“I would dip my feet in a bowl of ice cold water and that would kind of change the mindset, dealing with the food,” she said.

“Or my arms – sometimes I’d scratch them so much, especially at night, that I’d draw blood.”

But with the condition being “invisible” and not knowing anyone else with it, Ms Rich said she kept the diagnosis largely to herself.

“How do you tell someone I’m passing through molasses, I’m really tired, my bones hurt – when I looked good?” she said.

After years of feeling “quite isolated”, Ms Rich approached a charity supporting people with the condition, the PBC Foundation, and later met a fellow patient who set up a peer support group in Nottingham.

Wendy Wheat, 53, of Arnold, started the support group after she was diagnosed in 2012.

But it was five long years of misdiagnoses as she tried to manage what she said was “debilitating” fatigue and a persistent itch on the arches of her feet before Ms Wheat got answers.