I need to deal with my eating disorder.
November 12, 2008 4:20 PM   Subscribe

I really need to get my eating disorder under control, and have no idea how to do it.

I've been dealing with bulimia for at least ten years, since I was in high school. I don't go on true binges very often any more, but I do overeat and then purge. It seems cyclical - I'll go for weeks eating normally, and then I'll suddenly go off into several purges a day for a week or two. I am an otherwise perfectly well-functioning adult with a stressful, somewhat high-profile job, a fulfilling life, and a loving, supportive boyfriend, friends, and family. I am not overweight, nor very skinny, and I think most people would consider me to be fairly well-adjusted. Nobody knows, though I'm sure my boyfriend has suspected on and off - it hasn't suddenly become worse or anything, but I'm just so sick of feeling so dependent on something, and going through ridiculous logistical contortions to keep doing it and to keep it a secret. I'm starting to feel crappier every time I do it, too - my tooth enamel is apparently very weak now, my heart races for an hour afterwards, my running (I'm trying to get back into distance running) is suffering, I think because I'm perpetually dehydrated.

Anyway, I don't know how to deal with this at all. I have been, with varying degrees of effort, trying to deal with it on my own for a long time - trying to change my outlook on food to fresh, whole, clean, nourishing - and then to the opposite side of the spectrum, to trying to think about it only as fuel and cut out all the sensual pleasure from it (I've always been a big food nerd/cook). I've been trying to apply the compulsion part of it to something healthier, and run about thirty miles a week. I don't even care if I lose weight or whatever any more - I just want to not feel weird every time I approach a table. But ten years of failure is probably long enough to conclude that I can't fix myself.

SO. I haven't been to the doctor in years, and never under my health care plan with my employer - I think I need to just pick a doctor and go in for a checkup anyway, but can I just tell him or her about it? Will they refer me to someone, I guess a therapist? I don't want anyone in my life to have to deal with this, is that going to be part of whatever happens once things are set in motion? It just seems really overwhelming, and I'm not sure where to start or what to expect.

Or are there alternatives I haven't considered? Books or groups or, I don't know, some excellent habit-breaking plan that worked for you? Anecdotes and advice are so, so welcome.

Thank you so much for your help.
posted by anonymous to Health & Fitness (20 answers total) 5 users marked this as a favorite
First off, congratulations for finally deciding to do something about it. Many people don't get this far.

I think that just going to your doctor will help. They may notice things automatically, but if they don't, you need to bring it up. They may then refer you to a therapist, a nutritionist or both, just to start with.

Just take it step-by-step. It doesn't all have to happen at once.

One thing you really need to watch for down the road is that you don't replace the binge/purge cycle with something else. Eating disorders are all about control, and you may find yourself exercising fanatically, counting every calorie (whether it slides into anorexia or not), obsessing over nutrition facts or organic foods or veganism, etc. Not to stay slim, mind you, but just to prove that you can control how your body acts. You've already seen that you're trying to replace the binging/purging compulsion with something else, so BE CAREFUL.
posted by Madamina at 4:29 PM on November 12, 2008

Talking to a therapist is a good start, as well as getting an overall checkup with your GP to assess what damage may have been done to your body that needs attention.

You don't want anyone in your life to have to "deal with it", but this is really a time to reach out. I was bulimic for awhile as well, and it definitely helped me to know that the people around me wanted me to stop hurting myself. Sure, I wanted to quit for myself---but having them to turn to when I was going through a lot of temptation, and knowing that they cared about how I was doing, really helped during those tough times.

The greatest success I've seen in myself and other friends with eating disorders is to overhaul how you view both the human body, attractiveness, fat, food, and exercise. You may want to mention the Health At Every Size movement to your therapist and tell them it is something you think would be beneficial to your recovery to look into at some point.

You are definitely doing the right thing and the hard thing here. Best of luck to you :-)
posted by lacedback at 4:39 PM on November 12, 2008

Therapy with a psychologist (you want to see PhD. or PsyD. after his/her name, not anything that starts with "M."). Don't be afraid to ask for a psychologist (not merely a "counselor") when you set up the appointment, and don't listen to any business about an "M" person being "specially trained" to deal with your eating disorder.

