Day-to-Day Struggle

"I was first confronted about my eating disorder when I was a junior in high school.  My close friend approached me. Our conversation feels like yesterday and the thought still moves me to tears. 'Amy, we need to have a serious talk,' she said. 'I love you too much to sit back and watch what's going on.  I need you at my wedding,and at this rate you wont make it.' I cried. We hugged. Two weeks later I got help."

Even today when Amy talks about life before she found help, tears fill her eyes.  However, those tears are no longer of pain or helplessness.  They are tears of hope, faith, and recovery.

Amy’s case isn’t a surprise to many experts.  According to the National Institute of Mental Health, 1 in 5 women struggle with an eating disorder. 

Amy was 16 years old when she first started to skip meals.  She went from eating a well-balanced and healthy diet to eating less than 500 calories a day.  She was anorexic. "I just started skipping meals and eating less and less," Amy said. "I was a dancer, so I was constantly around skinny people and I had always been small, but I didn't think I fit in." 

According to the MayoClinic, eating disorders are a broad group of serious psychological conditions that cause one to be preoccupied with food and weight and often focus on nothing else. People who suffer from eating disorders usually have low self-esteem, feel inadequate, and suffer from depression or anxiety.  Other factors that can lead to eating disorders are personal relationships, difficulty expressing emotions, or cultural pressures that glorify being thin.  The main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.  A person who has anorexia nervosa is usually obsessed with denying oneself food and being thin, sometimes to the point of deadly self-starvation. One may exercise excessively or simply not eat enough calories.

Bulimia nervosa involves episodes of bingeing and purging.  Typically one would eat a large amount of food quickly and then try to rid the body of the extra calories by vomiting, taking laxatives, or exercising excessively.

The last main eating disorder is binge-eating disorder.  This is when a person will binge eat for hours at a time and then try to diet or eat normal meals, triggering another round of bingeing. Binge-eating is commonly defined as excessively eating during a relatively short time. 

Many factors can cause an eating disorder.  A need for control commonly causes people to have eating disorders.  A person who has an eating disorder usually feels they have lost control of their life, but feels eating is the one thing they can control.  Other causes of eating disorders include personal characteristics, such as feeling helpless or worthless, or having a poor self-image.  Emotional disorders such as depression or anxiety, and stressful events can also cause eating disorders.

Eating disorders can lead to many complications, some of which are life-threatening.  The more severe or long lasting the eating disorder, the more likely a person will experience serious complications.  MayoClinic explains some of the complications that include: high blood pressure, depression, heart disease, seizures, nerve damage, and death.     Dr. Debbie Rhea, a kinesiology professor at TCU, struggled with an eating disorder when she was younger.  Dr. Rhea believes and has seen proof that specialized treatment is the only way to get to the root of an eating disorder. Not only is it important to see a psychologist who specializes in eating disorders, it's also important to visit a nutritionist.  Nutritionists are able to monitor deficiencies, and re-teach patients how to eat and receive the proper nutrients in order to become healthy again. Amy's problem was prolonged because she didn't work with a specialist.

"I didn't tell my parents why I wanted to go see a therapist," Amy said.  "It was right around the time my grandpa died and my dad lost his job so I just told them I cried all the time and needed to talk to someone.  I was diagnosed as being depressed and that's all my therapist really treated me for, because she didn't specialize in eating disorders."

Treatment is often a long and continual struggle that depends on the person's specific eating disorder, but according to MayoClinic the typical treatment includes psychotherapy, nutrition education, and medication. Psychotherapy is used to monitor one's eating habits and mood, develop problem-solving skills, and explore healthy ways to cope with stressful situations.  Dietitians provide nutrition education and other health care providers who can offer information about nutritional eating habits and design an eating plan for achieving healthy weight gain.  Medications for anorexia and depression can’t cure an eating disorder, but they can help control urges to binge or purge.

Amy had been going to the same therapist for about ten months before moving to Fort Worth to start her freshman year at TCU.  Amy started doing  much better once she arrived at school because eating became a social event.  It is common in eating disorders to improve for a short time and then fall into a relapse. Relapses are caused by everyday events that might cause the person a large amount of stress or pressure.  Getting away from home, Amy believed she could change herself and her old ways, by putting on a front and becoming someone different in college. 

I went to high school with Amy and she was my roommate during the spring of our freshman year at TCU.  She told me she had an eating disorder in high school after we had been living together for about a month. During high school I was unaware of her weight loss, because I always remember her having a small frame.  She had always had a tiny frame and once again looked healthy to me. I thought she had turned her life around. 

