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You Can't Always 'See' an Eating Disorder

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Over the past several years, I’ve struggled with a severe exercise addiction, orthorexia (a form of disordered eating), anorexia nervosa, depression, and anxiety. Having worked for years to overcome these things, I’m invested in spreading awareness about mental illness, particularly eating disorders since they get left out of the conversation far too often.

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This picture is one I took right before cutting off several inches of hair last summer. The sad thing is my main reason for cutting my hair was because I thought it might trim a little bit off my weight. That’s the thing with anorexia, even half a pound can make or break your entire week and determine if and what you can eat. My hair was also falling out in chunks so I figured it would be less noticeable if it were shorter.

This picture is the face of someone with anorexia nervosa. When I started dropping weight people told me I looked great because I still looked mostly healthy for the first few months. This picture is from about a month before I started to actually look sick. What you don’t see in this picture is the pain behind it. You don’t see the hours spent agonizing over every single number down to the 3 calories in a stick of gum. You can’t see the pain. You can’t see the times I broke down crying because I was so terrified to eat. I was in constant agony, and every second was spent feeling terrified that I would gain weight. You don’t see the hours in the gym, the battles fought over dinner, the lies to cover it all up. You don’t see the times my mom held onto me crying because she thought she was going to lose me.

This picture doesn’t show you that I spent last summer at doctors’ appointments. I went to my psychologist and my dietician weekly, went to the doctors biweekly, and had to have blood tests done every month. It doesn’t show you I was a hospital outpatient for many months and was set to be made an inpatient many times. My mom and psychologist worked incredibly hard to keep me at home. You can’t see the painstaking work my parents put in by doing the Maudsley method, a form of eating disorder treatment for adolescents.

The stress on your body isn’t always obvious. My muscles, including my heart, were deteriorating and being used to fuel my starved body. I had severe heartburn. I couldn’t eat more than a quarter of an apple without my stomach hurting. My nails were blue. My skin was grey. My bones poked out. I bruised from a tight hug. My body was dying, but from this picture I look like a normal, happy teenaged girl.

You can’t always tell someone has an eating disorder by looking at them. You don’t have to “look” severely sick. In this picture, I’m underweight, but you can’t necessarily tell. Plus not all eating disorders cause you to become underweight. The idea that you have to be underweight to be “sick enough” for treatment stops a lot of people from seeking the help they need and deserve. There is no such thing as “sick enough.” If you are sick, you are sick enough. On top of having this widely held idea of what someone with an ED should look like, an ED will tell you you aren’t sick enough too. It will convince you that you’re “fat,” that you’re not enough, that you don’t deserve to recover.

Anorexia isn’t skipping a meal or thinking you’re fat. Eating disorders are not an edgy punchline on a sitcom. It’s much harder to laugh at when looking at the painful repercussions on both the person and their loved ones. It isn’t a “white girl illness” –anyone at any age can be affected. They are not about vanity or about being skinny.

Today, I am strong. Today, I am healthy. I listen to my body, and I treat it as lovingly as I can. I work on it every day. I nourish myself so I can be a good friend, a good daughter, a good student, a good person. I feed myself so I can be myself. Loving my body is not easy. I don’t love how it looks yet. But I’m learning to love what it does for me: it lets me walk, and talk, and have fun. I’m able to run, jump, go to school, dance, spend time with friends. I’m able to be Abby again.

To anyone reading struggling with an ED or disordered eating, you deserve recovery. You deserve treatment. You deserve a life without your ED screaming at you nonstop. There is no such thing as an exception to recovery. We all can. We all deserve to. We are all strong enough to. I often hear people say they can’t recover or don’t want to. That’s the ED talking. Life with an ED is not a life at all; it’s a slow death. You’re worth more than that. I know everyone says “it gets better” and it means nothing coming from doctors who have never been where you are. As someone who told their psychologist to F herself over and over when she told me it would get better, I get it. But I’ve been there. I know how it feels. I promise it gets easier every day. Recovery is hard, but once you get to the other side it is so worth it. You can enjoy life again. You deserve to be happy. You are worth it. You are more than enough.

