Anorexia and Bulimia

In My Humble Opinion
1

They were showing this movie the other day and my daughter and I caught most of it. The things that struck me as very sad were:

  1. A few of the girls had to leave because the insurance ran out. I wish there were a way the treatment could be tailored to fit the time the insurance allowed
  2. This is a truly difficult disease to treat. All four of the girls they highlighted relapsed, which makes me wonder how effective the Renfrew Institute is in treating it
  3. After two of the women were released, they showed them eating in a restaurant. The careful, tentative way they were eating (scraping the dressing off a lettuce leaf, trying so hard not to let the food touch their lips) was very hard to watch, since it meant they were not better.
  4. Polly was kicked out because she was deemed a negative influence on the other girls. I thought her mother was a bit of an enabler…her first reaction was to beg the institute to let her daughter stay, to give her one more chance, then to berate them for being cold-hearted. Never once did she hold her daughter responsible for getting herself kicked out.
  5. Brittany was heartbreaking. This 15 year old girl was discharged because her insurance ran out. She was yanking at her skin, telling her mom she wanted it “off” (I’m assuming the perceived “fat”) and upset that she had a double chin again (which she didn’t.) An older woman in group, 28 years old, was trying to tell Brittany that she needed to get better and told horror stories of what her life was like, but Brittany was unconsolable…she was fat, dammit, and want to get thin again.
  6. They discharged Shelly after she reached 104 pounds. She later lost 17 pounds.

I was able to talk to my daughter about this disease while we watched it. She’s a healthy weight, not fat, not obsessed with food, but she does have some friends at school who say they’re fat. I explained to her that it’s a mental disease, that the girls’ brains refuses to process the reality of their body weight, and that they “see” themselves as fat even though they aren’t.

I mention this movie as a jumping off point for discussion on your experiences with anorexia and bulimia, if it’s not too hard to talk about. I’ve only met one anorexic girl in my life, and that only vicariously. I was a member of a gym and this girl, skeletal thin, apparently would spend ALL DAY on the treadmill. I asked one of the gym staff why they couldn’t help her, and they just shrugged their shoulders and said there was nothing they could do.

2

Sorry, here is a synopsis and here is the schedule of upcoming airtimes.

3

I wonder how she could afford to have a gym membership without having to go to work.

…I know that might come across wrong in print, so I am not being sarcastic, I honestly want to know who has that kind of leisure time that they can just spend ALL DAY exercising instead of earning money.

4

I don’t know. Maybe she was married and her husband paid for it. Maybe she got an inheritance from her parents. I had mentioned her thinness to one of the gym staff, and that’s when they told me “Yeah, she’s here all day.”

5

Thanks for the reference. I’ll try to catch it.

From my perspective as a psychologist, insurance payments for longer-term residential/inpatient treatment have dropped sharply since the 80’s. Better the insurance should be tailored to fit the treatment. There isn’t a quick fix for problems as difficult and as entrenched as seriousd eating disorders.

You said it–it’s difficult to treat. Instead of thinking in terms of “relapse,” I find it helpful to ask, "Do the folks who have had this treatment self-monitor more effectively and get themselves back into an adequate level of treatment sooner (or at all)? This reframes “relapse” as “more effective treatment engagement” which reduces severity and risk associated with untreated EDs.

Based on my experience as a counselor on an inpatient ED unit in the past, I’d say that the fact that they were eating, and (I’m assuming) not purging or restricting afterward, and allowing a film crew to see them eating, means that they were somewhat better. Certainly not cured, but recovery from EDs tends to be more incremental than that.

This is a good illustration of the hypothesis that anorexia is more like OCD than like bulimia (i.e., just because they both involve food and weight doesn’t mean they’re related problems). Reasoning isn’t terrifically effective.

This is a very sad illustration of the need for longer follow-up treatment and the commitment of the person and their medical team that if the person’s weight drops to a certain point, they are evaluated for re-admission. This supposes, however, that the person has insurance and that the insurance will pay for it.

6

Some gyms (I’m thinking of the YMCA in particular) have scholarships. The website of my Y doesn’t seem to have that information, but it is on the rate information they have in print.

Anyhow…I’m glad I haven’t seen that movie. I was anorexic for a long time, and in many different stages, and I don’t think it would do me much good to watch it. I still have a hard time when some mentions eating disorders on any of the message boards I frequent and people who are allegedly recovered still play the “who was the sickest” game (as in, stating their height and what weight they got down to).

I can barely remember what the recovery was like for me. It was slow and painful, but the disease itself was painful. I know there is still the reputation that anorexics and bulimics are self-indulgent brats, and in many ways yes, that was true for me at least, but logic statements like that don’t matter a single bit when one is in the throes of it.

My son is calling me—more thoughts later.

7

I really enjoyed Thin. The segment when they went to the one woman’s home and showed that she continued was disheartening. It was frightening to see the end come up with patient updates, as I was sure that someone must’ve died.

Mental illness is a horrible thing.

