Eating Disorder Forum

I found this transcript of an online conference about eating disorders to be interesting and helpful. The guest was "Aimee Liu, author of the bestseller: "Gaining: The Truth About Life After Eating Disorders." Ms. Liu suffered from severe anorexia as a teen, thought she had recovered, then faced a severe relapse in her 40s. Now she says "I’m fully recovered.""

Here are some of the parts I found most insightful and personally helpful.

Natalie: So our audience members understand, Aimee – when you were 19, how did you get to the point in your mind where you said “I really need help.”

Aimee Liu: In 1973, I reached what psychologist Sheila Reindl calls the “limit of distress.” That summer, following my sophomore year at Yale, I had designed my life to accommodate the demands of anorexia. I’d broken up with my boyfriend, pushed my friends and family away. As a painting major, I argued that I needed the summer to be alone and paint.
I earned money working in a room by myself, matting prints for the Yale Art gallery. I house sat for vacationing faculty. And I painted in the otherwise empty undergraduate art studio. I ate less than minimally and walked miles back and forth to the studio every day.
One very hot evening in August, I reached the center of campus and noticed that I was all alone. Everyone else in the university, it seemed, was away on vacation. The whole city seemed to have emptied to escape the heat. I felt a crippling wave of loneliness, and it dawned on me that I had done this to myself, that the compulsion to avoid food and keep losing weight was making me unbearably miserable.

Although I didn’t consciously connect the dots, emotionally I sensed that what I was avoiding was not really food but human contact; what I was so desperately afraid of was not weight but the risk of exposing myself to others – and yet what I most craved was human contact and intimacy. So I was denying myself what I most desperately wanted and needed.
It was a very, very distinct sensation and a very particular moment in my memory, and I’ve since learned that most people who recover can recall a specific turning point like this when they DECIDE they have to change. What’s critical to understand, though, is that this turning point is only the beginning of a very long and variable process of recovery.
Natalie: What kind of help did you initially get for the eating disorder?
Aimee Liu: In 1973, I had never heard of anorexia or eating disorders, even though I’d been watching many of my classmates starving, bingeing, and purging since junior high school.
One of my high school classmates had been hospitalized -- but she’d returned with her face bloated from drugs, and no one ever mentioned what was wrong with her or what had been done to her in treatment. Another girl in a class behind me died from anorexia while I was in college. Still, no one named the problem, and when I did approach the doctors at the university, they ran me through a battery of tests and informed me that I “should gain a little weight.” And although I’d daydreamed in high school about talking to a therapist, my family would not hear of this. So when I reached my turning point, it did not occur to me to seek professional help. Instead, I tried to think of the happiest, healthiest people I knew who would not judge or reject me for seeking their company.

Over the next two years, I watched these “normal” friends eat and party and talk, and I tried to imitate them, spending less time by myself, seeking out people who made me feel good and accepted. Two months after that summer turning point, I fell in love with a grad student who was so exuberant, so joyful, that I learned what it means to revel in life. He eventually broke my heart and I crashed hard, but in the meantime I’d learned enough from him to avoid sinking all the way back into anorexia. Instead, I became bulimic for several years. I wrote Solitaire as I was phasing out of bulimia – still on my own, with no therapy.

Natalie: And at that time, we’re talking about the early 1980’s, did you feel confident that you had beat this thing?

Aimee Liu: When Solitaire was published in 1979, I was 25, and I did think I was cured. As many people I’ve interviewed have found, it is enormously therapeutic to write out one’s entire life story, to tell the whole truth in one’s own words, and to see the connections between things that others have done to us and the behaviors that so often crop up in response, as well as the choices we make to excuse or cover up those events and behaviors.

But as important as it is to make sense of one’s past, the bigger challenge is to adjust one’s present choices and to develop the strength of identity and the skills to move forward. I’m talking about genuine self-awareness. And what I couldn’t admit at the end of Solitaire was that this level of self-awareness still eluded me. I was still faking a lot of my confidence, still trying on and throwing off different roles and jobs and relationships in an attempt to find one that would tell me who I was. What I did not realize until many years later, when I wrote GAINING, was that I was still restricting, bingeing, and purging – but I was doing it with sex, work, friends, alcohol, and exercise, instead of with food.

This persistent tendency to punish oneself and inflict suffering on one’s body for feeling imperfect in life…this is what I now call the half-life of eating disorders.

Natalie: Aimee, you reach your 40s, and bam!, here comes the anorexia again. Was getting to the point of saying “I need help” harder this time around than the first time? If so, why? Or why not?

Aimee Liu: I do not think it’s an accident that anorexia struck again when I separated from my husband after 20 years together. It did not strike when our marital struggles began a year earlier. It did not strike when we began therapy. It struck when I found myself alone with myself and realized I still had no idea who I was!
T
his, I’ve since learned, is exceedingly common among people with only partially resolved histories of eating disorders – who have been leaning on a spouse or partner to supply or prop up their sense of self. What was crucially different for me this time around was the therapist my husband and I were already seeing. He was not an eating disorder specialist, but he was a tremendously empathic and wise individual who refused to indulge me when I joked about the “benefits of the divorce diet.”

At his insistence, I stepped back and learned to observe what I was doing without judging or denying it. I learned to be interested in my actions and feelings instead of running from them. Fortunately, I had not lost a great deal of weight and was nowhere near a dangerously low weight, so my brain was in good shape to cooperate with my mind in this process. I was in psychological but not physical distress, and that made it much, much easier to commit to therapy. I realized just how much of my life had been short-changed by my failure to enter therapy when I was in my teens. Better late than never!

