By Julie Humphreys
Courtesy of Spokane Coeur d’Alene Living Magazine September 2012
At her worst, the pretty, dark haired young lady would throw up four or five times a day. After all, once she made the decision that it was going to be a “bad” day in her battle with an eating disorder she says she gave herself the green light to continue to eat large amounts of junk food and then vomit.
People with eating disorders, like bulimia, which is characterized by binging on and then purging food, use of diuretics and excessive exercise, or anorexia, in which one starves in a relentless pursuit to be thin, face similar mental struggles every day. Food— how much and when to eat it, how to limit or avoid it and how to get rid of it once ingested—consumes most of their day.
This particular woman in her twenties is real. She is from Spokane, Washington, and has battled anorexia and bulimia for 10 years. She doesn’t want to use her full name because she doesn’t want to be judged, and she’s worked hard to overcome the shame associated with her disorder. That shame is an overriding theme with the millions of people who have an eating disorder. Medical professionals in the field and sufferers themselves will tell you this disorder is just not accepted in society like other disorders, conditions and diseases, and it is still misunderstood.
We’ll call the young woman from Spokane, Christen. She is bright and beautiful but fragile from a decade of fighting herself mentally and from the physical toll of her disorder.
There are many medical complications that result from an eating disorder, including a slowed heart rate, abnormal heart rhythms, low blood pressure, poor circulation, constipation, diarrhea, muscle atrophy, amenorrhea (loss of menstrual periods), hair loss, swollen glands, cavities, teeth and kidney problems, and changes in brain structure. The list of mental issues associated with this disorder is also long. Eating disorders are classified as mental health disorders involving a psychiatric diagnoses.
Christen understands the psychiatric link now, looking back at how she felt as an adolescent, which is the time when the vast majority of people who will have an eating disorder develop it. Christen says she was chubby growing up and was teased for it. She went through a growth spurt and thinned out and it was the first time she got praise from boys. Her girlfriends stopped picking on her. She finally experienced good feelings about her body and about herself. But then she gained back some weight and with the pounds came the ridicule. At the same time, her parents divorced and Christen says her dad blamed her. Her self-image continued to spiral. She quickly found her own coping mechanism: eating whatever she wanted, and then throwing it up. And so the cycle began. Christen liked what she says was the rush of “getting away with it,” eating a lot of bad food with no consequences. Perhaps more important, she finally had control of something in her life.
But the cycle soon took its toll. After high school, Christen enrolled in college but couldn’t complete classes because depression and anxiety from her eating disorder took over. She says she couldn’t even deal with simple things in life like paying bills or studying; rather she would eat and purge. She felt alone and ashamed. Someone put her disorder in words that explained it so clearly: “From the inside looking out, you can’t explain it, and from the outside looking in, you can’t understand it.” Still, Christen had no answer to how to get out of her painful cycle. So she filled her life with more distractions, partying, dating and more binging. Her weight yo-yoed from 110 pounds to 160 pounds.
Christen hid her eating problem from everyone except her parents and her boyfriend. She says her parents wanted her to get better but were frustrated and didn’t know how to help. Eating disorder experts say positive family involvement is very important in the recovery of the person with the eating disorder.
On her own, Christen finally saw a doctor and shared her secret. The doctor referred Christen to a counselor but she felt the sessions weren’t helping and she quit going. Now, she knows that was just an excuse, she simply wasn’t ready for help. She wasn’t ready until a friend who also had an eating disorder and recognized the signs told Christen, “I know what you are going through and I know God wants to see you healed.” That was the first step in getting Christen into a six-month, intensive inpatient, Christian treatment center in California called Mercy. There she began to learn how to have a healthy relationship with food, and a healthy relationship with herself.
Christen has been back home for about a year now. While she says she conquered many of the mental demons of her eating disorder, she admits she is still struggling more than she anticipated. When stressed, Christen sometimes wants to, and sometimes does, go back to the familiar. She was paired with an accountability partner after treatment but experienced only limited success. She is now regularly seeing an eating disorder therapist and is hopeful of full recovery.
