Jana Pittman's story tells us an uncomfortable truth about living with an eating disorder.

“I was winning world titles looking lean and fit and you would never have had any idea. Because I never got really skinny… I was a completely normal weight.”

When you picture the type of person who suffers from an eating disorder, your thoughts might not immediately turn to an elite athlete.

One who jumps hurdles faster than any other woman in the world.

But for 35-year-old Jana Pittman, some of the most successful times in her career as an athlete occurred while she had a dysfunctional relationship with food. In 2004, she developed bulimia, and for the next decade her eating habits spiralled out of control.

“One of the hardest parts about it was that when the issues started happening with diet, I was at my best in sport,” she tells Mia Freedman in a recent interview for No Filter.

“So there was that… it was almost like a negative reinforcement saying, well, you’re getting away with it.

“Whereas if you’ve got an eating disorder or anyone who’s experienced it knows it’s really hard to beat, and if things start going wrong in life you can say, well, I need to fix this problem because it’s causing me relationship issues, it’s causing me problems with my work and my mindset. For me, I was winning world titles while this was happening. So it kept reinforcing in a positive way – well the skinnier you are, the faster you are, the better you are.”

What Pittman experienced – in terms of having her difficulties with food ‘reinforced’ by success  – isn’t unique. In fact, it’s a part of what makes eating disorders particularly hard to recover from.

It takes an average of seven years to recover from an eating disorder, and many sufferers never recover at all. Eating disorders are also the most deadly of all psychiatric disorders.

For Pittman, as for others, one of the ‘cognitive distortions’ or inaccurate thoughts that perpetuated her illness was superstitious thinking – the idea that her performance was in some way because of her illness.

“A person may attribute their achievements to their eating disorder and fear that by letting go of certain behaviours they will lose their identity and control,” says CEO of The Butterfly Foundation Christine Morgan.

In her years as an athlete, Pittman’s weight, and her need to control it, was central to her identity. Just as her success reinforced her disorder, when something went wrong, she attributed it to her weight and her need to be thinner, therefore restarting the cycle of restricting, bingeing and purging.

In her book Just Another Hurdle, Pittman writes about a knee injury she sustained in February of 2004. She had been in Perth for a race, where she went out on a friend’s boat, competed, then flew back to Melbourne overnight. The next day, she noticed pain in her knee, and was told she was injured and needed two weeks off.

“I was racked with guilt,” she writes. “It must be my weight. I am too heavy and I caused the injury.”

“I went into overdrive, writing myself the strictest eating plan that ever existed.”

In hindsight, Pittman thinks it’s far more likely the boat ride, followed by the cramped trip home contributed to her injury. But at the time, she was certain her weight was the culprit, which reinforced her need to take ‘control’ of it.

When Mia Freedman asked Pittman whether eating disorders were rife in the athletics community, the mother-of-three said they were. But they’re common in lots of fields, she said. Often among women who give off the impression of having it all together.

"We know there is a link between perfectionism and eating disorders and that quite often eating disorder behaviours can mirror or reflect how someone navigates their everyday world," says Christine Morgan.

"This, in itself, can make identifying a problem difficult."

Of course, it took Pittman and the people around her years and years to realise she was suffering from an eating disorder, and to start to address it. When exceptional performance and extreme discipline is just a part of who you are - how can you separate food from that equation? For Pittman, a focus on diet was also part of her livelihood.

“Jana’s experience is not uncommon. I think it is important to be aware that someone experiencing an eating disorder may still be excelling in their studies, expertise or career," says Morgan.

“High achievement, whether that be in studies, sport or other careers, can sometimes blur the seriousness of disordered eating behaviours for both the individual themselves and the people surrounding them.”

And perhaps that is the most uncomfortable truth about mental illness that emerges from Jana Pittman's story - that someone can be very sick while outwardly functioning remarkably well. It might take a while for the disorder to take its toll on a person's life, or for the damage to surface in real and irreparable ways.

Pittman says the area her eating disorder affected most was her relationship with her then-husband and coach, Chris Rawlinson. At first, he wasn't aware of her bulimia, but she remembers the day he found out.

"He found the stash of chocolate and goodies in my draw, and he's supposed to be gone away for the weekend with his mates," she told Mia Freedman.

"I'm sure as a husband he would've been like, okay, my wife is unwell and I need to help her, but as a coach his [attitude was] this is ridiculous, if you eat that you're going to run like crap. He wasn't pleased."

The former athlete, who eventually reached out for help in the form of therapy, says you never completely get over an illness like bulimia. Even now, at 35, she still has thoughts that emerge involuntarily, urging her to revert to her old behaviours. But she says once she became a mum, and started following her passion for medicine, the important things in life started to come into focus.

While Pittman's story might seem like an anomaly - it isn't.

“A good question to reflect on, specifically in relation to appearance or athletic performance based careers, is how normalised or encouraged are such behaviours within this environment?" says Christine Morgan.

"And how, in turn, is this affecting recognition of a problem or possibly diluting the problem?”

It's a question we should be asking ourselves about many of the spaces occupied by women, and increasingly men, if we want to prevent these complex and dangerous mental illnesses from developing in the first place.

If you, or anyone you know is experiencing an eating disorder or body image concerns, you can call the Butterfly Foundation National Helpline on 1800 33 4673 (ED HOPE) or email [email protected]thebutterflyfoundation.org.au.