does therapy work?

January 27, 2006 8:20 PM

What can I expect from going to see someone about my bulimia? Much more inside.

For the past four years just about, I’ve suffered from on-and-off (mostly on) bulimia of varying degrees of severity (anything from periods where I’d go 2-7 days without an incident, to successive daily 3+ purging periods). I’m in the demographic that is generally associated with eating disorders (18, female, college student) so I would imagine that most people who treat eating disorders are used to seeing similar cases. I read this post [http://ask.metafilter.com/mefi/27332], and some of the advice was helpful but my situation has some differences.

For one, what I really want to know is what to expect from getting treatment. My parents, extended family, and all of my friends (except for the two that finally convinced me that I should seek help) have no idea that this is an issue for me (in fact, I suspect I come off as one of the better-adjusted people they know with regard to self-image, and I try hard to appear utterly unconcerned) so I can’t count on them for any sort of support (although I don’t know- will I be needing it?). I’m still not at the point where I am really embracing the idea of being treated for several reasons- one is that I really can’t imagine life without it and it seems almost impossible that I could ever overcome this. The other is that I always convince myself, after I haven’t purged in a while, that I’ll be fine on my own. Unlike the other poster, the longer I go without purging the less likely I am to do so again, because once I slip up once and do it I can easily spiral into weeks of daily episodes.

It’s only of late that I’ve come to realize though that despite all my best efforts to both prevent incidents and determine what causes them, I really can’t seem to do anything sufficiently effective to help me stop. Every time it happens, and especially when it’s just one of many episodes, I realize how much I hate it and hate doing it, and how terrible it makes me feel. It’s been expensive, harmful, disgusting, and has at times even caused me to gain weight (truly, insult to injury). Even though it feels like a fundamental, if malignant, part of me, I know I can’t go on like this. To that end, I finally (with much assistance from the two friends) made a call to my very small college’s health center and set up an appointment with one of the counselors. I suspect that once I tell them that my issue is bulimia, they’d refer me to someone in town who specializes in treatment- the whole process seems dauntingly complicated, so is there anything else I should consider? What has helped you, or what did you do that helped someone else with a similar issue? I’m very much on a budget and I’m not sure yet what exactly my insurance covers (not very much, I suspect), so that limits my options considerably.

I’m probably leaving a lot of stuff out but you can email me at [e-mail]

Thanks in advance!

posted by anonymous to health & fitness (13 comments total)

Man oh man. First off, hang in there, this is a tough fight, and you've got all sorts of friends, family, and crazy Internet people rooting for you.

I'm very close to a girl who was having this problem, and I understand where you are right now. You sound like an intelligent person trying to understand or control your irrational actions. A therapist may or may not be able to help, a good therapist will almost certainly be helpful.

A tip from my own experience: if there's somebody in your life, be it a boyfriend, friend, relative, etc... who is triggering these attacks, you need to reason out how they have this control over you, and whether you are going to continue letting them do this.
posted by onalark at 8:44 PM on January 27, 2006

Don't think your family/friends won't be supportive.

Being 'well adjusted', doens't mean you're perfect. If you're as nice as you sound, they'll love to be there for you. And you're likely covered by your parents healthcare till your in your 20s.
posted by filmgeek at 9:00 PM on January 27, 2006

a) Expect to talk to someone who is caring, intelligent, insightful, and solicitous of your thoughts and feelings.

b) Expect to be medicated, possibly with an SSRI.

c) Expect the treatment to work, the unpleasant compulsive feelings and activities to stop, and your quality of life to improve immeasurably.

I wish you well.
posted by ikkyu2 at 9:42 PM on January 27, 2006

I have no experience with bulimia treatment (though I did once date someone who purged occasionally), but you should be aware that any time you sit down with a shrink, one of the first questions they're going to ask you is whether you have thoughts of suicide, have plans to kill yourself, etc. If you do look like a suicide risk or there's reason to think you'll harm yourself or others, they can and will put you in a mental institution. Now, I'm not sure exactly what the standard is. I mean, if you say "Hey, I've got two hundred valiums and I can't wait to take them all at once with a triple shot of Draino." you'll be in the booby hatch before you can say "Sigmund Freud." But if you tell them that you periodically go on purging binges for a week at a time to the point that you pass out from low blood sugar... well, obviously that's harmful. But whether it's harmful enough to justify committing you, I don't know.

