You are not alone.

I understand completely how you feel. I was anorexic at age 12-14 and then became bulimic and have lived with this ‘controlling’ disease for over 24 years. I, like you, am intelligent and energetic, once with a strong willpower but completely helpless to this disease. For years and years I have wanted to overcome it and have continued down the same shameful path. My family have been aware of my situation for years, and I continue to (try to) deceive them but I am sure they know what I am still doing. I feel so ashamed of myself and any meal I have with them I feel I have to be on my best behaviour and pretend I am ‘normal’. I often think about being granted three wishes and I would use all three on turning my life around as I can’t seem to do it myself. I also feel so lonely trying to deal with a constant and obsessive battle. I just wish it was as simple as turning off a switch to change things but I realise it is a very difficult journey, especially when I have !
been doing it for so long. I also suffer from depression which I think was triggered by my anorexia. Like you, I also believe there will be a turning point for me. It will be like winning lotto!

Kindest regards, M

This diet is designed to help you cope with the stress that builds up during the day.

BREAKFAST
Half of a grapefruit
1 slice whole wheat toast, dry
8 oz. skim milk

LUNCH
4 oz. Lean boiled chicken breast
1 cup steamed spinach
1 cup herb tea
1 Oreo cookie

MID-AFTERNOON SNACK
Rest of the Oreos in the package
2 pints of Rocky Road ice cream
1 jar hot fudge sauce
Nuts, cherries, whipped cream

DINNER
2 loaves garlic bread with cheese
Large sausage, mushroom and cheese pizza
4 cans or 1 large pitcher of beer
3 Milky way candy bars

LATE EVENING NEWS
Entire frozen cheesecake eaten directly from the freezer

RULES FOR THIS DIET

1. If you eat something and no one sees you do it, it has no calories.

2. If you drink a diet soda with a candy bar, the calories in the candy bar are canceled out by the diet soda.

3. When you eat with someone else, calories don’t count if you don’t eat more than they do.

4. Food used for medicinal purposes NEVER counts, such as hot chocolate, brandy, toast and Sara Lee cheesecake.

5. If you fatten everyone else around you, then you look thinner.

6. Movie related foods do not have additional calories because they are part of the entire entertainment package and not part of one’s personal fuel, such as Milk Duds, buttered popcorn, Jr. Mints, Red Hots, and Tootsie Rolls.

7. Cookie pieces contain no calories. The process of breaking causes calory leakage.

8. Things licked off knives and spoons have no calories if you are in the process of preparing something. Examples are peanut butter on a knife making a sandwich and ice cream on a spoon making a sundae.

9. Foods that have the same color have the same number of calories. Examples are spinach and pistachio ice cream, mushrooms and white chocolate. NOTE: Chocolate is a universal color and may be substituted for any other food color.

Dr Fishman comments:

These are silly dieting suggestions. But food control, even with real diets, is not key to eating disorders.

Eating disorders have to do with relationships and, importantly, how relationships are handled.

Our treatment of Compulsive Overeating, Bulima and Anorexia Nervosa emphases how relationships play a central part; suffers must strive to have relationships where they have a voice, to be equal and, very importantly, where conflicts are effectively addressed. To the extent that conflicts are not addressed, this smoldering antagonism can lead to compulsive overeating and other eating disorders.

In our culture, individuals especially women can be pressured to have a certain weight, to be thin, to be “stylish.” If someone in a relationship is making them feel bad about themselves, it is understandable to internalize it and think there’s wrong with them—it must be their weight.

This leads to tunnel vision—focusing only on the eating and the food. Instead, if the conflict the relationship is addressed, it’s much easier to control one’s eating.

Getting away from the intellectual to the practical – eating disorders are relevant to the world of eating disorders. While it is necessary in many situations, especially for women, that there be a culture of thinness, women should be thin, that’s not sufficient to cause the eating disorder. If it were sufficient, anorexia would not be a rare disease.

The number of women in New Zealand and America with anorexia is tiny. So what makes the difference? One concept we use with our clients is the idea that when the woman feels bad about herself, something is going on in her life that is making her feel bad. She says to herself, “I would feel better if I weighed less or dieted and got down to a size 6”. Of course, this becomes dangerous, as anorexia as well as other eating disorders, have their own tyranny – that is, if someone gets thin enough, they can’t force themselves to eat.

To coin a phrase – they are looking for love in all the wrong places. It’s not women’s eyes that are smaller than their waistline they are transformed what is making them unhappy. What’s really making the difference is their relationships and those paradigms and people that are making them unhappy.

In my experience, when I have asked people ‘what makes you unhappy?’ they reply ‘themselves’. But that won’t lead to change. We are all unhappy with ourselves at various points. What will lead to change is looking around and seeing what are the relationships that are making you unhappy.

For example, a young woman who I am working with had a very bad week. She doesn’t understand people who are making progress with her weight control (in terms of her compulsive over-eating), just couldn’t understand why suddenly she had the worst week in 3 months. In therapy, I asked her ‘what was happening in her relationships that were making her so happy?’ Suddenly it dawned on her that the child she was caring for was going to be leaving her. Her mother had lost her job and wanted to care for her baby full-time. This young lady and her mother was devastated. Again, the focus is on the stress and out-of-control behaviour. She was so miserable and felt that food addressed the sadness that now surrounded her.

