She was literally dying to be thin. "I wanted people to see me, the real me. Part of the reason I stopped eating was because I wanted my parents to see that I was in trouble, " she explains.

"But there comes a point when anorexia becomes nothing to do with food."

At 14, Lily's parents began to notice she was losing weight. They brought her to psychiatrists in Cork, where the family have lived with their two children since they emigrated from Germany when Lily was an infant. But none of the doctors could help; she got progressively worse. "It started at 12 but wasn't noticeable for a couple of years. I just didn't know how to deal with being a teenager. I was a nervous, unhappy and insecure child."

By her mid-teens, Lily's health had been so adversely affected she was forced to leave school and she began self-harming. "I would cut myself so that people would see it. I wanted people to be shocked." Her parents realised psychiatrists weren't enough; she needed treatment with an eating disorder specialist. They began a long and fruitless search for help. Thomas brought his daughter, who could barely walk, to Dublin. He tried in vain to get her one of three public beds at Dublin's St Vincent's hospital for adults with eating disorders but was told the waiting list was 18 months. He then tried two Dublin private hospitals that treat people with eating disorders, St John of God and St Patrick's. But again, all doors were firmly shut. "I remember the long drives to Dublin in the car or on the train, " Lily says, "I always felt weak and my parents were really worried. I couldn't get in anywhere. There doesn't seem to be the resources to deal with this in Ireland."

Out of control

Thomas was slowly watching his 18-year-old daughter die. Running out of options, he went online and found a private hospital in Germany that helped people with eating disorders. When he described Lily's condition, they said there wasn't a moment to lose and to bring her over as soon as possible. He booked a flight to the clinic in Hamburg the next day.

At this point, Lily felt she could no longer cope with life. "Things had gotten out of my control. I didn't know how to survive anymore. The thought of school, college or a job terrified me." Despite having seen numerous doctors through her teenage years to treat her anorexia, her father says she received her first thorough medical examination at the clinic. Her condition was more serious than anyone realised . . . Lily's heart muscles had shrunk and were beginning to suffocate her. "I do realise that going over to Germany saved my life.

I knew I was very underweight. It's just that my idea of fat was completely different to everyone else's." At the multi-disciplinary clinic, Lily was treated by a team of specialists including dieticians, physiotherapists and psychiatrists and she slowly began to recover.

In Ireland, there is no specialist public centre to treat children and adolescents with eating disorders . . . but at least one is badly needed, according to three child psychologists. There are no specific in-patient public beds for children with eating disorders although some paediatric hospitals will take children in emergency situations.

Lily's story of being forced to travel in search of treatment is not an isolated one.

"I know of parents who have brought their children to private clinics in Britain. People want the best for their children and if they are suffering severely, they feel they have no choice, " according to Dr Keith Holmes, a child psychiatrist at Lucena clinic in Drumcondra, a public psychiatric unit for adolescents attached to St John of God's.

Dr Martin O'Sullivan, who works in the child psychiatric unit at Dublin's Mater hospital, is also aware of parents who have brought adolescents abroad for treatment. "We certainly need a specialist facility for children with eating disorders, " Holmes adds. "The age profile is getting younger and we're seeing more boys than before.

The services for children are wholly inadequate."

Holmes has treated children as young as nine for eating disorders, while the charity Bodywhys believes children as young as six are overly concerned with body shape. Some 10% of eating disorders begin in children under the age of 10, according to the group. They develop for a range of reasons but are sometimes linked to a childhood fear of growing up and having to deal with the pressures adulthood brings.

Dangerous websites

The internet, too, is now being used as a sinister 'support service' for anorexics and bulimics. Hundreds of pro-ana (pro-anorexia) and pro-mia (probulimia) sites offer advice and tips on how to hide an eating disorder as well as offering malevolent emotional support. "These websites are like secret clubs, " says Holmes. "They are brainwashing and a lot of youngsters I've treated access them for support. It gives them a sense of identification."

Dr John Griffin, clinical director of the eating disorder programme at St Patrick's hospital, is also concerned by the proliferation of such websites:

"They are dangerous. They tell people, 'Don't listen to your mum or dad or doctor and try to get better. Be anorexic like us. Come and join our club.'" St Patrick's does not treat children under 14, always has a waiting list and last week was approached to treat two 12-year-old girls, who had to be turned away. Griffin believes one reason the age profile of sufferers is getting younger is down to role models: "In 1964, the role model was Marilyn Monroe who took dress size 16. Two years later, a waif-like model walked down the catwalk and that has remained the norm since."

Ironically, the quest for physical perfection that sparks eating disorders often leads to a destruction of appearance. "Dentists have had to remove all the teeth from girls who are severely bulimic because vomiting removes the enamel, " according to Holmes. "I've treated girls who had their teeth removed and it's not something they imagined would ever happen to them."

At her worst point, Lily was in a wheelchair and she lost much of the hair from her head while her body hair began to grow. After a three-month stay at the German clinic, she began treatment at Marino Therapy Centre in Dublin, a private facility partly funded by the Health Service Executive (HSE), which she still attends.

Thomas, who is studying for a diploma to counsel people with eating disorders, has secured HSE funding to set up a dedicated facility for people with eating disorders in Cork, having firsthand knowledge of the major gap in services.

Now 23, Lily did her Leaving Cert in June and is now a first-year arts student at University College Cork (UCC). She too hopes to eventually train as a counsellor. "My advice to young people is to get help if you need it. There are people out there who understand what you're going through.

Recovery is possible. Life is good once you learn how to deal with it."

WHAT PARENTS CAN DO . . .

THE ADVICE FROM BODYWHYS
>> Take steps to build your child's self-esteem.
>> Avoid talking about dieting and being thin or fat. Put the emphasis on health rather than appearance.
>> Be aware of the messages you are giving your child through your own feelings and behaviour around food and weight. Could you be contributing to their anxieties around weight and shape without realising it?
>> Listen to your child's feelings about their appearance. Try not to dismiss them or ridicule them however absurd they may seem to you at the time. Feelings are real and provide the most important clues to parents about what a child might be finding it difficult to cope with. Listening to your child's feelings will help you to work with your child to develop coping skills.
>> Talk to your child about the normal changes that their body will go through during puberty and what these changes mean.

Bodywhys helpline: Locall 1890 200 444