If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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The First Time I Spoke the Words 'I Have Anorexia'

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When scrolling through my Facebook timeline one is bound to find stories about my experience with mental illness amidst all the other life updates. Some people wonder why I choose to be so open, thinking I would like to keep that information private.

However, keeping what I was going through to myself is what led me to some scary places. I haven’t always been so open about my experiences, mostly due to the stigma surrounding mental illness. But I have found my voice and my power in sharing my story.

It all started when depression hit my senior year of high school. Though it was hard in high school, it really began to take a toll on me during my freshman year of college. I felt completely alone and this made it easier for me to isolate, which in turn fed my depression. I was too afraid to admit to anyone I was struggling for fear I would be met with judgment. However, things escalated when I could no longer cope the same way I had before. I began to isolate myself, began self-harming and engaging in disordered eating behaviors.

Eventually, going to class became too much and I felt like I was spiraling out of control. At this point, I didn’t think I deserved to eat and my restricting intensified. My mind was telling me I was worthless and had nothing to contribute to the world. I felt unworthy of the love I received from those who cared about me. I thought all I did was bring bad things to the people I loved most. But I still couldn’t tell them about these thoughts swirling around in my head.

With encouragement from my friend Juliette, who I knew cared about me, I sought out a therapist. I was diagnosed with anorexia nervosa. While I knew I had an eating disorder and had been formally diagnosed, I still could not accept it. I realized I was facing hard statistics, like the fact 5 to 20 percent of people die from this completely treatable disorder. Facts like this shook me because I was already experiencing physical complications characteristic of an eating disorder.

I was closely monitored by physicians because I had a low heart rate (if it had fallen any more they would have had to hospitalize me). Again with the support of Juliette, I entered a partial hospitalization program. I was terrified to go and wanted to believe I didn’t need this level of help. Juliette stayed with me the night before my first day and walked me to the door of the program I would spend the next five months in. I think she wasn’t sure I’d actually go if I was left alone.

My first day I was afraid to talk to anyone and sat in the corner doodling during breaks. A running joke among patients was if a new person knew where the bathroom was by the end of their first day they were doing well. So by everyone else’s standards my first day was a success. I quickly became lovingly referred to as “corner girl” because I always claimed the corner seat in every room. This nickname helped break the ice and I was able to build friendships with other patients in the program after recognizing we all shared a similar struggle. I felt it was safe to confide in them.

In the program I met Shayna who also struggled with an eating disorder. Her friendship provided me with someone to relate to about what I was going through. We supported each other through our recovery processes — eating meals together, going grocery shopping and lending an ear on the harder days.

After being in the program for a while, I found I still could not say the words “eating disorder” or “anorexia,” even though I was working towards recovery every day. When talking about my eating disorder I would vaguely call it my “food issues” or not label it at all.

Even after being in the program for months, I still hadn’t told my parents anything. I finally decided to call them and let them know what I had been going through. My voice was shaking but I finally blurted out the words: “I have an eating disorder and have been in treatment for a few months.”

What happened next contradicted all my worst fears. My parents said they loved me and were so proud of me for seeking the help I needed. I had expected rejection but was met with love and understanding.

Through my recovery process I came to own my story. I was finally able to admit to myself and others I had anorexia. When I finally said “I have anorexia” out loud, the words felt funny in my mouth and caught at the back of my throat, but the moment I said it I became free of my eating disorder’s control over me. My denial had ended. Though it scared me, I began to be more open about my experience and spoke on a panel about eating disorders. Anorexia no longer ran my life.

