helped or there is no point.”