Also seconding the advice to have a GP check you out for physical damage.
posted by Rykey at 4:58 PM on November 12, 2008

Therapy, therapy, therapy. Yes, head to your general practitioner. Get a check-up and a referral. Go. Go regularly (once a week or more). And then perhaps be open with your boyfriend. A little love and support on the issue can go a long way. Plus there may be a way for him to hold you accountable or at least just check in on you without nagging or being scared. At the advice of her therapist, one of my nearest and dearest (former roommate, current friend) came to me after ten years of the exact same thing you've been going through and said: "I have an eating disorder. These are the circumstances (xyz) that trigger it. I am dealing with it. Please ask how I'm doing once a week. And please don't store sweets in the house." I can't imagine what you are going through, but I have supported my friend for ten years and she has been "clean" for five. I commend you for your acknowledgment of something that needs to change and for your willingness and desire to change it.

Best of luck to you.
posted by cachondeo45 at 5:24 PM on November 12, 2008 [1 favorite]

I have been ... trying to deal with it on my own for a long time

You're seeking outside help, which sounds like the right thing to do. It may be scary or overwhelming, but it's more likely to lead to good health than trying to deal with things solo.

Sure, tell your doctor. They should know what's going on with you. Telling them let's them talk more openly with you and know what things to look for regarding your general health. But your GP probably won't be able to do much for bulimia. They may refer you to a therapist or psychologist. You may want to jump to this step yourself, which is fine, but you should also see your regular doc for a checkup, just to take care of your general health.

I'd also recommend that you go to your dentist regularly, and take extra good care of your teeth. Specifically, if you're purging, rinse / brush afterwards to protect your tooth enamel. They may also want to do an intense fluoride treatment to help protect and strengthen your teeth.

I'd recommend that you try therapy and check out some local 12-step meetings for people with eating disorders. The latter are free, so if they don't work, you've lost nothing but time. If they do work, then all the better.

It sounds like you're starting down a good path. Good luck.
posted by zippy at 5:39 PM on November 12, 2008 [1 favorite]

There are a growing number of residential programs (30 to 180 days) that have been proved especially effective. These are typically medically supervised and covered by most insurances... it may seem a radical move, but the length of time you've been dealing with this may warrant some intense approaches. Eating disorders are tough, and you are especially bold and tough to recognize that it's time to change. Good luck.
posted by moonbird at 5:41 PM on November 12, 2008

You must be so tired, and feel so alone. This really stood out to me:

I don't want anyone in my life to have to deal with this, is that going to be part of whatever happens once things are set in motion?

If you're talking about your loved ones, they already are dealing with it. They just don't know what they're dealing with because you haven't been able to communicate with them. They can see the symptoms, but they don't know what's causing them.

It's like you have allergies, but you don't want to tell anyone that you have allergies. They can see the red eyes, all the used tissues, they know you're cranky and tired. They just don't know that it's being caused by allergies. So, they can see the symptoms, and they are affected by the symptoms, they just don't have a name for the disease.

So. First, I think you should talk to a therapist, and get advice from them about how best to communicate with your loved ones. Then I think you should let other people help you. It will lift so much weight off of your shoulders.

Best of luck.
posted by sondrialiac at 6:14 PM on November 12, 2008 [2 favorites]

You say it comes and goes. Keep a journal of how you feel every day. Notice your stress level, your happiness level, what you ate (do foods that are too sinful make you go bulimic??), and where you are in your menstrual cycle.

You might be able to figure out exactly when and why you relapse into purges.
posted by KateHasQuestions at 6:17 PM on November 12, 2008

I agree with the recommendations above to tell your doctor. I have a family member who is a licensed medical nutrition therapist (aka, a dietitian - sometimes licensed with a different title, depending on the state). Doctors refer clients with eating disorders and/or other diet-related issues to her. She does private counseling sessions with individual clients like you, usually keeping in touch with the referring doctor to track progress. She sometimes also works with a psychologist or psychiatrist if the client has one (or needs one). I know that not everyone ends up needing or seeing a dietitian, but I think they can be a helpful member of the team of professionals helping you. They've been trained specifically to help people with these sorts of issues, and have likely seen a lot of it.
posted by pril at 6:23 PM on November 12, 2008

It sounds like you need a team - both a doctor and a dentist to help with the physical damage that you have done to your body and therapist to help you figure out why you are doing this and how to build alternatives that really work for you. Maybe a nutritionist as well.