In all the accounts of institutionalization I've read/heard, most patients seem to be schizophrenic or severely depressed or delusional in some way. My general impression is that most bulimics don't end up in mental hospitals. But I've certainly not made a close study of such things.
posted by Clay201 at 10:17 PM on January 27, 2006

I highly doubt that a "highly functional" (for lack of a better term) person with an eating disorder will be sent to "the booby hatch." Where the hell did that come from, Clay? WTF?

Ignore him.

You are on the right track. Seeking treatment and actually recognizing that this is a real problem is a good portion of the battle. Your health center will either have counselors to talk with you or they will refer you, so in that you are correct. I went to a very small school as welll, and the psychologists there treated people with pretty severe depression, so eating disorder may or may not be out of the ballpark for your heath center's people -- don't be surprised if you get treatment on campus, don't be surprised if you don't.

Now, I wouldn't say that you should seek treatment outside of psychiatric care, but depending on how you feel about the whole process, you may want to talk with a counselor as well. I went through a rough patch with a different type of self-destructive behavior, and the time I spent with a counselor was really great. It's different than a psychologist -- they'll still want to make sure you're not going to hurt yourself, but . . . . I don' t know, it felt less clinical to me and I was for some reason able to talk about a lot more wiht my counselor than I would have been with a psychologist. It's a thought. It's sort of like having a very well qualified best friend. It was good for me. It may be the sort of relationship you would want to have outside and beyond any eating-disorder specific sessions with an actual shrink.

Good luck. You're on the right track.
posted by Medieval Maven at 10:28 PM on January 27, 2006

Call your local Overeaters Anonymous and find out which meetings are geared to bulimics/anorexics.
posted by brujita at 10:42 PM on January 27, 2006

I highly doubt that a "highly functional" (for lack of a better term) person with an eating disorder will be sent to "the booby hatch."

I would, likewise, be pretty surprised if that happened. In fact, in my post, I said: My general impression is that most bulimics don't end up in mental hospitals..

I brought up the issue for several reasons:

1. We don't necessarily know all the details of Anon's situation. She might have - for any number of reasons - left some information out of her post.

2. Even if she doesn't need to know this particular fact, other bulimics will, hopefully, be reading this thread and they may benefit from the information. As Anon points out, female college students are, demographically speaking, more likely to be bulimic. I'm guessing that they're also, demographically speaking, a bit more likely to lurk on AskMefi.

3. Anyone planning to see a Psych professional should know about this in advance. In my opinion, there ought to be a miranda warning issued when you first call for the appointment.

4. Anon asked, specifically, what she should expect. Well, this is one of the things she should expect; an effort on the part of the shrink to determine whether she's a threat to herself or others.

5. Operating under the golden rule... If I were in her situation, I'd want someone to fill me in on this.
posted by Clay201 at 10:59 PM on January 27, 2006

I feel you, anon. I went through a similar thing at your age, and it's a bitch to sort out, but you will. You're on the right track and should most definitely seek professional help. Here's a little advice about that:

First of all, you're obviously a very intelligent and self-aware young woman. This can actually make it harder to find a therapist who can really help you, because you will require somebody both intelligent and empathic who can respect your capacity to understand and confront your problem. In my experience, therapists are like most other professionals -- nine out of ten are just doing their job. You need someone who is talented and passionate about their work. So if you don't feel comfortable with the first or the second or the fifth person you see, keep looking. The right shrink is going to be your best ally, and the wrong one may only confuse your issue further. Eating disorders can be insidious because they are by nature manipulative on many levels. They force you to decieve the people around you, and even to lie to yourself. If you're able to fool your therapist, you'll be tempted to. So look for someone who can cut through all of that stuff in a supportive way.

Second, meds are a great tool and can provide a real jump-start for your recovery, but they are not always necessary. If a psychiatrist suggests that you take an anti-depressant for a while and you don't have any deep aversion to it, I say go for it. When I recovered from my eating issues, I insisted on doing it without the meds and was able to, but in retrospect (and from seeing friends go through similar situations) I think I just made the process harder than it had to be. An anti-depressant will relieve some of your more urgent compulsions and allow you to tackle the underlying issues in therapy. Also, don't be put off by the term "anti-depressant". Even if you don't feel like depression is your problem, these drugs will help with bulimia. SSRIs like Zoloft work wonders to alleviate obsessive thought patterns (like when you're fixed on the idea of binging) and anxiety (like the kind that comes from resisting the desire to purge). But I recommend that even if you use meds and they help you, you should also be in some kind of talk therapy for a while. Usually an eating disorder is a symptom of some large unresolved chaos boiling under the surface, and if you don't start working on that thing it can pop up in other forms later, like other compulsive or addictive behaviors. You're young, and you might as well get a head start on figuring out your complexities now.

