Authors: Kathryn Hansen
I came to accept the idea that it could take me many years to finally resolve all the root causes of my problem, learn to deal with the daily triggers, and learn to eat normally again. I still made some resolutions to quit but only on big occasions like my birthday and New Year's Eve. I came to accept what I was learning in therapy: there were no easy answers, no quick fixes.
I don't blame any specific therapist or other professional, any specific book or resource; but the consensus seemed to be that my bulimia was complicated and recovery wouldn't be easy, and this idea turned out to be harmful to me. In therapy, I came to believe that I needed to travel a road of self-discovery and self-transformation in order to be fully free from my problem. I came to believe I needed to change many aspects of my personality; find purpose and meaning in my life; find spirituality and emotional fulfillment; learn to love myself; establish my identity; cure my depression, anxiety, and perfectionism; resolve my past; and find happiness—all in order to free myself from bulimia.
Therapy didn't suggest that I should be perfect in this journey of self-discovery; however, it was still a large undertaking for me. I was just starting my life as an adult and trying to find my way in a big and unknown world. Some days I was more motivated toward recovery than others, but day in and day out throughout college, I worked on my therapy goals, trying to better myself so that my urges to binge would go away. I tried to fix everything that I thought might be giving me those urges. I tried to improve my self-esteem, took antidepressants, practiced assertiveness, learned relaxation techniques, worked on new ways to cope with my emotions, learned to meditate, and sought spirituality.
I talked endlessly to my therapists about my family life, relationships, past failures and pain; but it didn't stop the cycle of binge eating and over-exercising. In fact, my binge eating only increased throughout my four years of college. It seemed that no matter how many deep-rooted reasons I found for my bulimia, no matter how well I followed my meal plan, no matter how well I coped with daily stressors, no matter how much I tried to find peace and fulfillment, the urges to binge kept coming; and I again found myself in front of the refrigerator or on my way to the nearest fast-food restaurant.
I didn't know it at the time, but my therapists didn't have all of the answers. I trusted them, and they certainly wanted what was best for me; but no one knew then what eating disorders were all about, and we still don't know. In a comprehensive book about eating disorders published in 2003—four years after I began treatment—experts said that no one understood precisely how or why eating disorders occur.
18
To date, researchers are still uncertain of the underlying causes and nature of eating disorders.
19
The explanations my therapists gave me for my bulimia were based on theories and conjecture, not on fact. Moreover, their suggestion that I needed to resolve the hypothetical root causes to recover wasn't sound either, as there is no scientific proof that resolving underlying psychological problems leads to recovery.
20
Without knowing this, I accepted therapy and put my faith in it.
CONFUSION AND LACK OF PROGRESS
As my therapy progressed, I came to feel that I wasn't making any progress toward my true goal: to stop binge eating. Sure, I was discovering many useful things about myself and learning new ways to deal with a variety of problems, but my bingeing remained. My therapists never suggested that I just stop binge eating abruptly or tried to explain how I could do that. I learned that I would most likely take a few steps forward, then fall backward many times before fully recovering; but my therapists assured me that the work I was doing in therapy would eventually pay off. It never did.
My therapists did encourage me to
reduce
my binge eating episodes. They did encourage me to set small goals, like putting off binge eating for ten minutes or bingeing one less time per week; however, this simply wasn't good enough. I wanted to stop for good, but no one could tell me how.
I'm not sure what consumed me more during college: my bulimia or my efforts to recover. Both swallowed so much of my time and energy that the rest of my life seemed to shrink. I quit the cross-country and track teams after my sophomore cross-country season, because of my bulimia and because I suffered four more stress fractures while running for my university. The damage I did to my bones during high school by losing weight probably caused all the fractures, and the injuries made it nearly impossible for me to run competitively. To this day, I try not to think about what my running career could have been.
I remember sitting in my cross-country coach's office, crying, as I told him I had to quit in order to focus on recovery, to get away from the pressures of a sport that demanded a certain body type, and to let my own body and injuries heal. He was disappointed but supportive. I didn't feel he blamed me for my failure; I felt he blamed the eating disorder, because like my therapists, he believed eating disorders were illnesses that needed professional help to cure.