I had been given many diagnoses and opinions from many well-meaning specialists in the mental health field. They included manic-depressive with rapid mood swings, severe anxiety disorder, borderline personality disorder, depression, bulimia, and anorexia. I was on seven different medications; all prescribed in an effort to enable someone as sick as me to live a somewhat normal life. I was very dependent on my medicine. I would not consider missing a timed dosage of any one of them for fear that I (or one of my many disorders) would break through.

On a particularly frustrating day I would use my diagnosis as a consolation: “It’s O.K.,” I’d say, “I’m too sick to expect much of myself anyway.” I was hospitalised a number of times and spent a year in a day-program that was designed to help ‘mentally ill’ people cope with their daily lives and learn to become independent. It was a wonderful program that included things like goal setting, time management, support groups, and daily meetings with professionals in the mental health field. All I had to do to receive the maximum benefit from this program was to accept that I had a mental illness, that I would always have a mental illness, and that I would need to be on medication for the rest of my life.

Daily, I would tell doctors in one way or another that I was not willing to accept that as fact, and that I was interested in getting well and moving on with my life. Daily, they would tell me that I not only needed to accept my ‘mental illness’ status, but that they could not help me until I did.

Eventually, I stopped talking with them about it, but secretly hope I could prove them wrong someday… It became a private vendetta, one which I eventually found difficult to maintain. Well-meaning people would tell me or insinuate that this sort of denial thinking was, in fact, part of the ‘illness’ itself. I did eventually graduate from this program, considered ‘stable’ on my seven different medications (I was, however, still bulimic, had frequent anxiety attacks, and resorted to self-destructive behaviours when things got too stressful.)

My release was conditional; I needed to find a psychiatrist who would monitor my medication. I met with this doctor once a month and he refilled my prescriptions. We spoke very little. I needed more. I wanted to work on my life, my relationships, figure out why I was so angry all the time. I had one or two sessions with 5 different doctors, all of which I walked out of very disappointed and/or angry. I didn’t know what I was looking for but I did know that none of these were it.

Dr Fishman – a different approach

My sixth try led me to Dr Fishman’s program in New Jersey. I was still terrified of my medication lapsing, so our first interaction was on the phone; me pleading with him to refill my many prescriptions. I made an appointment for a few days later.

The minute I met him, I knew something was very different. He didn’t want to hear long stories of my mental health history. As a matter of fact, he didn’t want to talk about my past very much at all, except to find out briefly what brought me here. He basically wanted to know how I was doing right now. Where did I want to go, and what were my plans for getting there?

A part of me reacted violently to this ‘taking responsibility for my life’ approach. “How dare he!” I thought. “Doesn’t he know I’m ‘sick,’ way too sick to be expected to participate in this line of reasoning?” I was very angry. I almost left, but I didn’t. You see, there was another (very medicated) part of me that was yearning for this sort of recognition, this kind of opportunity, this chance to use my own inner strength to make something of my life. Here was someone who believed in me, who validated my strengths.

My therapy became about what I could do well, and looking for ways to do more of it. No longer was I focused on the limitations of my ‘illness’. As a matter of fact, it seemed to be a sort of unspoken rule in this place to leave ‘limitations’ and ‘illness’ outside the door before you came it. In this process, I came to believe in myself again and I began to flourish.

Soon I was able to stop my medications, one by one. I was required to bring the people I was in close relationships with into my sessions, one at a time. This was a very important part of my treatment. We didn’t talk ‘about’ my life, we worked within it.

One of the things I discovered is that I tend to isolate myself, especially when things get tough. We had worked on this in my previous day program a bit, but we called for support only within our groups in the program. Dr Fishman essentially was asking me not only to do this in my daily life, but to bring my friends and family right into his office, so I could get my support network set up right here and now.

There were times when this was the last thing in the world I wanted to do. (I would have much preferred to talk about how hard it was.) But as difficult as it was, I felt like ‘I’ was really doing my life; I was at the helm. I discovered in this process why I was so angry all the time. I felt alone (I isolated myself), I felt powerless (I hung around with amateur ‘shrinks’ and let them define me). ‘I’ was disappearing.

In our sessions, I let people in my life know, one by one, that I wanted their support in where ‘I’ was going. I established that I was strong and capable and that I could be even more so with their support. I learned to ask for this support in effective ways.

I would say that the most impactful insight for me has been the realization that I am, in fact, not ‘mentally ill’, I am very, very sensitive. I’ve had difficulty setting boundaries, and I tend to take on too much, which I try to do alone. Once we broke it down into these basic components, it was much more manageable. I’ve been able to make powerful changes. I actually keep a note which I read when things get hard and I need to remember. It begins with: “I am not mentally ill – I am a very sensitive person”.

