She grew addicted to visiting the gym, where she “discovered there was this amazing world where you could watch the number of calories you’d burned on the treadmill and translate that into extra calories [to eat] that evening. Then I thought, ‘if I don’t eat more, I’ll feel even better tomorrow’, and it just spiralled. It was completely out of my control”.
Her illness worsened as the years went on until she went to her GP and was immediately referred to an eating disorder service, but had to wait for treatment. In the meantime, her weight plummeted further – the only clothes that would fit her were children’s ones. Services and campaigns are, she says, “all very much geared to prevention and young people and it’s almost like ‘oh, sorry we missed you’.”
Acknowledging that you have an eating disorder can be hard in adulthood, says Dr Bijal Chheda-Varma, a chartered psychologist and cognitive behavioural therapist. “It’s very shame-based… The key issue is that it’s the shame that stops people from coming to clinicians.”
Each time a celebrity shares their own struggles with a mental illness, as Diana did, clinicians do see a slight uptick in those with symptoms coming forward, she says. “But there is a taboo. The most unfortunate myth is [eating disorders] are… vanity-based, when there’s such a range of complexity. I’ve sometimes heard dads of teenage girls or partners of adult women [saying to them] ‘What’s not to understand? Just eat healthily!’ ”
In fact, such illnesses are born of a desire to regulate emotions with food; a need for control and a yearning for numbness, she explains.
“The complexity increases with adulthood because we then need to look at what could have triggered it,” she says. “Adults become high-functioning; they may be holding down jobs and be married with families. Life becomes more complex.”
Treatment, as well as public perception, has improved in the years since Diana spoke out. Where once people were admitted to hospital, often far away from home and for long periods of time, there is now a greater understanding of the value of community treatment instead; of keeping people with their families and social networks.
Yates is a healthy weight today, but still struggles with binge-eating. Pursall is currently recovering.
Experts say the Diana effect endures to this day – and hope the modern retelling of her experiences in The Crown will help to improve understanding of eating disorders.
For more information or support, visit beateatingdisorders.org.uk