Despite my doubts and better judgment, I, too, began believing my bulimia was an illness, not a lack of willpower. After much therapy, I accepted the idea that I needed to travel the road of self-discovery to completely cure my disease. I traveled that road for a long time, trying desperately to get control of a behavior that I didn't understand. At the end of my senior year, I was up to 140 pounds and binge eating about four times a week. I was consuming about 8,000 calories per binge and exercising six to seven hours the next day to purge. My habit took up much of my life.
Despite four years of therapy, college ended just as it had begun—I was still eating other people's food in secret, stopping at gas stations and fast-food restaurants to get more and more food, using all my spare change in vending machines, exercising for hours on end, trying unsuccessfully to make myself throw up, and gaining weight.
I could write endless stories about the friendships I lost, the relationships I never formed, the wasted time, the missed opportunities, the health problems I caused myself, the pain I caused my family, and the food—how good it tasted and how horrible it made me feel afterward. But I won't. I have given a glimpse of what my life was like as a bulimic, and anything more would be repetitive and tiresome.
I don't want to give the impression that my college years were all bad. There were moments, sometimes days, and once over two weeks when I was not caught up in my bulimia. I did make many friends, a few of whom I remain close to; I did date occasionally and fell in love once. I laughed often; I went to bars with my sister and her friends occasionally; I drank every now and then; I enjoyed many of my classes and got good grades; I had a few good cross-country races; I played intramural softball and tennis; I attended football and baseball games, concerts, parties, and church. I had moments when I felt like a normal college student, and those are the moments that I try to remember. I've found there is no use lamenting all the time I lost to my bulimia, because I can't get it back. I can only hope that by sharing my experiences, another young woman doesn't waste some of the most promising years of her life.
7
: Topamax to the Rescue
T
he day after my college graduation in May 2003, I was alone, my stomach painfully full, in my apartment. My family had been in town for the ceremony but had since gone home. I was going to move back home in a week, so I'd given away most of my furniture. All I had left was a computer desk and a folding chair, a blanket and a couple of pillows, and my dresser. I was lying on my side on the floor with a pillow under my bloated stomach. This was something I often did when I was really full because this position relieved some of the pressure.
I began thinking about my college years. I had graduated with a degree that I didn't really want or know what to do with. I originally went to college planning on majoring in meteorology, but after my freshman year, I changed it based on something I learned in therapy. My first therapist, Jim, and I talked extensively about learning to live life to the fullest. I admired his apparent ability to enjoy the moment and not let work or responsibilities squelch his zest for life. Jim told me several stories about his most fulfilling adventures and encouraged me to try to find fulfillment in ways besides binge eating. I took the wrong message away from these interactions with him. I took away the idea that I needed to live life to the fullest in order not to binge. I thought living life to the fullest meant having fun, enjoying each moment, welcoming adventures, and living easy—free of any major workload.
So I asked myself what major and career path I could choose that would allow me to live life to the fullest. Meteorology, I thought, wouldn't allow it because I would have been required to take difficult science and math courses in college. Furthermore, I saw the work of a meteorologist to be interesting, but also complicated and perhaps tedious. So I chose to be adventurous and change my major. I decided, since I loved music, I could be happy as a publicist for an alternative rock band, and so I chose to major in communication. That would have been a fine career path for someone else, but it didn't fit my strengths or personality.
I didn't care. I was determined to find fulfillment so I could stop binge eating, even if that meant risky decisions for my future career. At eighteen, I didn't understand that fulfillment could run deeper. It didn't have to mean fun or adventure; instead, fulfillment could mean hard work, diligence, or making a difference. My dad protested my change of major and tried to convince me otherwise, but I didn't listen to reason. Instead of considering his advice, I thought it was an affront to my independence and my desire to recover from bulimia. This was one of the most ridiculous connections I made between my life and my bulimia. I honestly thought promoting a rock band—the most out-of-character job for me—would allow me to stop needing to binge.
Eventually, in my junior year of college, I came to my senses and realized that wasn't the career path I truly desired. But I wasn't sure what I wanted to pursue. By this time, I felt so lost in my eating disorder that it was tough to consider my future at all. School had become an afterthought. My daily struggle with food was so pressing, it was tough to keep up with my classes. I briefly considered changing my major again—to what, I didn't know—but I felt it was too late. It would have required an increase in academic stress and extra time in college, which I didn't think would be conducive to stopping bulimia.
