Authors: Kathryn Hansen
4
: Introduction to Therapy
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T
he summer after my junior year, my weight was down to 100 pounds; my parents became so concerned that they sent me to my first therapist. I was reluctant to go, because I still didn't think my weight loss was a problem. But the therapist said I met the criteria for anorexia because I had dropped below 85 percent of my normal body weight and had missed my period for four months. She told me anorexia was an illness, and not about food and weight. She said my concerns with food and weight were symptoms of more difficult life issues. Treatment, she said, would involve uncovering the reasons why I was dieting, improving my self-esteem and body image, reducing my anxiety, evaluating me for depression and treating it if necessary, working on any family or relationship problems, and improving my social skills.
This was all new to me, but the idea that my weaknesses needed to be treated so that I would stop dieting seemed more than a little odd. Yes, it was true that my self-esteem needed work. I never thought I was a good athlete, even though I excelled in several sports; I never thought I was smart, even though I usually made straight A's; and I doubted people liked me, even though I had many friends. Yes, it was true that I had high anxiety. Even before I had begun dieting, I'd let tests, homework, softball games, cross-country meets, and many other things stress me out. Yes, it was true that my social skills needed work. I was always painfully shy and got nervous in social situations.
Those flaws were simply me, and I was willing to live with those flaws. I felt that my dieting was about losing weight, not about my life's problems. But I wasn't ready to stop dieting because I wasn't convinced I could trust myself to eat normally. I left the therapist's office vowing never to go back.
RAVENOUS
I continued to diet during the summer after my junior year. As my senior year began in August 1998, I felt I was losing control. I started slipping much more often, eating foods that were previously off-limits, and in larger quantities. To make up for these slips, I increased my running even more. I was well aware that my restrictive eating habits were the cause of my strong appetite, and I decided that maybe it was time to start eating normal meals again. I feared I would completely abandon control—yet I felt that was already happening, so what did I have to lose? Maybe, I reasoned, eating normal-sized meals and adding some fatty foods in moderation would help some of my cravings subside.
I started to eat meals that were more substantial, but it didn't feel right. A regular-sized meal in my stomach felt uncomfortable and wrong; it made me feel fat and want to go running to burn it off. Furthermore, eating normal meals and reintroducing sweets and fats into my diet didn't help my cravings subside, it only made them stronger. A normal-sized meal, even though uncomfortable, still left me wanting much more. Eating a few cookies made me want the entire box; eating a handful of potato chips left me wanting the entire bag; eating a bowl of ice cream made me want to polish off the entire carton.
I spent most of my senior year alternating between eating normal meals and restricting foods. On days when I ran more than four miles, I allowed myself to eat more; on days when I ran less, I ate less. I maintained my weight between 100 and 105 pounds for most of the year, bordering on anorexia. My running continued to improve, and I enjoyed my success, but I still felt that my heart wasn't in the sport. Nevertheless, after my senior cross-country season, I signed with a Division I university in Mississippi—the same university my sister already attended—to run cross-country and track. Part of me was excited about it, but another part of me was not.
I hated the fact that I'd given up my dream of pitching in college, when only a couple years before, that had been the only thing I wanted to do. I hated the fact that my weight and food obsessions were tied up with running, and I dreaded that the obsession would linger in my college years. I wondered if I'd be good enough to compete in college, or if the other girls would be much faster than me or thinner than me and better able to control their appetites. Part of me wanted to break free and no longer participate in a weight-control sport, but another part hoped that things would be different in college ... and that I would be different as well.
To prepare for college, I decided to run track at the end of my senior year—something I had never done because track interfered with softball. I still played softball, but a freshman pitcher all but took my position because I was no longer strong enough to be effective on the mound. It was difficult to participate in both sports at the same time, and the stress made me start losing weight again. It was during that time that I dropped below 100 pounds, and my appetite finally got the better of me. Throughout my dieting and weight loss, when I'd eaten a little too much, it had never been more than about 500 calories. It wasn't until March of my senior year that I binged for the first time.
