Depression, anxiety, a craving for control—any of these can fuel an eating disorder. For one Olney woman, anxiety and boredom triggered nightly bingeing and purging sessions that she secretly carried out for more than 30 years. “The acts of bingeing and purging provided a release and gave me back my equilibrium,” the 54-year-old says. “It was a catharsis that was very addictive.”
According to the Renfrew’s Morris, “People with eating disorders often have a rigid need for control. They tend to be more rigid in terms of how they deal with life in general, so when something stressful or surprising happens, it can really throw them.”
That’s what happened to one Gaithersburg woman. By the end of 2007, she had been married three times, divorced twice and had survived cervical cancer and melanoma. Her aging mother had been given eight months to live after a third diagnosis of cancer. Mother and daughter underwent genetic testing and discovered they both carried mutations in the BRCA1 gene, signaling a genetic propensity for breast cancer. So the daughter decided to have a prophylactic bilateral mastectomy as well as a prophylactic hysterectomy, including the removal of her ovaries.
“There were a lot of physical changes that happened to me in a short time period that affected my body image,” says the woman, who is now 42, “and I was suddenly thrown into menopause and struggling with the anticipatory grief regarding my mother’s death. I’d always been a perfectionist, and the person I was changed.”
She’d been anorexic and bulimic in college, and had exercised compulsively throughout adulthood. Now she started bingeing again, and “the urge to purge was super strong because during the recovery from surgery, I could not exercise the way I had for 20 years. That was scary,” she says, “because the last thing I wanted to do was gain weight.” Finally she decided to enter the Renfrew Center’s outpatient program in Bethesda.
“The traditional thinking is that eating disorders are an attempt to gain control. But if you really think about someone with an eating disorder, they’re so out of control,” Ratner says. “Being in control means having choices. Having an eating disorder is a life that’s so ultimately driven by these obsessive thoughts and behaviors.”
Many women seek treatment for their children’s sake, whether to improve their health so they’ll be around to care for the kids, or to avoid passing along their eating disorders. A 2008 study at Western Oregon University found that teenage girls were more likely to have body image problems and/or disordered eating patterns if their mothers made negative comments about the girls’ eating habits or bodies and/or if the mothers suffered from those problems themselves.
Concern about the hand-me-down effect led one woman in Upper Northwest D.C. to seek treatment after spending nearly two decades vacillating among anorexia, bulimia and over-exercising.
At one point she weighed only 85 pounds.
“My daughter was the inspiration for my getting help,” says the woman, who is now 36. “When I thought of her crying for Mommy while I was in the hospital with an eating disorder—I just couldn’t bear that. And I didn’t want this to affect her. My goal is to be the best example for her, and to do that I need to feed myself and be healthy.”
The woman sought therapy and nutritional counseling. She quit her job as an accountant, which she found both stressful and unfulfilling, and decided to stay home with her daughter. She started eating three healthy meals a day and finding new ways to handle stress. At 5 feet 4, she now weighs 110 and feels healthier.
Eating disorders need to be treated both psychologically and nutritionally, experts say. That often means gradually reintroducing foods—in greater amounts—and talking through the feelings involved with eating. “This is not an easy fix,” Mitchell says, “and the longer the person has been engaging in restricting, bingeing, purging and other eating disorder behaviors, the longer it will take her to get better.”
Treatments may be family-based (involving the family as a source of support) and/or involve cognitive-behavioral therapy (which works on developing healthier coping strategies while addressing the underlying psychological issues). Sometimes medications, including antidepressants, are used to treat the underlying depression or anxiety. But “some of them don’t work well in people with anorexia because you need fat to process the drugs,” Smith says. “They need to get to a normal weight first.”
A third of individuals with anorexia are believed to recover fully; another third are prone to relapses; and the rest contend with a chronic disorder.
“Some people are not really invested in getting better, even though the eating disorder is destroying their lives,” Ratner says. “Clearly it’s very hard to feed yourself when all that does is make you anxious. I do think eating disorders are curable, but they’re incredibly tenacious illnesses.”
One 35-year-old Bethesda woman can attest to that. “Having an eating disorder has defined me for 20-something years—it’s who I am, it’s what I’m about, and it’s hard for me to give it up,” says the woman, who has a family history of addiction and is currently being treated for her anorexia and bulimia. “I’m trying to get better, but just like with any other addiction, it’s hard to imagine doing things any other way.”
Smith says the rate of recovery is higher for bulimia. And for those who binge but don’t purge, “the results are even more favorable if they seek help.” By identifying why people binge—whether they get overly hungry or engage in all-or-nothing thinking—therapists and nutritionists can help them normalize their eating. That might mean creating a plan for three balanced meals and a snack each day and helping them see that there’s no such thing as a “good” or “bad” food.
Therapists also can help patients find better ways to deal with uncomfortable feelings, such as anger, loneliness or emotional exhaustion.
“For me, restricting what I ate and exercising so much was a way of not feeling things,” says Robin, the Potomac woman. “My way of dealing with stress and unpleasant emotions was to not feel them.”
Robin decided to seek help in 2008, when she saw that her eating disorder was affecting her children. Her son, now 13, had started to sneak food and had developed a weight problem. Her daughter, now 16, resented her mother’s restrictive eating habits and sometimes made herself vomit if she overate. Robin sent both kids to therapists and started seeing one herself.
In therapy, she explored her out-of-control feelings and how to regain a sense of empowerment while developing healthier eating and exercise habits. A nutritionist eased her into a more balanced diet, and she began doing volunteer work. “For a while, my husband came home from work every day at lunch, and he’d be home by dinnertime to eat with me,” she says. “Had he not done that, I don’t think I would have gotten better.
“I can admit that I still have issues with food, but I’m no longer anorexic. My habits are more balanced, and I eat with my kids now,” she says. “I’m hoping that I’ve put this behind me.”
Where to Get Help:
- The Renfrew Center, the country’s largest network of eating disorder treatment facilities, including an outpatient center in Bethesda: www.renfrewcenter.com; 800-RENFREW.
- Academy for Eating Disorders, a professional association committed to leadership in eating disorders research, education, treatment and prevention: www.aedweb.org/; 847-498-4274.
- The National Association of Anorexia Nervosa and Associated Disorders, a nonprofit organization dedicated to the prevention and alleviation of eating disorders: www.anad.org; 630-577-1330.
- The National Eating Disorders Association, a nonprofit organization dedicated to supporting individuals and families affected by eating disorders: www.nationaleatingdisorders.org; 800-931-2237
Stacey Colino lives in Chevy Chase and regularly writes about health, psychology and family issues for national magazines.