For a long time, I had felt that college was getting in the way of my recovery. I looked forward to the day when I didn't have to study or write papers; maybe after I graduated, I thought, I could get well. I would be able to go to more therapy appointments, spend more time journaling and doing the emotional work I needed to do. I knew my major wasn't for me, but still I pushed through classes, bingeing and purging all the way. When graduation day finally arrived, I felt no pride walking across the stage because I knew I was a failure.
The next day, lying on the floor of my apartment with a pillow under my bloated stomach, I felt like even more of a failure. I looked at my diploma in the corner of the room; the notes from my last final on the floor by my computer; the medal I'd received for maintaining a 4.0 grade point average hanging on the folding chair; and the gifts and cards from my family piled by the door. I felt relief and regret at the same time. I knew I had to get myself back up—figuratively and literally—and continue the long, hard journey of recovery, because I had no more excuses.
A "MIRACLE" CURE
The next week, I moved back into my parents' house and began seeing a new therapist, psychiatrist, and nutritionist in my hometown. I did not get a job, so I could devote my time to therapy, but even without the stress of school, my bulimia remained. My treatment at home was very similar to my treatment in college. I continued working on dealing with the daily triggers and the deep-rooted emotional reasons for my behavior. I still worked on curing my other problems, like depression and anxiety, and I still followed a meal plan. I still binged.
I began to think I wasn't getting better because I simply wasn't good at therapy. I wanted to be less anxious, less depressed, manage my emotions well, have a good self-image; but this was very difficult for me. I worried that I'd never change and therefore be doomed to binge for the rest of my life. Sometimes I felt like I was making progress, and sometimes I didn't. Sometimes I felt I understood why I was bulimic, and sometimes it was still a mystery to me. My new therapists were supportive and knowledgeable, but the result was the same: there was no marked change in my binge eating.
However, I did learn one valuable lesson that would become vital to my eventual recovery. This lesson was about the link—really the lack of a link—between my bulimia and my emotions. In June 2003, my psychiatrist put me on a new medication called Topamax (topiramate). This particular medication was traditionally used to treat epileptic seizures, but at the time, it was beginning to be used in bulimics and showing decent results. Although I was wary about using an anti-epileptic drug, considering I had never had a seizure, I was desperate and decided to try it out. I used it in conjunction with my antidepressant, which I had been taking on and off throughout college.
I was amazed that, within a week or two of starting Topamax, I didn't want to binge eat very much. My appetite decreased, and I cut my bingeing down from four times a week to once a week, then to once every two weeks, where it remained stable. By September of that year, I had lost about 15 pounds, putting my weight at about 125. Even though I was still binge eating a little, I felt better than I had in years. The constant shame and disgust were suddenly nearly gone.
I began an internship at a local news station and volunteered to do media for a local church, in an attempt to find something fitting to do with my communication degree. I also got a part-time job working with children and adults with special needs. I helped a 12-year-old girl with cerebral palsy do her homework a few times a week, took care of an 8-year-old boy with learning disabilities for a couple afternoons a week, and organized field trips and activities for adults in assisted living community homes.
Ever since I was six years old, my mom had taken care of special needs citizens in and out of our home. One of my best friends growing up—Eden, who passed away during my sophomore year of college—was physically disabled and in my mom's care a few days a week. She was like a part of our family, and her death was difficult for me, not only because I would miss her terribly, but because I felt like I neglected her during the last few years of her life while I was caught up in my eating disorder. As young girls, Eden and I used to play for countless hours in my room, creating the elaborate, imaginative lives of our Wish World Kids—small figurine dolls who had rooms that transformed into beauty salons, pizza parlors, and playgrounds. We also played video games, watched countless hours of Disney movies, and memorized every word and song in
The Little Mermaid.
As a child, my greatest interests were doing active things outside—going to our neighborhood pool; playing basketball, football, and baseball with the boys on our street. But a few days a week when Eden came over, I mostly put all that aside—not because I had to, but because I wanted to and loved our time together. However, when I began dieting restrictively and exercising excessively, I selfishly placed my focus on weight ahead of most everything else in my life. When I was eight, I would not have considered leaving Eden to go outside to play with the boys, but when I was an upperclassman in high school, I often skipped hanging out with her so I could go to the gym or run.