Upon arriving home for the summer after Amy's freshman year, Amy's depression problem was never brought up again and her parents never spoke of the disorder. Her mom was aware she had a problem, but felt uncomfortable talking about it.  I guess they all thought she was in the clear. It had been a phase. Something in the past, but nothing more.

"I tried to talk to my mother about my anorexia, but it made her feel uncomfortable. So I just stopped. Deep down I know she is worried, but she didn't want to talk about it," Amy confessed.

According to Rhea, parental denial is common. Parents never want to believe that their child has a problem or that they themselves could be the root of the problem.  "Parents also tend to listen to their children and if a child tells their parents that they had a stressful few weeks and didn't have time to eat, their parents are going to believe that excuse instead of believing that their child could have an eating disorder," Rhea said. 

Amy's parents' continued to be in denial.

Then, right before fall finals began our sophomore year, I received a call.  I couldn't understand the voice on the other end of the phone because it was muffled by sobs and broken sentences.  I knew something terrible had happened.  I arrived at Amy's apartment to find her curled up in a ball on her floor, rocking back and forth, crying and randomly screaming, "why?"  Although I was concerned with her behavior I was more concerned with her appearance.  My best friend laid on the floor and all I could focus on was how her grey tank top and Nike running shorts hung from her unusually thin frame. 

She had relapsed.

According to Dr. Rhea, relapses are common when people don't receive proper treatment early on.  She compared eating disorders to alcoholism to illustrate how powerful triggers can be.  "A person who has had an eating disorder is like an alcoholic. It is something that will always be with them, no matter how much time has passed.  Also like alcoholics, people with eating disorders always have something that triggers a relapse."

Amy's trigger was sensing a lack of control.

Her feeling of being helpless was caused by the events that surrounded her, such as roommate problems and her grandfather being in the hospital.  These feelings led to a personal lack of control, which directly caused Amy to fall into her old anorexic habits.  Amy's grandfather had become very ill in December and soon passed away. In February, Amy moved into her own apartment, after having roommate trouble throughout the fall semester. Soon after moving, she learned she had a cancerous melanoma on her leg, which was removed. The combination of these stressful events led to her downward spiral.

"Living alone made things worse for me, until I started going to a therapist and dietitian who focused on eating disorders. This time I got help all on my own, because getting better was finally something I wanted for myself."

Amy's dietitian gave her a meal plan filled with the nutrition she needed to get better and gain healthy weight.  Amy had to log everything she ate, which made her conscious about eating, instead of conscious about not eating, but also helped her realize what she needed to eat in order to be healthy. Another tool used to double- check that Amy was eating more, was a weekly weigh- in at her appointment to prove to her dietitian that she was in fact gaining a healthy amount of weight.  After years of limiting her eating, Amy was a calorie counter.  Her dietitian told Amy to only be concerned with the amount of protein she was eating. 

"This has really helped me because now I'm not constantly looking at how many calories are in what I'm eating.  Now I'm focused on the amount of protein and making sure I'm eating a healthy amount of that." 

Amy has been visiting her therapist and dietitian for the past five months, once a week and is getting better, but every day is a constant struggle.  "It was my life. It controlled my life. I'm recovering because I want to.  It's all my choice, it's all me."

Once treatment begins, the best thing to do is be supportive of the patient and be willing to listen and talk to them.  Amy acknowledges the importance of such support, "My friends are easier to talk to, because the whole situation makes my parents feel awkward."

Although Amy feels more comfortable talking to her friends than her parents, her situation isn't something she wants to make public.  For her  privacy her name was changed for this article.

"People tend to be insensitive to the fact that people have eating disorders. It's hard because an eating disorder isn't a visual problem, so people are unaware who it affects and make rude, silly, and insensitive comments. The stereotype and stigma that comes with having an eating disorder is hard enough.  I don't need people joking about something that isn't a joking matter."

Amy can tell she is getting healthier.  Her clothes no longer hang off her body and she is eating at least five times a day.  Getting to this point hasn't been easy.  For Amy, it is a day-to-day struggle; she treats every day like a new day full of new decisions and new choices.  "The hardest part is looking back on it now, and seeing how it affected my life, but not just my life.  It affected my relationships with other people as well.  I can only hope that all the other people who are struggling realized they aren't just hurting themselves and seek help, because it really is the only way."