Finding Health and Healing in the Aftermath of an Eating Disorder

A past anorexia and bulimia sufferer shares her story of faith and renewal.

By Catherine H. Knott, Ph.D.

Anya is a social worker who works long hours at a community health center. You would never guess that this fit and trim, radiantly healthy woman – a skilled mountain climber nearing 50 years of age – has experienced decades of struggles with eating disorders.

Her early life experiences seem, to an outsider, to be full of the positive experiences that would give any child a healthy future. Anya grew up on a farm on the East coast, where she rode horses, raised animals, and worked in the garden. When she attended college, she got involved in the hiking and climbing groups on campus, eventually leading one of the clubs as its president. After she graduated, she decided to travel in Europe for a year.

Warning Signs

Eating unfamiliar foods in France and other countries turned out to be a challenge, and eventually Anya started to refuse to eat a wide range of foods. By the time she started climbing in the Alps, tackling some of the most difficult rock climbing and mountaineering in the world, Anya had begun to develop her first eating disorder, anorexia.

Her friends noticed her extreme thinness and her reluctance to eat full meals, and questioned her about it. She merely told them she was running a lot. One friend, another runner, asked “How many miles a day?”

“Oh, I don’t know, sometimes I run wherever I am going, so maybe 20 miles or so most days.”

She was running the equivalent of nearly a marathon a day. At that rate, she was losing weight quickly, and not eating enough to replace it. Despite her friends’ concerns, Anya continued to restrict her eating and to exercise as if she were training for the Olympics.

She moved so quickly from place to place during her travels that friends she stayed with did not have much time to see what she was doing to herself – not that they could have persuaded her. Anorexia requires professional help. But in the early 1980s, anorexia was much less well-known, and Anya lived with it for several years before experiencing the kind of nutritional and psychological breakdown that often results from the disorder.

Assessing Eating Disorders

After receiving inpatient and outpatient treatment over a period of years, and losing a coveted work position due to the problems the disorder caused, Anya settled into a job closer to her parents’ home. She continued receiving intensive therapy and lived an extremely simple lifestyle so that she could manage the continuing effects of the disorder. While she had many friends and devoted herself to her career as a social worker, she never dated. Close friends noticed that it was difficult for her at times even to answer the telephone.

Eventually, she confided in her therapist that although the anorexia was no longer apparent, she had learned binging and purging as an antidote to stress from another patient in one of the hospital programs she had attended. Anya had become bulimic.

She says now that she was desperately ashamed. She also says it was the greatest stress reliever she had ever experienced. How could such a harmful disorder be a stress reliever? It turns out that anorexia and bulimia have much in common with other addictions. They stem from a wide range of causes, including depression, past history of abuse, perfectionism, extreme competitiveness among athletes, a lack of ability or opportunity to express emotions, and other psychological causes.

Like other addictions, eating disorders are a way for some people to relieve tension and temporarily reduce psychological pain. Unfortunately, once an eating disorder starts, the downward spiral of disordered behavior looks ominously similar from one patient to another.

Anorexics derive a paradoxical pleasure from controlling their eating to the point that they become emaciated. What often starts as dieting becomes a competition with the self and with others to lose weight. But the competition does not stop when the anorexic becomes fashionably thin. By that point, a mental preoccupation with self-control has set in that drives the anorexic to continue to diminish her weight to dangerously low levels.

Mentally taxing, the eating disorder requires constant thought and ordering of the day’s activities so that she can avoid situations where she may have to eat. Eventually, she may become totally preoccupied. Below a certain weight, the anorexic plunges into the danger zone for illness, serious depression, and even death through heart failure and other starvation-related causes.

Bulimia, on the other hand, causes secretive behavior and shame. People suffering from this disorder first binge on larger-than-normal quantities of food, and then purge the extra calories by vomiting or using laxatives. Bulimia eventually becomes obvious to friends and health care providers because of deterioration of the teeth due to repeated exposure to stomach acid during vomiting, scarring of the throat lining, and other health problems. Many bulimics appear to have normal weight and normal behavior, even in their eating patterns, because they keep their disordered behavior a secret from others.

Discovering Help and Healing

How, then, can a person suffering from either of these eating disorders find help? First, it is important that professionals help to identify the disorder, and to assess the individual situation for each patient. Second, treatment must begin at a level that matches the ability of the patient to change her behavior. Third, the person with the eating disorder must reach a new understanding and adopt new behaviors that prevent the return of disordered behavior.

Sometimes successful treatment may require a period of hospitalization. Programs providing intensive onsite or outpatient treatment can also work, if the patient is ready to respond at that level. Intensive counseling, behavior therapy, and positive alternatives are a part of most successful programs. Unfortunately, eating disorders can be extremely persistent, and may return even after intensive treatment.

How did Anya finally succeed in returning her eating behavior to normal, decades after she started to suffer from eating disorders? She attributes her success to three major factors. First, hearing the stories of others with addictions of various kinds helped her to see the addictive patterns in her own behavior and to identify the problems they were causing for her. These stories also helped her to identify hidden sources of pain in her childhood – knowledge that she had repressed for many years.

For Anya, it was her job as a social worker that gave her access to therapy groups where she listened to other addicted people discuss their problems. Most eating disordered patients gain support from individual and group counseling sessions where they are more directly involved in receiving the counseling themselves. It helped Anya a great deal, however, to see that not only was she able to absorb some of the lessons herself, but also that she could actually help others more because of her greater understanding of the problems and her compassion for the people suffering from addictions. At the same time, she began regular weekly counseling sessions for herself.

Second, she spends a great deal of time in the wilderness. A healing environment provides a natural stress reducer and an outlet for the healthy use of her body’s energy. She loves to climb mountains, and knows that if she is exhausted from binging and purging, she won’t be able to make it to the top to see the beautiful views that are so uplifting to her. The fresh air and the beauty of the woods and wildlife, lakes, and mountaintops inspire her to take better care of herself. By committing herself to hiking and mountain-climbing every weekend, she ensures that she stays committed mentally and physically to healthy eating.

Third, and most important for Anya, she discovered that her sense of spirituality could include compassion and unconditional love for herself. Paradoxically, caring for her sister’s children helped her understand that she herself could receive unconditional love. Anya says she realized over time that she loved those children no matter what they did, and that even if they grew up making lots of mistakes, she would always love them. From this insight, she began to understand the kind of unconditional love that she herself had always needed and deserved. Before, she had understood her faith intellectually, even on a deep philosophical level, but had not been able to accept its deepest core value in her heart. When she finally understood the unconditional love that she had, “that made the compulsion and out-of-control behaviors melt away completely.”

Today, she knows the eating disordered behaviors could return, but she is full of hope. “I take it one day at a time,” she says. She hikes, meets regularly with a trained counselor, and continues to have faith that she can lead a healthy, productive life, full of compassion for others in need, as she once was.

REFERENCES AND RECOMMENDATIONS:
Bradshaw, John. 1988. Healing the Shame that Binds You. Deerfield Beach, Florida: Health Communications, Inc.

Brumberg, Joan Jacob. 2000. Fasting Girls: The History of Anorexia Nervosa. New York: Random House.

Hornbacher, Marya. 1998. Wasted: A Memoir of Anorexia and Bulimia. New York: HarperCollins Publishers, Inc.

Lucas, Alexander R. 2008. DeMystifying Anorexia Nervosa. New York: Oxford.