Then, when I began binge eating and became consumed with my eating disorder and therapy in college, I didn't make much of an effort to contact her, or any of my other friends from home. An eating disorder can be very secluding and can make even the most important people in your life fade into the background. I regret that I wasn't a good friend during that time, especially to Eden, because it turned out to be our last few years together.
I thought about Eden a lot during the summer after college, as I still do today. While on Topamax and temporarily unconsumed by the binge eating, I suddenly had time and mental space to think about meaningful things, even if some of those things were painful. I often wished I could stop by Eden's house, which was less than a mile from mine, just to talk or play a video game. I felt the capacity—for the first time in a long time—to be a true friend, to possibly build lasting relationships.
That summer, I did start trying to make new friends in my hometown and I reconnected with some old ones. I also began a long-distance relationship at that time with Greg—the cousin of one of my college friends and the man who would later become my husband. It was amazing to have a life again, and surprisingly, it wasn't due to any changes I had made in my personality. It had nothing to do with any progress I'd made in therapy. I simply stopped having those all-too-frequent urges to binge, all because of a medication that somehow regulated my brain.
Topamax was not without side effects, however. I experienced a constant tingling in my fingers and toes, my head felt cloudy much of the time, and I got jittery often. Even though the side effects were preferable to the constant urges to binge, I worried about the possible long-term consequences of using Topamax. I had wanted to quit on my own, and I was concerned that I would become dependent on the drug. Despite my doubts, I continued to take Topamax because, after a taste of being somewhat normal again, I didn't want to go back.
UNCONSUMED
I visited Greg in Chicago in 2003; we became closer and arranged for a few more trips to see each other. In September, we met in Missouri, which was halfway between our homes and about an eight-hour drive for each of us. I remember driving alone from my home to our meeting point, listening to music and some audiotapes about world religions—one of my budding interests at the time. I was amazed that I did not contemplate binge eating even once.
As I drove, I thought about how different this trip was from the many drives I'd taken between my home and my university, when I'd thought about food constantly and stopped at nearly every exit to get more of it. On my way to meet Greg, I stopped to eat only when I was hungry, and I ate only enough to satisfy me physically. It was as if my mind was all of a sudden free to focus on other possibilities. In Missouri, we went on a canoeing trip, hiked in the Ozarks, and simply enjoyed our time together. I suddenly felt like myself again.
The veil that I'd been under for so long was nearly lifted, and although my life's problems didn't disappear, my biggest problem had faded almost completely. I still had low self-esteem; I was insecure in my new relationship with Greg; I was still confused about my career direction; I still had unresolved family stressors; I still didn't cope well with many of my feelings; and I was still prone to depression, anxiety, and perfectionism. Yet I'd nearly stopped binge eating in spite of all that. Topamax improved my real problem—my urges to binge—even though my other problems and flaws remained.
GOOD-BYE TO THERAPY
This experience made me question everything I'd learned in therapy. Why had I sat in therapists' and nutritionists' offices for four years if taking Topamax could make my urges to binge disappear so quickly and easily? It made me angry with my therapists, who'd led me to believe that my flaws, insecurities, upbringing, and stress were to blame. But even with all that mostly still intact, this drug had basically eliminated the central issue that had consumed my life for years.
Maybe there was no link between my bulimia and my emotional state after all, I thought, or maybe it was simply unnecessary for me to resolve those internal problems in order to stop bingeing. Still, I wondered what would happen if I stopped taking the drug. Would my urges return as quickly as they had dissipated, or would the effects be enduring? Those questions were answered soon enough. My honeymoon on Topamax was short-lived, as I suspected it probably would be. After roughly four months on the drug, in October 2003, the positive effects seemed to wear off, and I began having more and more urges to binge. My binge eating increased rapidly through October and November, until I was bingeing about as much as I had before graduation. My psychiatrist suggested that I increase the dose of Topamax, but I wasn't willing to take the risk of more side effects; plus, I had no idea what the long-term consequences could be. I would have to find another way.
My therapists remained constant in reminding me: neither Topamax nor any other drug could be a miracle cure for my bulimia; to be fully cured, I would have to resolve the underlying causes and triggers. Even though I had accepted this theory for a long time, it was difficult to swallow now because my experience on Topamax had taught me two very important lessons: first, that my urges to binge were the real problem; and second, that self-improvement work wasn't necessary in order for me to stop binge eating.