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When I write about what I learned in therapy, in this chapter and throughout this book, I am simply repeating what my therapists told me. The things I learned in therapy are not unequivocal truths and are, by and large, very different from what I believe today.
5
: My First Binge
M
y first binge was on sweet cereal—one of the foods I'd restricted for a long time and never felt comfortable reintroducing into my diet because I craved it more than most other foods. Nearly every night, my dad would eat a bowl of cereal, often the sugary kind that I craved. He always sat on the rocking chair on one side of the couch eating his cereal, and I sat on a recliner on the other side watching television, doing homework, or eating some bland cereal or low-calorie food. When I watched him eat the cereal, I always felt emptiness in the pit of my stomach. I wanted nothing more than to have some of it.
I feared my cravings. I thought that if I took one bite of sweet cereal, I would eat the whole box. So I didn't have any. That is, until that March morning when I binged for the first time. When I woke up that morning, I immediately began thinking about the cereal in our kitchen cabinet. It was not unusual for food to be the first thought in my mind on any given day, but this day, somehow, it was more compelling. I quickly got ready for school, thinking I could distract myself by just getting out of the house. I walked to the kitchen, trying to convince myself I would have only an apple, but soon I found myself staring into the pantry at the cereal.
I told myself I would just have a little bit, but I think I knew what would happen. My heart raced as I picked up the box, and my hand shook a little as I poured the milk. Before picking up the spoon, I told myself I'd have to run a few extra miles that afternoon to make up for indulging. I tried to eat the first few bites slowly, savoring the taste, but it was so good. I hadn't eaten sweet cereal for at least a year, so I began to chew more quickly, taking less time between bites. As I came to the last few bites in the bowl, I was eating faster than I'd ever eaten before.
I poured another bowlful and ate it much more quickly than the first. After the two bowlfuls of that cereal, I ate two of another, three bowlfuls of still another, then one more bowlful of the first. While I was eating, I felt as though an intruder had taken over my body. But when I finished the last bowl, my senses returned a little and I felt the first agonizing twinge of guilt for what I had done. I put the empty bowl in the sink and walked slowly out of the kitchen to the reclining chair in the den. I felt like I was in a dream. I still couldn't quite believe that I had eaten so much.
AFTERMATH
I reclined the chair, feeling a mixture of pleasure and apprehension. It felt so good to at last be really full, and I felt enormous relief from finally giving in to my cravings. But I also felt uneasy about gaining weight and shame for being so gluttonous. Temporarily, the comforting feeling of fullness outweighed the negative emotions, and I drifted off to sleep, not caring that I'd be late for school and feeling more relaxed than I'd felt in a long time.
When I woke up an hour later and drove to school, all the good feelings were gone. I felt guilty, fat, and foolish. The episode seemed to prove once and for all that I could not control myself around sugary or fattening foods, so I resolved never to let that happen again. I decided that I would be even more determined to keep my eating under control, and I vowed never to touch sweet cereal.
I thought about my first binge all day in school, unable to concentrate on my classes, my friends, or softball practice. I felt like a failure for ruining all of the work I'd done to lose weight. I skipped lunch that day, even though I was hungry again by lunchtime. After school and softball practice, feeling weak and tired, I ate an apple and some crackers, then ran six miles. I felt better about myself after my run, as though I had righted a wrong; but when I sat down to dinner that night, part of me wanted nothing more than to binge again. I didn't understand how, when just that morning I had been so full that I could barely move, I could want to stuff myself again. I was obviously not to be trusted around food, I thought. I would have to keep a tight rein on my appetite, or I might binge again. Little did I imagine at that time that bingeing would consume my life for six more years.