Though my friends didn’t always say or do the most helpful things for my recovery (like standing outside the bathroom crying or questioning if/how much I’d eaten) I knew they cared because they were trying. I’d much rather them try and stumble along the way than stay silent. The silence I experienced from others made me feel alone. Juliette and Shayna were my primary supports and we all learned along the way what kind of support I needed. Juliette guarded my scale for me, kept me accountable and challenged my bad body image thoughts by telling me to “say something nice about myself” whenever I said something negative about my body. Shayna helped me plan my meals and navigate the grocery store. You could often find us in the toilet paper aisle — by far the safest area of a grocery store because there is nothing triggering there. They were great support because they weren’t afraid to ask what I needed. Even though I didn’t always know what I needed, them asking reaffirmed to me they were there for me.

A big part of my recovery has been breaking the silence around mental illness because one in four college students will face a mental health challenge. This means 75 percent of us have a friend who is struggling and needs our support. I choose to speak about my experience with an eating disorder because the conversation is so frequently avoided when many mental health issues are completely treatable. The way we respond to someone who has shared with us they are struggling could affect how they seek treatment for the rest of their life. Don’t be afraid to say the wrong thing — you don’t need to be perfect, you just need to be there.

I share my experience with anorexia for the benefit of others but also for myself. I want others to know they do not struggle alone as well as educate those around them so they can be supportive during recovery. It has been a tremendous blessing to be able to share my story as it has helped me heal.

If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

We want to hear your story. Become a Mighty contributor here.

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When I Realized My Therapist Wasn't the Enemy

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As may be the case for many people with an eating disorder, my first therapist was imposed on me at a time of medical crisis. It was far from a match made in heaven.

He was a busy intern with scant understanding of anorexia and even less empathy. His questions were superficial and often insulting, and it felt like he saw me as a set of symptoms, not a person.

But to be fair, anyone in the grip of an eating disorder can be a difficult patient, and I was no exception. My illness had turned me from a compliant, communicative adolescent into a hostile and openly defiant patient. And my ability to engage in meaningful therapy was compromised by the confusion my starvation had caused.

By its very nature, this was an adversarial relationship — one side advocating weight gain and one resisting. As a result, I cycled through petulance, defiance and despair during his daily visits, and we got nowhere.

Over the course of several hospitalizations, I encountered countless psychologists, psychiatrists and counselors, all of whom treated me with disrespect and contempt. After my last hospitalization, I decided the best thing I could do for myself was to try to reestablish a “normal” life, which meant a break from my medical team. They saw this as an attempt to go back to my “bad old ways” and in the most patronizing of ways said they would wait until I needed them again.

I never went back. I worked hard to create a new life and was proud of what I achieved. But in moments of honesty, I admitted to myself the causes of my anorexia had not been dealt with, despite my much healthier weight.

So after many years, I found a new therapist, and while she was a vast improvement on those I had encountered during my hospitalizations, I was still defensive, and we made limited progress. When she retired, I made no effort to replace her — it seemed like so much trouble to start again with someone new.

Fast-forward another few years, and my general practitioner suggested I see yet another therapist. Finding a doctor I trusted had been a major achievement for me, and when she said she knew a psychologist who specialized in eating disorders, I understood my doctor really believed this would help me heal.

I remember her exact words: “I think you will like her, Clare.”

“Like”? Could I really like a therapist?

Yes, I did like her, and this time I have come to understand the power of a positive therapeutic relationship. I have come to believe you do need to like your therapist, because this is hard work, and you need a sense that your therapist is your partner, not someone to be outsmarted.

I don’t mean “like” as in someone you want to hang out with — although I do think if I met my therapist at a party we would hit it off.

By “like,” I mean someone you value, respect, and maybe even want to please.

Unlike my previous therapist who was a lot older than me, this time I have someone whose life experiences are similar to mine. And our communication is not one way — she shares little parts of herself with me, which is very brave I think.

And perhaps most surprising of all, we are able to laugh together. If you strip away everything, I feel there is something quite absurd about an eating disorder, and it is amazing to me that it was a therapist who showed me this.