8

I was bulimic for about 12 years, beginning at age 13. I’m almost 5’4", and my weight fluctuated from 96 lbs to 148, and back down again, and back up. Eventually I gave up on the “purge” part and got fat, which was actually a relief in some ways.

What aspects of this illness were you curious about?

9

Some gyms do. The Rec Hall, the old gym at UC Davis refused one girl to go into the gym because she was so skeletal and would go to work out constantly. I know because I saw her try to swipe her school ID to go in, and the staff member politely asked her to leave and that she knew why she was denied access. The girl got angry but left. After she was out the door I asked the staff member why he asked her to leave and he said that she was notorious for daily, multiple hour-long workouts. And you knew there was a problem because she was seriously and almost nauseatingly thin. Her bones protruded behind her tight clothing. I was amazed and relieved that the school took that case seriously because it would have been so easy to just turn a blind eye and let her continue to destroy herself in the school gym. It’s too bad that every gym can’t do the same for others who need help.

10

I had a good friend in college who was – and probably still is – what I call “borderline anorexic” in that she had periods where she didn’t eat and exercised for hours, but at some point her hunger would win over. She’d never stuff herself then purge like a bulimic, though. She just simply wouldn’t eat.

Her home life was tumultuous at the time – her parents were divorcing after 30+ years of marriage – plus she was OCD about perfection when it came to anything she touched. If she was writing a paper, for instance, her notes had to be within a certain angle to her typewriter, they had to be arranged in a particular way, and she could not have any stray bits or snacks near her or she would – and did – go into major meltdown. For awhile after graduation she refused to walk anywhere because she honestly believed people would be judging aloud how she looked. I spent an entire weekend trying to convince her otherwise.

Our friendship drifted apart in part because of her obsessiveness, and more often than not I was put in the position of being her amateur psychatrist (she utterly refused any professional help during this time, btw). At one point I nearly snapped because nothing I ever said or did would change her.

I often wonder what’s happened to her. Is she still on the same pattern?

11

Whoops – I should’ve said <i>…but at some point her hunger would win over. She’d never stuff herself then purge like a bulimic, though. She’d eat regularly for a few days in a row, then just simply wouldn’t eat anymore.</i>

12

I saw that, too…

It was a really good portrayal, I thought. I’ve done the early-morning weigh-ins, the crying over supervised meals, the NG tubes, IVs, the listening to people tell me over and over that i’m killing myself…

and the water-loading before weigh-ins, rolls of quarters in my underwear, ankle weights… they’re less rigorous about checking with me. They’re kind of dumb, actually.

And I’ve done the relapse. The couple weeks after release where I think someday I’ll be totally okay with the idea of being above 90 lb… and then resigning myself to the idea that no… I’d rather get down to 50 first. And really, recovery is so difficult that, at this point, I’d rather die of anorexia.

The problem I saw with Thin was that it put a lot of emphasis on the quest for thinness. Which is really only… say, a symptom. or perhaps a perk. anorexics aren’t all stupid girls who went on a diet and couldn’t stop and it’s not just that we’ve got this unnatural obsession with thinness.

With me, it’s purity and need. It isn’t that I want to be thin like a model. (I realize, logically, that I’m thinner than most models now.) It’s that I don’t want to be a glutton. I don’t want to take more than I deserve and I don’t want to take more than I need. And if I can survive on nothing, than I want nothing. and if it kills me, then good because I don’t really care. And, as far as I can tell, everything else is auxilliary. Yes, I fear being fat, because fat means everyone can see that I lost cotrol and ate food just like veryone else in the world does. That’s what keeps me down.

It takes everything from you. I can’t dance anymore unless I maintain a weight that I’m not willing to maintain. (it’d mean gaining thirteen pounds.) I can go to class and watch and sometimes I’m allowed to mark or take one of the beginner classes, but I’m not allowed to be in any of my advanced classes and I’m not allowed to teach. I don’t get to dance in the christmas show. I wasn’t allowed to be in the current theatre production at school because the director says I’m too much of a liability. He says if I gain some weight, maybe I can be in the musical. I was the STAR of the musical last year. Most of my friends don’t really talk to me anymore. And the sad part is, I’m kind of glad because it means they won’t be bugging me. And the fewer people who care about me, the freer I am to do my own thing.

So yeah. That’s a little piece of my experience with anorexia.

13

Surrender, are you still getting help?

From what I could see, a lot of the girls (and it seemed all the girls were white, I believe black teenaged girls don’t have EDs as much?) suffered from depression. Shelly (one of the girls in the documentary) had electroshock therapy after her release from the institute to treat her depression.

Regarding the weigh-ins…they made one girl get on the scale backwards, so she couldn’t see her weight.

14

It’s so interesting that you’re not just Dorothy, but Surrender, too, when you’re spending so much energy fighting.

I hope that you don’t die. I think you’re an interesting person who makes the world a richer place. I hope you decide to live, and take.

There’s a woman up in Canada somewhere who’s been somewhat successful in treating anorexia (moreso than most, anyway). I saw a show about her years and years ago. From what I recall, it’s not a matter of talking and reasoning, or force; she’s all about touch. She holds her clients, cradles them, just loves them unconditionally with her physical presence. Eventually most of them start to trust life a little bit.

