Awhile back Psych Central contributing writer Margarita Tartakovsky interviewed me on the topic of eating disorders. Tartakovsky's blog, called "Weightless," covers a variety of different angles on this topic, and I was honored to be one of the first interviews. You may find my interview by clicking here. I have excerpted some of the questions and answers below.
1. How and when did your eating disorder start? What do you think contributed to it?
My eating disorder started in the sixth or seventh grade, once I began to dance (ballet) seriously and get pressured by my dance instructors to maintain a willowy figure. By the time I was in eighth grade, I wanted to pursue becoming a professional ballerina, and to do so (at that time ... I hear the pressure on young dancers is less now) pretty much required watching absolutely everything you put in your mouth. By the time I was in ninth grade, I was no longer menstruating and weighed 103 pounds (at 5"8').
Even if I hadn't pursued dance, however, I was extremely susceptible to an eating disorder at that time. My parents separated when I was in fifth grade, and our home life was a bit of a mess in the years that followed. As so many adolescents do, I manipulated my relationship with food because it was one thing that I could control ... the only thing at that time, and so it gave me a false sense of power, which was very seductive.
2. Many women with eating disorders are reluctant to seek treatment. Some describe their eating disorder as a friend and, as a result, tend to be very protective and secretive about it. What motivated you to seek treatment?
I didn't really seek treatment. Treatment sought me. What I mean was that it wasn't until my freshman year at college that I really admitted to having an eating problem and started to ask myself the hard questions about what might be lurking behind it. Throughout high school, I simply transferred my eating problems to alcohol abuse. It was only when I gave up drinking, right before I graduated from high school, that I could begin to heal.
So when I asked a counselor at school early my freshman year where I could find a support group for my drinking, she invited me to come back, suspecting there was more to my story than the need to stay away from booze. She is the one who confronted me with my eating problem, and also my depression and OCD.
3. Eating disorders are tremendously treatable but the key is to find the right treatment. How did you go about seeking services?
I was tremendously blessed to treat my eating disorder while attending Saint Mary's College in Notre Dame. Since it is an all women's college, the school provided excellent resources. For example, one semester I logged in everything I ate into a nutrition software program. That way, with the help of my counselor, it could guide my diet, and let me know if I was eating enough calories, the right kinds of foods, etc.
My counselor helped me to begin eating three meals a day. I entered a contract whereby I would have to tell her if I started to skip meals. In many ways, that first year of recovery--my freshman year at college--was like starting to learn healthy living from scratch. It didn't feel right, because my life had been so unmanageable from the beginning.
4. Do you still struggle with eating disordered thoughts and behaviors? If so, how do you overcome them?
Yes. When I overeat, it is extremely hard for me to not want to skip the next meal or to over-exercise to compensate for it. I have to simply forgive myself and move on, as weight loss blogger Janice Taylor says. I also struggle with the fat voice: "You're getting fat. You look fat. You are so fat," and it's not helped by statements like the one my lovely spouse said last night, "That sweater puts about 15 pounds on you." So I have to treat those thoughts just like I do the ones of depression: as an uninvited houseguest with an opinion for everything. Sometimes I employ the cognitive behavioral tips of Dr. David Burns, where I "examine the evidence," like seeing that the majority of my clothes still fit me, so I'm not obese yet. Or, if I have gained five pounds, that the world is still going around in the same way it did before I gained the five pounds. Or, if I can, I just try to put a name and face to the voice (Ed, standing for eating disorder), and tell him to go to hell.
I have a few rules that I live by: I eat three meals a day, I weigh myself once - no more - a day, and I don't exercise more than once a day. There are exceptions to the third, but you get the idea. I still have to operate under a structure of sorts.
5. What can family members do to help a loved one with an eating disorder?
That's by far the hardest question. I know that a person isn't going to recover until she wants to recover. She's got to get there on her own. But I also know if my counselor hadn't been there at the right time, I might still be skipping meals, and who knows if I would have been healthy enough to get pregnant, carry a baby, and give birth. Twice. So I first recommend having a candid talk. Especially if there is "proof" of a disorder--times you've noticed a family member throw a meal into her napkin instead of eating it, or if you've caught her in a lie, or overheard her throwing up, or found a laxative box in the trashcan.
By far the best thing a family member can do is to become educated on eating disorders and why they happen. It would be helpful if you had some resources on hand in case the family member is open to seeking help, or at least to inform her about for the time when she is willing to pursue treatment.