And finally, time will be your best friend. You are at an age right now that is beautiful but utterly exhausting and confusing. Not even the smartest gal gets through the life phase you're in unscathed. Surround yourself with good people and learn your lessons well, and in a few years everything will make a lot more sense.

Oh, and I wish that I could help you on the insurance/money issue, but that's always a tough one. Could you tell your parents that you're going through some emotional issues and let them help you foot the bills? Another thing is that most insurance policies will provide for mental health treatment, but it can be a windy road to get your coverage and your folks might be more adept at handling that stuff. You could go on the website for your insurance company and look for providers in your area. But it sounds like you've got enough on your plate as it is, and your job right now is to focus on recovery, not to spend hours dealing with your insurance company. Everybody's got problems, there's no shame in asking for a little support from your family. Even if they won't get it or they're nuts or you're embarassed, that's what parents are there for -- to be nuts and to help you when you need it.

Best of luck, I'll be rooting for you!
posted by wetpaint at 2:39 AM on January 28, 2006

One other thing -- there seems to be a lot of different information in this thread regarding whether you should see a psychiatrist,a counselor, a psychologist, etc.

A psychiatrist will prescribe medication for you if you need/want it, and will probably not do a lot of therapy aside from medication management sessions, where they'll check in to see how your meds are affecting you. Some psychiatrists do therapy, but many don't, and the ones that do often take a more clinical approach to it that may not suit your needs.

You should probably start by looking for a therapist. This can be a certified social worker, a psychologist, a psychotherapist, a mental health counselor -- there are many different titles for a person who does therapy, based on their education and certification. In my experience, these titles don't tell you much about their approach to therapy. When you call to make an appointment, you can ask if they have experience in treating eating disorders and if they've done any postgraduate work in that particular area. Then after you find a therapist with whom you feel comfortable, you can discuss with them whether they think that a psychiatric evaluation would be appropriate if you are interested in taking meds. The therapist can refer you to a psychiatrist who will prescribe medication. Chances are that if you feel good about your therapist, they'll refer you to a good psychiatrist. And with two mental health pros on your team, you can't lose :)
posted by wetpaint at 2:55 AM on January 28, 2006

As someone who has stood with many friends as they struggled with eating disorders, I want to let you know that things will eventually get better.

First off, I'd ignore Clay201's remarks... don't get me wrong, read them through, then disregard them. Bulemia is something that you must deal with head on. Whatever type of professional you speak with (I'll use the generic term counselor), tell them every detail of what you are going through.... I can't help but have a wry smile on my face when I suggest to my friends that they think of this as the GOOD type of purging. If you've been having suicidal thoughts, be very specific when talking about them, so that your counselor is able to accurately comprehend what you're going through. It isn't wrong to have the thoughts, think of them as a symptom of what you're going through, you can't pretend they aren't there, but there's a good chance they'll abate once you get your mind wrapped around your current situation.

As for what to expect? If you are upfront and dont attempt to hide what is going on with your counselor, they'll utterly respect your wishes, as long as you aren't an IMMEDIATE threat to yourself. I have never known anyone that walked into a doctor's appt. of their own free will that didn't get to make every decision (about staying or not staying as an inpatient), even when they admitted to suicidal thoughts.

Your family and friends will be a huge asset. I know it is hard to admit that you aren't the person they may see you as, but it truly is a wonderful experience (in retrospect, at least), to take that leap and trust people with who you really are, including all of your faults. You may have family members that like to fix things, my mom was such, and their initial reaction may be along the lines of the Spanish Inquisition.
Don't Fret... if you don't have answers to their questions, don't try to make up things that relieve them of responsibility (like "Don't worry mom, it wasn't anything you did"...)... just explain that the whole reason you're seeing a counselor is to get an outside perspective to help find the answers you need. I'm sure you already have a decent idea about your daily triggers and initial trigger, but talk it all out with the counselor.

And like WetPaint said, medicines can make the whole journey much smoother. They don't "fix" any problems, but they do help lift the fog so that you can really concentrate on whats going on inside your head.