15

Dorothy, I also hope you decide to live. I think you’re fantastically smart and clever and I like seeing you around here.

I recall seeing something about that woman, too, fessie. It’s interesting, so many treatment models for eating disorders are about taking control away from the patient. The idea being that having the type and degree of control they do over their eating is what gets them into trouble in the first place, I guess, even though that “control” is really out of control by the time treatment is necessary (if that makes any sense). Times when I was in the hospital for anorexia, I had some choices in terms of, say, chicken or fish for dinner, but I was required to eat a certain amount and drink Ensure. The last time I was anorexic, I basically recovered on my own outside of the hospital/day treatment, so I can’t say that taking all the control from me was necessary in order for me to recover. That was over 10 years ago and I’ve been within a normal range since.

When I was in the hospital, they offered to weigh me while I stood backwards on the scale, but I knew that my imagination would probably be worse than reality. If I couldn’t see the number, I was likely to believe it was much, much higher than it really was and react to that, rather than to anything based in reality.

I think the worst part of recovery was feeling so helpless to stand up to the disease. Knowing that I was destroying myself, knowing that I would get in trouble with my treaters if I lost more weight, feeling so exhausted and starving and sad and cold all the time, but carrying out all the unhealthy behaviors anyhow. Skipping one more meal, exercising for one more hour, drining water before a weigh-in, all with this resigned feeling of “I couldn’t change even if I wanted to…and I’m not so sure I want to.”

I consider myself very fortunate these days. I have a marriage (impossible to really have a relationship when your primary one is with a disease), 2 children, a job, a healthy respect for exercise and my body. Sure there are days when my self-worth is based on whether I feel fat or thin, but for the most part, I love feeling strong and capable. Dorothy is right that the deisease takes so much away from you, but it’s possible to get it back.

16

The somethingfishy boards supposedly have rules about mentioning weight, pounds, food items. Plus you’re supposed to put an alert if you think your posts might trigger behavior in others.

17

I was afraid Polly (the girl who got kicked out) or Brittany had died. Polly was managing a photo studio and still struggling with purging, and all they said about Brittany was that she went back to restricting and had moved back in with her mother.

18

I was what I would term a borderline anorexic as well. My weight never got low enough that I was in danger of death but it easily could have been if I hadn’t changed my behaviors. The hard part for us guys that go through this is that since a majority of people with these disorders are teenage females, we don’t get a lot of attention to our problem or we see it as a ‘girl problem’ that we couldn’t possibly really have. (I told myself that a lot.)

I didn’t even think I had a problem, or at least wouldn’t admit it to myself until I started dating a new guy and he got to see what my eating habits were like. He saw me weighing myself several times a day, not eating for days at a time and excercising way too much. If it wasn’t for him and his love and encouragement I would probably have severe problems at this point.

19

Yes, and I think that’s a great idea.
I’m talking about non-ED boards. For instance, I post to a running message board. Every once in a while someone will ask about EDs and all these people will answer with “Boy I’m glad I got better. I’m 5-feet-X-inches and got down to ZZ pounds. Anyhow, what helped me was…” Just makes me think that people still get a competetive thrill out of seeing themselves as “sicker” than someone else.

20

I’ve spent twenty years doing therapeutic work, lecturing, and resource development for an eating disorder program in Canada. I’m undergoing a complete career change next month, and will miss working with this population.

For what it’s worth, I’ll make a few comments. The restrictive type of anorexia has strong biogenetic hallmarks: it has remained relatively constant in prevalence since first identified, and looks the same across cultures, genders, and socioeconomic backgrounds. In other words, a man in Beijing with restrictive AN will describe his symptoms in much the same terms as a female figure skater from Minneapolis will, though of course you will be harder pressed to find such a male, since only about 5% of restrictive ANs are male, and only 0.5. - MAYBE 3% of the general population will turn up with restrictive type, with a larger percentage (say, 3-5%) fitting into the bulimic subgroups. Prognosis for treatment is universally poor for restrictive AN, with relapse rates of about a half to two-thirds within a year post-treatment anywhere you care to look, and intractability increasing with each subsequent treatment failure.

Bulimia is much more readily influenced by the outside world: investigators have found that factors such as Westernization and urbanization seem to have an influence on the incidence of bulimia within a given population. However, it is worth noting that much of the basic symptomatology of bulimia is very much biologically driven – that is, hunger will induce bingeing, which will in turn induce some form of purging, driving the cycle. Take hunger out of the equation, keep it out of the equation, and that part of the syndrome will show improvement (though the more persistent psychological distress will take at least a year – under the best of conditions – before it starts to change – which is a large part of why prognosis is not exactly stellar for this group as well).

In short, I would not wish an eating disorder on my worst enemy. Many are called (dieting behaviours), but thankfully few are chosen (go on to develop full-blown syndromes). Those who do manage to recover have to be able to tolerate extreme, disabling, and persistent anxiety for a very long time just in order to rejoin that treadmill we call “normal life,” and are truly heroes in my eyes, each and every one.