Natalie: Just so we’re all on the same page, how are you defining “recovery” from an eating disorder?

Aimee Liu: I call my book GAINING because I really do think that the ability – eagerness, even – to “gain” in all areas of life is a good definition of recovery. Note that I say gaining in “life” because I think that eating disorders are seated in core anxieties over what it means to be alive. Someone who is fully recovered embraces genuine (as opposed to superficial) gains in confidence, trust, intimacy, personal power, perspective, insight, faith, joy, nourishment, health, peace, love, and pleasures of the body and mind. Crucially, she makes choices in life out of desire, passion, compassion, and love instead of fear. She does not confuse perfection with suffering, nor does she feel she must measure up to some external standard of perfection.

Natalie: Since the mind can play tricks on you, how does one know if they’ve truly recovered?

Aimee Liu: There are so many signs!
- Can you sit quietly with yourself and be at peace?
- Can you face a significant problem or decision or experience stress without obsessing about your body or what you’ve just eaten or are planning to eat?
- Do you exercise because you honestly enjoy the activity – and not because you’ll feel “guilty” if you don’t?
- Can you look at your body with appreciation for all that it does, and not berate yourself for how it looks?
- Can you be open and intimate with those you love, without worrying about how they’ll judge you?
- Can you enter an argument without feeling that you either have to dominate or disappear?
- Are you able to joke about your human failings and your flaws without secretly feeling ashamed of them?

Natalie: One audience member asked this question Aimee: Many of us are told that recovery is an "ongoing process" that never ends. Yet, you speak about having fully recovered as "being cured." Do you see it that way?

Aimee Liu: What never ends are the temperament traits that make us vulnerable to eating disorders. Scientists liken an eating disorder to a gun.
Genetics, which account for around 60% of one’s vulnerability, manufacture the gun;
Environment, which includes family dynamics, fashion magazines, social and cultural attitudes, loads the gun; and
The personal experience of unbearable distress pulls the trigger.
Genetics combine with family dynamics to create the personality types that are most at risk. We have these personalities as long as we live, but once we learn to re-direct our core traits -- perfectionism, hyper-sensitivity, persistence -- to goals and values that have genuine meaning TO US... then we become protected against the eating disorder.
Many of us start to relapse instinctively under intense stress, but if we know this tendency is there -- and that it's a natural attempt to cope -- we can redirect the instinct . It helps to develop an arsenal of positive, constructive coping mechanisms -- true friends, passions, interests, music, etc -- that can help us through the bad times. These are "life skills" that will help anyone; we just need to work harder to learn them!

Natalie: You interviewed 40 people, women and men, who you knew from your youth. One of the things that really struck me, was the common theme of “shame” that each felt. Shame that they had an eating disorder. Shame that they shied away from intimacy or had a compulsion to be perfect. Could you talk about that?

Aimee Liu: In general, I’ve found, an eating disorder is a response to shame. In other words, the shame comes first. The shame is in the body and mind before the eating becomes disordered. So the shame that may develop about the eating disorder is usually an extension of distress that runs much deeper. People need to understand that an eating disorder is a coping mechanism. No one chooses to become anorexic or bulimic. It’s that experience of unbearable distress that triggers the obsession with body and food as an escape or distraction or attempt to reconcile pressures that cannot be reconciled. Usually that unbearable distress involves shame.
Several of the people I interviewed had, like me, been molested as children. Others had been sent to fat farms as children and told by their parents that no one would love them if they didn’t lose weight. Others had struggled since childhood with shame over their sexuality. Some had been shamed by parents because they did not sufficiently mirror the parents’ values or appearance.

The persistence of an eating disorder is a signal that the underlying shame is still driving one’s thoughts and behavior. And of course, because this group is perfectionistic, any residual problems are seen as imperfections and thus a source of further shame! That cycle can be broken, however, if we treat eating disorders as natural signals, instead of as character flaws.

Natalie: From guests we interview during our monthly chats, it’s not uncommon to hear “don’t give up hope. There’s reason for hope.” When it comes to having anorexia or bulimia, why should anyone believe that?

Aimee Liu: The best evidence comes from neuroscience, and it’s not remotely trite. The brain has an almost miraculous ability to change, and researchers are finding that we hold the keys to that change within our minds. I have met many, many gifted therapists who have helped people who have been sick for decades. Therapies such as dialectic behavior training (DBT), equine therapy, the Maudsley Method, and mindful awareness practices are showing tremendously promising results. But the brain cannot rewire itself over night or, in most cases, without a good therapist. And no one can “cure” someone who is unwilling to change. An eating disorder masquerades as an identity and it offers a compelling illusion of escape and comfort. You have to be willing to give up that illusion and take the risk of developing a healthy identity – as long as that takes. One of the obstacles to recovery I hear over and over is the notion that there is a moment when one is “recovered.” Recovery is not a grade, or a state, or a status to be attained – it is an ongoing process that begins from the turning point when you decide you have simply had enough.

A young woman who wrote to me recently described this process best: “We have trained ourselves to empower our minds/bodies to restrict the foods, now we have to use that same power to re-feed ourselves. In other words, the reason we develop these disorders in most cases is to have power, and what we need to do instead of complaining or saying we can't, is just training the power to be used in a different way.” That way leads to life instead of loss, love instead of isolation, self-direction instead of self-denial, and hope instead of shame. It’s all part of the process not just of recovery but of being fully human.