The key to recovery from an eating disorder, according to medical professionals is indeed, treatment. Dr. Ponrat Pakpreo is an adolescent medicine physician at Providence Sacred Heart Children’s Hospital who has specialized training to care for adolescents with eating disorders. She is one of a few providers in Spokane who care for patients suffering from eating disorders. She also works with local family practice residents to increase their awareness and medical knowledge on how to care for patients with eating disorders. Pakpreo says what has changed in eating disorder treatment is the multidisciplinary approach practitioners take today. Patients may see a doctor to get stabilized medically, a therapist for the psychological component, a dietitian to help with proper eating and nutrition, and also be involved in individual, group, and/or family therapy for support. That’s a lot of resources that cost a lot of money and not everyone can afford it. Just one reason, Pakpreo says why local practitioners are also working hard on awareness and prevention. There are increased efforts to talk to schoolchildren about healthy eating and body image.
The hard work of educating the public about eating disorders, treating patients and providing services is second only to the hard work for the person with the disorder. “People not affected with an eating disorder get the mindset of ‘why don’t you just eat?’. It’s not that easy,” Pakpreo says. “For the person with the eating disorder, it’s almost an abusive situation where they hear a voice saying ‘you don’t deserve to eat, you are fat, you are ugly, that has too many calories.’ That inner voice calls to them sometimes 24/7.”
Dee Myers, MS, is a Spokane therapist who specializes in eating disorders. She explains that while food and weight become the issue for people with eating disorders, and adds they are very real issues that have to be dealt with, they usually stem from other underlying issues. Some commonalities include low self-esteem, lack of a sense of self, history of trauma, and a need for control. Myers’ job and passion is to help the patient work through those issues and get control over their negative eating, starving or excessive exercise behaviors. “There are a lot of normal weight women who have eating disorders. So it’s not always about weight, but often it’s about the way they see themselves, not only their body image but who they are as person. Usually both are negative,” Myers says.
Alyson Hiebers’ parents may never fully know what underlying cause contributed to their daughter developing an eating disorder. But after mom Debbie read the journal Alyson wrote while in a treatment center, she has a better idea. Debbie relays, “In ninth grade some of Aly’s volleyball teammates went to a fast food place before a game and as teenagers do, stuffed themselves. Aly threw up afterwards and went on to have a great game where her coaches praised her performance. From then on she would equate binging and purging with success.” But Debbie and her husband John will not get all the answers now; Aly died three years ago this September, ten days after getting out of rehab for her eating disorder. She was only 22.
Through the indescribable pain of losing a child, the Hiebers have been able to speak out and take action to help other young people with eating disorders. Debbie says she knows Alyson would want that. She describes Aly as an accomplished athlete, a dedicated and loving friend to many, and an outgoing popular girl who loved to entertain. Debbie says Aly’s eating disorder began innocently but ultimately it took over her life. Debbie knew how ashamed Aly was of her bulimia. She began to shy away from friends and gatherings, too ashamed to let her friends know of her struggle. Eventually Aly reached out for help but Debbie was frustrated with what she saw as a lack of qualified health professionals in Spokane who could take new patients. For three moreyears Aly fought her disorder, finally going to a rehab clinic in Arizona. Debbie says there she got the help she desperately needed. What happened in those ten days back in Spokane after treatment, the Hiebers don’t know for sure. They only know Aly fought a hard battle with bulimia but in the end they say, the sad and lonely disorder took her life.
More than 800 people attended Alyson’s service. Debbie says afterwards six of Aly’s close friends admitted they too had struggled with an eating disorder. Debbie’s message is, “We have to make eating disorders acceptable, they are not uncommon, they are not shameful, no one chooses to have one. It’s an addictive disorder like drugs or alcohol.” Debbie says Alyson’s death has saved the lives of two of her friends who also suffered from eating disorders. They both went outside of Spokane for intensive help.
INCED offers hope
Bringing more help to Spokane prompted the Hiebers to host a memorial event for their daughter a year ago on the two-year anniversary of her death. The fundraiser brought in $30,000 dollars for an organization called INCED (Inland Northwest Coalition on Eating Disorders). The goal of INCED is to be a resource hub for those suffering from eating disorders in the Inland Northwest. The coalition strives to expand treatment resources, provide professional educational opportunities and increase awareness of eating disorders. The money raised at Alyson’s Memorial event is helping INCED meet those goals and expand them. Work is underway to bring an intensive outpatient treatment program to Spokane. For Alyson, Christen and countless others, it will be a much needed gift of hope and healing.
For more information about INCED, visit www.incedspokane.org
Julie Humphreys is a health reporter, and herself along with Dr. Ponrat Pakpreo are board members of Step UP and Go, a community effort to encourage you to be more physically active and to eat healthy. Visit http://www.stepupandgo.org for your free activity trackers and health information.