None of the progress I have been able to make would have been possible without a truly nonjudgmental environment, and this was the crucial flaw in the approach of my early therapists. Now, I have a safe place where I can reveal the worst parts of myself without fear.

Many people may blindly accept a therapist just because they don’t want to create trouble. I now believe this never ends well.

To be clear, I am not talking about rejecting everyone because you are not ready to do the hard work (and it is hard!). That shortchanges everyone.

But if you are ready to commit to recovery, find someone who feels right. Even then, understand there will likely be times when your therapist will challenge you, and you may feel rejected. This relationship is a confronting one, but in my case, I have never felt like running away when things got tough. I know how blessed I am to have found my therapist, and I encourage everyone to fight to find the support they deserve.

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If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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How 'Healthy' Concealed My Eating Disorder

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I live with anorexia nervosa and struggle daily to choose recovery. The longer an eating disorder goes untreated, the more difficult it is to reverse not only the physical effects, but also the beliefs and behaviors associated with it. Early intervention is crucial, but eating disorders often go unnoticed.

When we think of someone with anorexia, it’s likely that we picture an individual whose bones protrude from their skin, their bodies composed of sharp angles. In essence, they “look” sick. This is all too often the point at which treatment begins. We must change what we think someone with an eating disorder looks like because too many struggle until they develop complications.

For so long, too long, I flew under the radar while I struggled with anorexia. No one thought I could possibly be dealing with disordered eating because I didn’t look like the stereotypical person with anorexia. I was a “healthy” size, a “healthy” weight and had a “healthy” diet. Yet, at some point this was no longer true, and my illness began to show. I began to experience many of the physical complications that come with anorexia.

Physicians monitored me closely with weekly appointments because I had a low heart rate. (If it had fallen any lower, then they would have no choice but to hospitalize me.) Though I hid my eating disorder fairly well, its effects were became increasingly noticeable to those around me. All my energy was devoted to keeping my mental calculator running, keeping track of the numbers that haunted me. My eating rituals and behaviors drew more and more attention as I became a shell of the person I once was. It was then that people began to question whether or not I was truly healthy.

The truth is most of us who live with an eating disorder do not look like what you would imagine. Though some do fit the description of “skin and bones,” many are overweight or within the bounds of what is considered a healthy weight. The thing is, you “look” healthy until you don’t. We don’t start out “looking sick,” but that “ideal” body is often our goal.

We have ultimate goal weights. We count, we restrict and we compensate. We can do all these disordered eating behaviors and still maintain the appearance that we are healthy. This allows us to struggle in silence and continue to suppress our emotional pain. While the manifestation of an eating disorder is a focus on food, that attention only masks what is truly going on. Eating disorders are both about food and entirely not about food.

The more time that passes without recognizing the signs of disordered eating, the more adept we become at hiding our behaviors until it becomes all too obvious that we have moved from “healthy” to sick. This does not occur overnight. Developing an eating disorder is a process, and it is possible to intervene early on if we are educated.

If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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To the Therapist Who Called Me a 'Typical 17-Year-Old Anorexic'

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Dear R,

I’ve have been seeing you for over a year and a half, but some things you say to me hurt. They hurt more than I let on. I have been trying to find my place in life. I have tried to differentiate myself from my anorexia, but you still make me feel like I am my anorexia. Although you said I was,“the typical 17-year old-anorexic,” I am here to say I’m not. I am not a statistic! I am an individual who had the misfortune of having an eating disorder. I do not associate myself as my anorexia. I try not to define myself as it, but when you tell me things like that it hurts.

R, we used to have sessions twice a week, then once, then twice, and now once again. I feel as if you do not care. I feel as if you want to bring me down at times just to see what I’ll do. You know me, you know what pushes my buttons, yet you still say hurtful things. You told me I should change my goal of becoming a psychologist. You told me I was not equipped for that goal. You have turned my misfortunes into weaknesses about me as an individual. You never let me live it down. Although you do not let me forget my mistakes, I have people who do.

