Bulimia

From ED's Half-life to Your Full Life 
By Aimee Liu
What happens to people with anorexia or bulimia who don't get treatment -- or who don't get
enough of the right treatment?  This is an important question because, according to the National
Association of Anorexia Nervosa and Associated Disorders, only ten percent of people with eating
disorders are ever treated. So when I began writing my book Gaining: The Truth About Life After
Eating Disorders, I decided to interview some of the other 90 percent.
I knew that most of those who struggled with eating disorders when I was growing up in the
1960s and 70s did not get proper treatment.  To a large extent that was because doctors at that time
did not recognize these illnesses and "treatment" often consisted of forced feedings and little else.  I,
for example, received neither a diagnosis nor treatment; only years later did I realize that I'd been
anorexic from eighth grade until my junior year of college.  So were several of my high school and
college classmates.  Others struggled with bulimia. And the strange thing was that because we were
constantly comparing ourselves to each other -- what we weighed, how much we ate, how we kept
the weight off, how we hid how much we'd lost -- we knew exactly who had which of these then
unrecognized conditions. So thirty years later, when I decided to explore the long-term effects of
eating disorders, I knew whom to ask.  
Almost all of us had survived, but did that mean we'd fully recovered?  If so, how did we
recover? My interviews suggested that most of us owed our physical health in large measure to the
love of friends, partners, and family members who saw past the physical shape of our bodies and
insisted on connecting with the person hiding inside. Recovery was as much about restoring that true
self and building healthy relationships as it was about rebuilding a healthy body, and the more we felt
we were gaining full and meaningful lives, the less of a stranglehold our obsession with food and
weight had on our brains.  Unfortunately, few of us back then were conscious of this process, much
less intentional about maintaining it.
Decades later, many of us appeared objectively to be doing quite well, with good careers and
seemingly stable marriages and families. But on closer inspection, I discovered that many were also
struggling with what I now call the half-life of eating disorders.  That is, we no longer necessarily
binged, purged, or restricted food, but we binged, purged, and restricted in other ways. Some used
exercise, others sex, drugs, alcohol, work, or religion. We still obsessed, still beat ourselves up
emotionally, still engaged in compulsive behaviors.  A few also cycled through periods of relapse
into full-blown -- and generally secretive -- anorexic or bulimic behavior.  This was especially likely
to happen during periods of profound change or loss -- when a divorce, say, or death of a loved one
triggered the old self-defeating distress signals.
Those most vulnerable were those who were most socially isolated; one such classmate died
of an anorexic relapse just last year, at age 57.  Those doing the best seemed to be those of us who
eventually had sought counseling and discovered the missing link between eating disorders and other
patterns of thinking and behavior.
To better understand this missing link, I turned to the researchers now investigating the roles
of genetics and personality in eating disorders. Their studies confirmed what I had observed when  
interviewing my former classmates: people with anorexia and bulimia tend to share certain innate
temperamental traits.  Those who've struggled with restricting anorexia tend to be highly persistent,
introspective, and cautious.  Those who develop bulimia are often impulsive by nature and drawn to
novelty.  Perfectionism is common in people with all eating disorders. These traits precede the eating
disorders, and they do not go away when you recover.
There is nothing inherently positive or negative about these traits.  If recognized and steered
in a positive direction, each can contribute to a fuller richer life.  Perfectionism and persistence, for
instance, can be a boon if you're an artist, architect, or scientist, so long as you don't confuse the
quality of your work with your value as a human being. But if misdirected, persistence can cause you
to overwork yourself, and perfectionism can cause you to fixate on meaningless or irrational ideals,
such as extreme thinness or starvation, and then conflate them with identity.
Full recovery requires profound and honest self-examination, as well as a mindful approach
to managing and directing your basic instincts. As psychiatrist and eating disorder specialist Joel
Yager said to me, "Know thyself… What is your biology? What is your calling?  Study your
temperament.  Be respectful of it."
Can you do this on your own? Theoretically, yes.  But in reality, most of us need the help of
an experienced professional who understands the true nature and complexity of eating disorders.
Recent studies have shown that the earlier treatment for an eating disorder begins, the better the
prognosis and the faster the rate of recovery.
The results can be breath-taking, as I learned from one young woman, just a year out of
treatment, who recently wrote to me:
Before starting recovery, I was afraid to go anywhere with people, especially
anywhere there'd be food. Since beginning recovery, I've discovered that I'm a people
person!  Who knew? Also I found out I have a true passion for the outdoors. Rock
climbing, rappelling, hiking, all of it. I thought I was supposed to be a dud. But that's
not true. I'm supposed to enjoy living.
Note to everyone who's ever had an eating disorder:  We are ALL supposed to enjoy living.
Fortunately, most eating disorder treatment programs today understand this.  They move well
beyond the initial and necessary focus on eating and weight to address temperament, identity, self
direction, and other key predisposing or contributing issues.  Qualified professionals in your area can
be found through NEDA’s website under “Get Help Today” or the Academy for Eating Disorders at
www.aedweb.org/source/EDProfessional/.  I wish this help had been available when my classmates
and I began our struggle to recover.  If it had, we wouldn't have spent so many years caught in our
eating disorders' half-lives.

XO-WB