I look to see what I need to do to take better care of myself. Mostly it begins with calling a friend; telling the truth about something uncomfortable, or telling someone how much they mean to me. Above all it means remembering that I am a super-woman to do what I do in my life, and that I need to let up on myself.

Bulimia disappears!

Another incredible outcome: my bulimia began to disappear. I felt like I just didn’t have a craving to overeat anymore. We never worked directly on my eating disorder; as a matter of fact, we rarely mentioned it. Instead we worked on making effective changes in how I do my life.

I began to see that my eating was directly related to who is in charge of my life. If I let others tell me how it is, if I can’t tell someone the truth when I need to, or if I’m withholding love in any way; it directly affects my eating. The more I worked on these areas, the more my eating became normal. My bulimia is basically not ‘my’ bulimia anymore. I’ve learned to see my now very occasional bouts wit it as a signal – a signal that something is out and that it’s time to take a look at what I can do to take care of myself better.

I have been suffering from bulimia since I was 14. I got treatment for it but a year later it began again and has been on-going since then. I just want to be better. I hate the way I am, and I can feel my body is taking the affects. Please advise me on how can go about getting help.”

This is a letter I received some time ago. My initial reaction was, What a lost opportunity for this young person and her family. The earlier eating disorders are treated, the easier they are to treat. The flip side of that is the longer you wait, of course, the tougher they are to treat. When the gains from the original course of treatment were not maintained, her parents should have found a way to get her back into treatment. Eating disorders are tenacious; the family must keep up the pressure against them.

The second issue is her question inquiring where to get treatment in New Zealand. There are public facilities provided by the District Health Boards. There are also private programs such as the New Zealand Eating Disorder Specialists. From our perspective, treatment should involve the family: indeed the family should be welcomed and included in the therapy for maximum effectiveness.

This question is potentially fraught. The danger is not that her 3-year-old may have a disease that manifests itself fully in adolescence, but that the family could be too focused and become transfixed by the concern that this is an “eating disorder”. This can result in struggles at every meal regarding food, and could indeed, in my experience, perhaps increase the likelihood that the child could ultimately develop an actual eating disorder.

Dear Dr. Fishman,

I was wondering if it’s possible for a mother to pass on an eating disorder to her daughter even if the daughter has never really known her mother. My partner’s daughter is 3-years-old and refusing to eat. She won’t eat anything except for potatoes and spaghetti, but even that is a struggle. We have tried a lot of different methods to try and get her to eat but she’s just not interested and often gets upset over it. It’s now at the point where she’s not gaining weight and losing her hair.

I am taking here to the doctor this week as I feel it can’t go on. Any ideas would be gratefully appreciated.

Concerned Stepmother,
Amanda*

*Not the stepmother’s name, which has been kept private for confidentiality reasons.

My reply was as follows:

Dear Amanda,

This is not an eating disorder like anorexia nervosa. It sounds like she does eat – just not the right things. And her eating gets more reluctant when the struggle emerges. It is a fine line to be concerned and vigilant and yet not have every meal turn into a power struggle. Your GP should be helpful in advising you of her ideal weight according to the norms for her age and build.

When there is enough food on the table, no child starves. They have a built-in hunger mechanism. For children this young, the parents are the ones who control the access to food. Limit the choices to better foods – but be flexible. In moderation, even occasional sweets are alright. The important point here is that meals don’t become battle grounds. That in itself is more dangerous than ice-cream!

Regards,
Dr Charles Fishman

Dr Fishman was asked to contribute:

Psychiatrist Dr Charles Fishman, director of NZ Eating Disorder Specialists in Auckland, believes Prescott would have been given a very different reception if he had been a woman with an eating disorder.

“Bulimia is absolutely a hidden issue – it’s a private hell and a private shame”, he says. “Males who have bulimia are sometimes told they have a girls’ disease, which is an additional shame for them to bear.”

Recent research suggests that men could make up as many as 25% of those with anorexia and bulimia, and 40% of binge eaters.

Fishman says perhaps one in 10 of his patients with anorexia are men. Their obsession with weight is more likely to be hidden because many exercise compulsively rather than controlling their eating.

He believes both male and female bulimics tend to avoid conflict, and often come from families, in which food has a significant status. Fishman says the consequences of an eating disorder can be just as devastating for men as for women; one 19-year-old with bulimia had such low levels of potassium that his GP was surprised he was still alive.

Eating disorder services in New Zealand are widely considered to be-woefully inadequate and underfunded, making it unlikely that much extra attention will be given to male sufferers. But eating disorders are reported to be on the rise among men in Western countries, and Fishman expects a similar increase in New Zealand as society becomes more obsessed with men’s physical appearance.

Read the full text of ‘Slim Chance’ in the Listener online.

The organisers of New Zealand’s Fashion Week are taking an independent stand in the international debate over which models are too thin to do their jobs. Various international fashion weeks have issued guidelines and rules about how skinny is too skinny for the catwalk.

Fuelled by scathing media attention and the recent deaths of three South American models, apparently from complications of anorexia, the pressure has been on European fashion insiders to resolve the problem of unhealthily thin models…but the organisers of New Zealand Fashion Week have no plans to follow suit.