My bingeing increased gradually. I binged one more time in March and three times in April. During those months, I still managed to maintain my weight because I was running more than ever. In April of my senior year, my two-mile track time was the best in the state after two meets; however, my success came to an abrupt end at the third meet. As I crossed the finish line after my two-mile race, I felt a sharp pain in my left heel. I tried to ignore it and kept running for the next few days, but even walking became excruciating. The pain got so bad that I had to go to the doctor, and I was diagnosed with a stress fracture.
This was to be the first of five stress fractures I would stuffer in the next two years. My doctor said the injury was most likely from running so much at a low weight. He explained that, without sufficient fat cells, a girl's body cannot store enough estrogen; without enough estrogen, the bones weaken and can fracture. My low estrogen levels also explained why I hadn't had a period for a year. He prescribed hormone replacement therapy and told me not to run for at least three months.
I spent the remainder of my senior year on crutches and then in a walking boot. I feared my weight would skyrocket since I couldn't run, so I cut back on my eating and increased other types of exercise. I got permission from my doctor to ride a stationary bike at the gym; so I biked and biked, often for two hours or more. I also took up running in a pool with a flotation belt. I still went to softball practices and games and track meets, to cheer on my teammates, but when I got home, I immediately drove to the gym or the pool to exercise.
THE END OF HIGH SCHOOL
Less than a month after my stress fracture, my weight dropped to 93 pounds. This was the time when others began truly worrying about me. It seemed that my friends, family, coaches, and teachers could justify my low weight in their minds when it was linked to my dedication to being a successful runner. However, when I fractured my foot and then dropped weight rapidly, they began suspecting something more. A few of my teachers approached my mother to express their concerns; but by this time, she was already the most concerned of all.
She and my dad tried to talk me into returning to therapy, but I wouldn't hear of it, and I was good at reassuring them. I ate normal meals in their presence, so they saw that I was taking in calories. They knew I was driven to maintain a certain level of fitness due to my approaching collegiate athletic career, and they knew I had a high metabolism and had always been thin. Furthermore, I wasn't completely honest with them about the amount and intensity of exercise I was doing. They thought I was moderately riding the exercise bike and lifting some weights at the gym, when in fact I was biking at extreme intensity for long periods of time. I often showered before coming home and hid my sweat-soaked clothes to hide the evidence.
None of this was normal, as much as I tried to convince my parents and myself that it was. My increased exercise brought decreased desire to be with my friends and a loss of interest in the remaining weeks of high school, usually the high point of a teenager's life. I did go on my senior class trip to Orlando, but my clearest memories of that time are of being stressed about not being able to exercise and maintaining my diet while traveling. I packed a lot of healthy snacks for the trip and tried to order low-fat meals from the fast-food restaurants where we stopped. I have pictures from the trip of me smiling with my friends, but it felt like I wasn't really there. I mostly lived inside my head during that time, calculating calories and looking forward to my next meal and the small indulgences and desserts I allowed myself.
As high school came to a close, I withdrew from most of my friends and lost my first love. I graduated emaciated and unhappy in May 1999. I spent the summer before college completely devoted to exercise. I increased my aerobic exercise—running in the pool or riding a stationary bike, very strenuously—to about 2.5 to 3 hours per day. I bought my own stationary bike, and each day, I carried it outside to ride it on the back porch in the hot and humid summer weather. I felt I got a harder workout outside, and I thought I needed to stay acclimated to the heat for when I began running again. Looking back, I feel terrible knowing my mom had to watch me abusing myself through our sliding glass door every day. A few times that summer, she came outside crying, begging me to stop, because I was pouring with sweat and she was worried that my body could not take the strain any more.
I wouldn't stop. It didn't matter how hot or humid it was; I felt I had to keep up my routine. I didn't know why I felt so compelled to exercise and maintain an abnormally low weight. It became an obsession, an exhausting and self-perpetuating habit. I didn't believe I was vain or selfish at the time, but I was. I focused on my body instead of on more important or worthwhile things.
