Case History: Margaret
Patient Profile:
Name: Margaret
Age: 71
Eating Disorder: Bulimia
Anorexia condition: 30+ years
Started treatment: February 2007
Symptoms:
- Unseen – intermittent binge/purge pattern never identified by symptoms.
- Sought treatment in association with other health problems and dramatic weight loss at that time.
Referral: From GP
Past history: No treatment sought previously
Medical history: Series of health problems beginning with osteomylitis in childhood, multiple surgeries including appendix removal, ovary removal, hip replacements, lumbar back fusion. Recently diagnosed with breast cancer.
Treatment: Intensive Structural Family Therapy (IST). Therapy for four months involving husband in sessions. One hour sessions held once a week.
Margaret’s Story
The following account is by Margaret and her husband Douglas and shares their experience with treatment through the NZ Eating Disorder Specialists.
A lifetime habit
Douglas and I met each other 52 years ago through a church group gathering in Auckland, and we have been married for fifty years. Douglas’s career with a government department took us from New Plymouth to Palmerston North and then to Tauranga and finally, Auckland.
I was always a finicky eater, ever since childhood – perfectly normal, really. However, because I had osteomylitis as a child, and was in and out of hospital, I had to eat well, in order to keep my health up.
I had a great family – my mother was wonderful when I was sick. She studied nutrition and was really way ahead of her time in terms of her knowledge. But there certainly was a lot of pressure on me to eat, and to eat “right”. Really, it seems like food has been a focus my whole life!
I perceived myself as being plump as a young girl, round…but a lot of girls were plump at that time, so I don’t think that I was all that concerned about my body image. Of course, Douglas says I was never “overweight”, and no different to anyone else, but I do remember wanting to lose weight before we got married, and I was always aware that his family were all small people.
I can’t really say when the bulimia “started” – it seems to have been with me most of my adult life. When we were living in Whangarei in my 30s, it became more of a real habit. My parents were also living in Whangarei at the time, and when my father died of a heart attack, it fell upon me to look after my mother. She was partially disabled with hip problems and suffered from what was eventually diagnosed as Parkinson’s disease. She lived in her own home, so I was essentially looking after two homes and my mother liked things done a certain way.
I was under a lot of pressure at that time and circumstances made it difficult for me to do my own thing. It’s difficult to know exactly why things happened – it was such a long time ago – but I do know that I had good days and bad days. On the bad days, I’d binge eat and then get rid of it.
Douglas was aware of what was happening, and in a way that made things worse. I didn’t like being pushed to eat, being told, “Have some more…eat this.” I had that kind of pressure for most of my life.
Douglas says that bulimia allowed me to enjoy my food and then get rid of it. He became more aware of this behaviour when our daughter was 12 or 13. At one stage, I lost a lot of weight and had migraine headaches, and looking back, those things might have been related to the way I was eating. However, because it didn’t carry on continuously, and because I was never really sick, the problem never came to the forefront.
Of course, we never talked about it. People didn’t talk about those kinds of things at that time. There was no real help out there, even if we wanted to get help. I’m pretty strong-willed, and Douglas just lived with it. It was easy to ignore because I wasn’t bulimic all the time, you know, we’d do things and go on holiday and I’d be fine. Then I’d have those bad days.
Neither one of us really knew why I did it. It’s only looking back now that we’ve started to analyse it a bit.
Better late than never
I was quite reluctant to get help for my eating problem. Really, I only agreed to discuss my eating habits with my GP in order to please my husband.
Douglas was very concerned because I have had a series of health problems, one thing happening after another. I have always kept in relatively good health, and recovered quickly, but recently I began to look quite thin, so Douglas got worried. He discussed his concerns with me, and that was the first time that I could admit that I had a problem.
In the past, I had never discussed my eating habits with any of my doctors or GPs. I never mentioned it, because even with the way I ate I had never fallen sick. I had mixed feelings about what I was doing sometimes. In one hand I didn’t like it, but the other it somehow no longer worried me.
In the end, we made an appointment with the GP specifically to discuss my problem. Douglas and I went in together to discuss it. The GP was very good to talk to and he mentioned some psychologists who could perhaps help.
Douglas did some research and found Dr Fishman via the Internet in early 2007. We discussed Dr Fishman with our GP, and he thought that going to Dr Fishman would be a good option for us, so he made the referral.
I was most concerned about what the “treatment” would be like – I didn’t want to dwell on the problem, and I didn’t want to be weighed over and over again. I like to believe it’s better to just get on with things.
Bringing things into the open
We first saw Dr Fishman in February 07. He saw us together, and then separately. We had six sessions with him.
I didn’t know what to expect, however after the first few visits, I felt like we understood each other and the therapy was making a positive change. It also allowed my husband and I the chance to openly communicate about the issue. Not talking about it had contributed to the problem.
It has surprised me how much it helps just to talk about it. Out of concern, Douglas could at times be a bit overwhelming, telling me, “You’ve GOT to eat this…” I felt like he was always watching over me. With Dr Fishman’s advice he no longer does that as much, which has helped.
Dr Fishman has encouraged me to eat smaller meals, to snack when I feel like it, and to just eat when I need to eat, rather than feel like I have to eat extra food or dessert.
Douglas says that the treatment hasn’t fixed my attitude to food. I have always been a finicky eater! However, by bringing it all out into the open, it allowed me to see the damage I was doing to myself through my eating patterns.
Getting on with life
Douglas tells me that I look miles better now, and I know my weight has improved. I feel comfortable with the way I’m eating.
I feel more in control. Things are easier with my husband, thanks to our time with Dr Fishman, we know how to deal with each other even better. Douglas sometimes does check in to satisfy his own concerns, asking me whether I’m “still being good.” That’s all right. Before, I always felt like somebody was watching me and commanding me. I know Douglas was just worried, but it didn’t help me change my habits.
I’m lucky and don’t have a “horror story”. I’ve always kept pretty fit, have recovered quickly from setbacks, and have never collapsed or been hospitalised as a result of my eating disorder. Having lived with it so long, it seems strange to address it after all these years.
Now that we have, I am glad. I’m ready to just get on with things. It’s nice to know that Dr Fishman is there for us if we need him. In fact, we’ve got a picture of Dr Fishman on the cupboard door at home, just to remind both of us of what we’ve learned!
