She says she is forced to travel to  Sydney for treatment because the central west has limited facilities capable of dealing with the illness.

Every few months, when she falls below a safe weight range, she packs up her life and admits herself into a clinic in Sydney for weeks at a time.

There she can receive the specialist care she needs to get her life back on track.

But the problem is cyclical. She goes to Sydney, gets help and comes home, only to lose weight and end up back in treatment.

“It’s very lonely,” she said.

“None of my friends or family are there.”

Ms Howarth struggles to keep a full-time job because she must take long periods of time off work to get treatment.

Every meal is a battle for the 24-year-old.

“It’s like a cliff, I just have to jump off,” she said.

Ms Howarth would not say what she weighed because she said people with the eating disorder were very competitive.

“It’s not so bad now that I am older, but when I was younger, yeah it was very competitive,” she said.

“We used to learn the tricks of the trade off each other.”

She feels people in regional areas with anorexia have been forgotten by the system. 

“I have a really good public health nutritionist. She’s great and I’ve had her for six months, which is really good, because half the problem is people in the public system swap and change all the time and you really have to build up that trust,” Ms Howarth said.

Infant, child, youth and family mental health services district coordinator Dr Sharon Jones said there were services available in the area for young people with eating disorders, but the specialist services required to treat adults with the condition were limited.

She said Dudley Private Hospital offered a range of mental health services and the Orange Health Service had specialised paediatricians who treated eating disorders in children and adolescents.

“What we are doing is expanding our youth mental health department to cater specially for 14-24 year olds and it would cover all areas of mental health holistically,” she said.

Dr Jones said adult eating disorder patients may be referred to Sydney because there was specific psychiatry  there.

“Here it is more general, in Sydney there are whole teams that work specifically with that condition,” she said.

She says mental health staff are trained in all areas but focus on issues with higher prevalence.

“When you’ve got not as many services you tend to focus on presentations that occur most often,” Dr Jones said.