Those who were concerned about me approached me so delicately, as if I were fragile and had a problem I couldn't control. I didn't. I was strong and strong-willed. I was stubborn and deceptive. I placed exercise and weight control above most everything else in my life. I wish someone would have called me out on my foolishness, as people often do with teens who are using drugs or abusing alcohol. I don't know if it would have stopped me or not, but I certainly deserved to be reprimanded. I knew I could stop anytime I chose, but I was too good at it. I was too good at being super thin—a shallow goal that simply wasn't worth it.
Despite all the exercise and outward restraint around food, my only true desires were to rest and to eat—a lot. My infrequent and secretive binges continued, but despite that, I continued to lose weight. Aside from the binges, I maintained a structured and rigid diet—eating the same types of foods, in the same amounts, in the same places, every day. It seemed as though whenever I gave myself the slack to eat a little more or eat something different, I overindulged and sometimes binged.
In early July, my weight dropped to 86 pounds, and my parents began trying to force me into therapy. I probably would have finally agreed to it, but in mid-July, I began gaining some of the weight back ... not by choice.
DOUGHNUTS
I worked at a bakery that summer, and until mid-July, I didn't eat any of the foods there. To an outsider, it must have looked like I had remarkable control; but it didn't feel like control to me. To me, it was the opposite—I felt so tempted that if I let myself have just one bite of a cookie or a cupcake, I feared I'd devour much of the counter. The manager let the workers take home leftover doughnuts, because we could not resell them the next day, but it was too risky for me to take any. One day, though, I decided to bring a half dozen to my parents. They never even saw them. Two hours after I got home, I ate all six of them.
Just as when I'd eaten eight bowls of cereal, it was such a relief to finally give in and not fight my cravings anymore. All my anxiety about the bakery, my exercise, and my weight temporarily vanished while I ate; but after the last doughnut, I panicked. I was terrified at what I had done, and I had to find a way to undo it. A promise to myself to work out more tomorrow was not enough this time. My binges were becoming too frequent, and eating six doughnuts was intolerable in my mind. I needed immediate relief, so I went to the bathroom and tried to make myself throw up for the first time. I tried for about ten minutes, gagging until my eyes watered profusely and I had sharp pains in my stomach. But my first attempt at self-induced vomiting failed, like all my future attempts would—thankfully.
I'd heard of bulimia before, and as I was shoving my fingers down my throat, that word came to mind. However, I did not want to consider the possibility that I could be becoming bulimic. That wouldn't happen to me, I vowed—I would get control of my eating, and I'd never binge again. For nearly a week, it seemed I was in control again. On the day after eating all six doughnuts, I worked out for four hours and ate only fruit; then I got back to my regular eating and exercise routine. But six days later, and again five days after that, I binged.
I began to crave not only food, but the act of binge eating. Once I'd tasted what a binge felt like—how wonderful it felt to have the pressure of dieting lifted for a few brief moments, to give in to all my cravings and just stuff myself—it became even harder to resist. When trying to fight an urge to binge, I'd remind myself how guilty and fat I always felt afterward; but I remembered the pleasure much more. It was as though part of me knew the consequences but another part of me didn't care.
I steadily put on weight through the rest of July and August as I binged more and more. My parents were glad to see that I was gaining weight, but they were unaware of the terribly unhealthy route that was leading me there, and how I was exhausting myself desperately trying to burn it off.
By the time I packed up and left for college at the end of August, I was binge eating about twice a week. I thought that college would help because I could occupy myself with school, new friends, and—now that my stress fracture was mostly healed—running; but instead, I only binged more as I began college. I didn't have much of a desire to make friends or go out because my daily struggle with food consumed my life. I didn't like running on the cross-country team, mainly because I had to do so much extra exercise to compensate for my binge eating that I had no energy left to run. Also, many of the girls on the team were concerned about their weight; I didn't like being in an environment where there was so much talk of weight, calories, and diets.