I'll make an assumption, and just ignore this if it doesn't fit.... I'm guessing that your relationships with friends, family and any type of significant other are almost always under your close scrutiny. I can tell that you're very concerned with appearing unconcerned, and it takes a great bit of analyzing friend's reactions to things you say to figure out what the best thing to say to your friends would be. Telling the people you love about this is very important. However, you need to turn off the analyzing part of your mind when you tell them. Many people have had very bad experiences with people getting out of control with eating disorders. If the person you are talking to doesn't believe you, or seems to pull back from you, you need to stand your ground, assure them that you're doing what is best for you, and that while you might not be comfortable talking about everything, you'll get there eventually, and you'll share as much as you can. People's reactions may be entirely unexpected, but you need to realize that this is 100% their own experiences with bulemia/bulemics, and nothing to do with you. Once they can separate you from any negative ideas, they'll go back to status quo.

Wow... that was probably entirely too long... know that my heart aches for what you've gone through, and is overjoyed in knowing that you've already made the most difficult decisions. If you have any questions, feel free to email me @ the email on my profile.
posted by hatsix at 4:19 AM on January 28, 2006

One thing that struck me about your post is that you've obviously done a lot of research into bulimia. Maybe you even know as much about it, or more, than the average health professional. You state that when you see a counsellor, you intend to "tell them that [your] issue is bulimia" rather than merely presenting a list of symptoms as the average person does.

Be careful with this. I speak as someone with an equally "obvious" condition - transsexualism - who reached the same decision to seek medical treatment at around the same age as you did. Although your goal is simply to get well whereas mine was the more contentious goal of gender reassignment, I do think that when you have a clearly classified condition it's easy to label all the things troubling you as a symptom of that condition, rather than considering other possible causes.

In my case, I presented an almost classic case of female-to-male transsexualism to a general practitioner and got sent to see the only psychiatrists specialising in gender dysphoria in my town at the time - much as you assume you'd get sent to an eating disorder specialist. The shrinks had seen just about every tranny in the city and as wetpaint comments, they were a lot more interested in fitting me into the DSM IV definition of transsexualism than how I functioned, or failed to, as a human being. I was recommended for gender reassignment with very little consideration for how I was actually going to function as a man when I was so depressed - everyone (including myself) assumed that would just go away somehow. As it was, I became so depressed & anxious I just couldn't see the point of starting hormone therapy, & I drifted away from medical help altogether at a time when it might have really benefitted me.

A few years later, the transsexualism hadn't gone away (it generally doesn't) & I was still struggling with depression. Fortunately, by this time the shrinks I saw previously had moved on & I got to see a new psychiatrist who was a lot more interested in helping people, rather than just diagnosing disorders. He saw my depression as something that needed to be treated separately from my gender issues, referred me to a psychologist for cognitive behaviour therapy, and continued to see me long after I'd transitioned as male. I'm certain if he hadn't taken this holistic approach, I would have failed in my attempt to live as male for a second time.

Not sure how helpful this will be to you, but the wording of your question just reminded me that sometimes I think one can be too accurate with self-diagnostics. I hope you find someone who will see you as a person and not just a walking case study.
posted by hgws at 8:26 AM on January 28, 2006

I have never known anyone that walked into a doctor's appt. of their own free will that didn't get to make every decision (about staying or not staying as an inpatient), even when they admitted to suicidal thoughts.

Unfortunately, I do know people who've shown up for a scheduled doctor's appointment, admitted to thoughts of suicide, and been involuntarily committed.

Doctors and head shrinking professionals can and do involuntarily commit people who they consider a threat to themselves or others. Anyone going to see a shrink should be aware of this.
posted by Clay201 at 9:23 AM on January 28, 2006

I second brujita - check out Overeaters Anonymous. Even if you don't find support groups helpful, the literature is really good. Also, I really recommend a therapist that specializes in eating disorders if you can afford it. Not all general therapists have the knowledge or experience to help with eating disorders. The first therapist I went to insanely recommended that I join Weight Watchers (that was her answer to an eating disorder issue).

I struggled for years with "occasional" bulimia and even though I'm not struggling with that particular form of eating disorder now, I still have pretty severe issues with body image and food in general. It's not easy, but then again, I don't want to die of esophogeal cancer or something crazy like that.

Also, onalark said "this is a tough fight, and you've got all sorts of friends, family, and crazy Internet people rooting for you." Not to be overly negative, but I recommend OA or support groups in general because not everyone in your immediate circle is going to necessarily be consciously supportive - even if they think they are. I think people often know subconsciously what is going on and people sometimes get frightened of their friends/loved ones changing, even if the change is a healing process. You might see some acting out on a subconscious level. Hopefully you will be lucky and not experience this.

Good luck with this.
posted by gt at 10:03 AM on January 28, 2006