I am here to tell anyone who has been put in a category due to their mental illness that you need to fight. You need to tell the individual you are not a statistic because you are unique. You are different, every eating disorder was triggered by some different event. You may not have the same recovery pathway as the next person who walks in your therapist’s door, but that is OK! Life would be boring if everyone was the same. You are not typical, you are beautiful in your own way.

So, thank you R. Thank you for all the times you have brought me down and at times brought me up. Thank you for making me realize the only one who knows what upsets them is the person being told the upsetting information. Thank you for calling me “a typical 17-year-old anorexic” because maybe if you kept that to yourself, I would not fight so hard to gain the weight back. Without your help, I would not be able to fight for the life I so desperately want, instead of the life I may get with my eating disorder.

Sincerely,

The patient

If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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What Makes Anorexia Recovery Different

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At this point in my eating disorder recovery, I often find myself consulting a friend who has been sober for five years. She gets it. She’s experienced addiction. It tore her life apart. She worked hard, and now, she is on the other side. Her insights have been invaluable, and I owe her more recognition than words.

As a special educator, I study human behavior at length. The cyclical patterns of behavior present in anorexia have been a long-standing interest of mine. It’s exciting to see research is beginning to focus on new methods to change the thought patterns and behaviors of individuals living with anorexia.

Psychology Today defines an addiction as a condition that results when a person ingests a substance or engages in an activity that can be pleasurable, but the continued use or act (of the substance or activity) becomes compulsive and interferes with ordinary life responsibilities. While anorexia is not clinically recognized as an addictive disorder, one could argue the symptomology and the level of impairment of people with anorexia equate to a clinically significant obsession or addiction.

The behavioral change process is a growing phenomenon in our society. A common misconception is all behavior change is aimed at decreasing or eliminating a behavior. Cutting out foods, spending less money and reducing bad habits are all examples of decreasing behaviors. Unsurprisingly, the behaviors of people with addictions, alcoholism and bulimia all fall into this category. With each of these addictions, one must eliminate or reduce a targeted behavior.

This is what separates anorexia recovery from recovery of similar illnesses. For individuals with anorexia, rather than focus on the elimination of a behavior, an individual must significantly increase his or her energy. This not only includes consuming a greater quantity, but also a larger variety of foods and nutrients. Herein lies the dichotomy of this mental illness. No other addiction-based illness requires an individual to actively increase a single aversive behavior.

One could argue individuals with anxiety and depressive disorders must engage in non-preferred behaviors to manage their illnesses, too. For example, someone with depression may need to increase his amount of time out of bed, while someone with an anxiety disorder must increase her socialization. While these disorders require the individuals affected to engage in new behaviors, symptomologies associated with these disorders present in various ways with no single solution. No other mental illness requires those in recovery to increase a single, specific behavior without alternative options.

So, what does all this mean? Why does this matter? The treatment of anorexia is different. Individuals impacted must constantly come in contact with their addiction every day. While people recovering from alcoholism, drug use and bulimia can go “cold-turkey” and avoid their addiction, someone with anorexia must actively engage in a non-preferred behavior to cure their illness. This is not to say treating anorexia is easier or more challenging than treating substance abuse or other mental illnesses. It is just different.

In my opinion, this makes anorexia recovery exhausting. Every day, several times a day, I must make an active choice to eat. I must engage in a behavior I despise. I cannot avoid my fear or numb it; I must face it head on. I must learn to tolerate and then accept eating meals and gaining weight.

While it can become easier, the demand never fully goes away. This is an unbelievably terrifying realization. There are no days off or breaks. There is no finish line. I must continue to eat three meals a day for the rest of my life. In these moments when doubt and uncertainty creep in, I look to my sober friend and think: If you can eliminate liquor completely, I can choose to keep eating completely, too.

If you or a loved one is affected by addiction and need help, you can call SAMHSA’s hotline at 1-800-662-4357.

 If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

We want to hear your story. Become a Mighty contributor here.

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