A specialist in eating disorders may be able to guide you to a group therapy where you can talk to other people who really understand because they are going through the same thing, as well as the individual therapy where you can really go into the personal stuff. (Ignore Rykey's comment about psychologist vs. master's level - you want someone who is experienced in eating disorders and who you feel like you, personally, can trust. In California that would be an MFT (marriage and family therapist), LCSW (licensed clinical social worker) or PsychD (psychologist).)

Assuming you do this on a outpatient basis, you can decide how and what to tell others and how you want them to help. For example, there was a posting above, where the friend said "I want you to ask me once a week how I am doing" This means the friend did not want to be asked five times a day, did want the poster to monitor the friend's food intake but just to show concern in a way that was helpful to the person needing it.
posted by metahawk at 6:31 PM on November 12, 2008

yeah, seek outside help. even if it's just a support group, it will be a good place hash out what wroks and what hasn't and why.

seconding the above recommendation to hook up with a dietitian--they do work with people with disordered eating all the time.
posted by thinkingwoman at 6:31 PM on November 12, 2008

I'm so glad you've reached out here. Even if you don't feel you've gotten a definitive answer, you've taken a huge and very important first step: you've admitted it to someone. When my best friend admitted her bulimia to me 15 years ago, it broke my heart. In retrospect I should've seen all the signs, and I felt terrible that she felt so alone for so long. I don't want you to feel alone too.

Now that you've taken this first step, try to put another foot in front of this one. Who would it be less scary to tell next: your boyfriend? A doctor? A friend?

You're at the age when you should be seeing a gynecologist every year, and a GYN can be your regular doctor and will likely encounter more eating disorders over the course of his/her practice (since the prevalence is much higher in women) and therefore have more experience at it than a GP.

I find the best way to find a new GYN is to ask all my female friends and coworkers for recommendations. Make an appointment on the premise of needing a pap smear. (You actually do.) But while you're filling out the forms in the waiting room first, what if you went ahead and checked off the box that said "eating disorder"? That would save you from having to broach the subject with words in the exam room. The doctor would likely ask you to elaborate, and that would be your opening. Talk about it like you're talking about it here: that you want to kick it, that you're looking for strategies. You'll likely get a referral.

If you prefer to find a psychologist yourself to begin therapy (and you do need to be talking to someone in a therapeutic relationship to help deal with your compulsion), every state has a state psychological association. Most of those have online lists of member psychologists listed by name, gender, location, specialty, and sometimes hours. It would be great if you could find one of those close to you, make an appointment, and keep it.

I wish you the best of luck. Take the next step! You can do it.
posted by ImproviseOrDie at 6:39 PM on November 12, 2008

An ex-girlfriend benefitted a great deal from a stay at a clinic, and has faithfully continued her therapy (drugs + counseling). She is well within the healthy BMI range now, and (last I checked) continuing her path to a better & better life.

It's not a short road, but not trying to help yourself is the only way you can fail. Kudos for you, for starting the journey.

Now, go find a psychologist/psychiatrist who specializes in ED. And best of luck, dear one.
posted by IAmBroom at 6:44 PM on November 12, 2008

Ignore Rykey's comment about psychologist vs. master's level - you want someone who is experienced in eating disorders

I should clarify-- find a psychologist who is experienced in eating disorders. But please don't ignore my advice about master's level counselors versus PhDs and PsyDs.
posted by Rykey at 7:19 PM on November 12, 2008

I know from a relative who's a therapist (but not your therapist) with experience treating ED that cognitive-behavioral therapy is the treatment of choice; but that it may be hard to find a good CBT practitioner where you are. Christopher Fairburn's Overcoming Binge Eating, despite the title, is relevant to both binge eating disorder (BED) and bulimia, and is highly research-tested. Finally, for $20/mo. you can make use of the programs at MySelfHelp.com, which are also empirically supported. For people with a lot of self-discipline, the books and websites can be effective (though in practice most people do better with a therapist coaching them through it perhaps in conjunction with the book.)
posted by escabeche at 8:10 PM on November 12, 2008

Congratulations on facing your problems.

One of the best ways to deal with things like this is to modify the AA mantra of One Day At A Time. Just decide that today you won't binge or purge. Just today. Tomorrow will take care of itself. Think about today. Or this afternoon, or the next hour, or even just the next five minutes. Baby steps are key. And--this is the most important point--if you slipped up at lunch, so what? You slipped up. People make mistakes. So tonight, you won't binge or purge. And tomorrow will take care of itself.

Also therapy of course, but sometimes it can take a while to find the right therapist--or any therapist. Making decisions for today is something you can start doing right now.

Best of luck.
posted by dirtynumbangelboy at 8:53 PM on November 12, 2008 [1 favorite]

Do not keep anything you can easily vomit in your house or that are triggers for you. Only eat those foods in front of others, if you must, and preferably in public, where vomiting is really difficult. Do not purchase your binge foods. Sugar was my trigger; I try to keep only jam and honey in the house most of the time.

Be careful with your portions. Don't comfort eat.

CBT helped me; what genuinely makes me repulsed at the thought of ever doing it again was the damage to my teeth. My teeth are damaged more severely, it seems, every year and I have been in recovery for almost a decade. I didn't do it as long as you have. Realize that what you do will affect you for the rest of your life, physically and mentally.

Self-hypnosis can help you control any food-related panic attacks. Be careful with overexercising; you can end up with lots of physical problems from it, especially your knees and joints.
posted by Unicorn on the cob at 9:22 PM on November 12, 2008

This worked for me.

1: See a doctor and get some bloodwork done so you can correct any deficiencies (you're sure to have some.) It's difficult to control the wild appetite if you're not somewhat nutritionally stable.

2: Then see a nutritionist/dietician - they'll help you.

3: Are you on birth control? After years and years I finally figured out my binge-purge cycle followed a pretty predictable pattern. The first two weeks of each month, I was fine. The next two weeks, my appetite would go nuts. I had a hunch it was rising levels of progesterone - my doctor agreed. I tried one brand; it was TERRIBLE, made me worse - then tried another (Yaz) which is fantastic. My appetite remains constant for the whole month now. It's still not easy, mind you - but it's good to know what my baseline is because it sucks having coping mechanisms that only work for half of every month.
posted by nomnomnom at 9:57 PM on November 12, 2008

i'd like to disagree with this comment: I should clarify-- find a psychologist who is experienced in eating disorders. But please don't ignore my advice about master's level counselors versus PhDs and PsyDs.

I can definnitely agree that you need someone with a high level of experience and sensitivity. however, i see a practitioner whose credentials start with "M" and he's the only one who's ever even thought to ask me about the possibilities of an eating disorder. i would qualify myself as have subclinical issues in this domain, but my therapist is the first person who hasn't scared me off from discussing them in general. and i've made a lot of progress because of him. just sayin'
posted by Soulbee at 11:08 AM on November 13, 2008

Some people find Overeaters Anonymous a lifesaver. A great thing about OA is the strong support network and the relief of finding the companionship of people who truly understand what it's like to have an eating disorder. On the other hand, some people find the 'disease' message disempowering and the members too cliquey.

Regardless of whether you ultimately stick with it, going to a meeting can be a valuable step in facing up to the true extent of the problem (as was the act of posting your question!) and meeting people who have in many cases made a significant recovery from eating disorders. The emphasis on spiritual and mental health as well as physical health that you find in 12 step groups can also be a complete revelation. A couple of years ago, at the point where I had read every damn book I could find, been to several psychologists, all kinds of diet groups, and just felt completely despairing about my ability to ever eat normally again, OA's support and the friendship I found there helped me enormously. For that I will always be grateful.

Christopher Fairburn's book has already been recommended and I second that. Also, Gillian Riley's "Eating Less" is fantastic.

I can't say that one thing in particular helped me to recover from my eating disorder. It was really the accumulated combination of a lot of different strategies over a period of several years, and various changes in my circumstances, values and attitudes to reach a place where sooner or later, inexplicably, I just gradually began to feel and act 'normally' around food again. Occasionally I still exhibit addictive behaviour to food, drugs, shopping, etc (like a lot of people I guess!)... but it's just a million times better than it was and I certainly would no longer classify myself as a bulimic.

Try everything you can and don't give up. Just keep trying and if something doesn't work, try again or try something else! I also had "nearly ten years of failure" in dealing with my eating disorder, and it was a very lonely, demoralising and exhausting journey. Even while, like yourself, other things in my life were going really well, and people might never have guessed the painful internal struggle that was going on every single day from the moment I woke up. Remember that you are not alone, there are so many people out there like yourself, and whatever your negative thoughts might tell you, RECOVERY IS POSSIBLE and I know what it feels like. It's like coming out of a shadow and into the sun.

Good luck my friend.
posted by Weng at 5:04 PM on November 14, 2008

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