Case History: Shelly
Patient Profile:
Age: 32
Eating Disorder: Anorexia Bulimia
Anorexia condition: 17 years
Started treatment: December 2005
Weight when treatment commenced: 52 kgs
Symptoms:
- Obsessed by not eating
- Viewed eating as a bad thing
- Unable to eat
- Running excessively daily
- No menstruation
- Lack of energy when working
- Non assertive personally
- Feeling like her anorexia was uncontrollable
Referral: From GP
Past history: Seen various counsellors and GPs
Medical history: On antidepressants, Suicidal
Treatment: Intensive Structural Family Therapy (IST). Family therapy for three months involving husband, parents, sister and brother in law involved in sessions. Treatment one hour sessions once or twice a week for three months.
Shelly’s story
The following account is by Shelley and her experience with being anorexic and seeking treatment through NZ Eating Disorder Specialists.
Teen years – running as a form of control
I grew up in Dargeville on a farm and was 17 years old when I started to focus my weight. I had started running as a form of exercise and this turned into an obsession. Looking back, I see the running gave me a form of control over myself. The more kilometers I ran the more fat I knew I would burn. This drove me to push my body harder – instead of running every second day it became daily, running six to seven kilometers at a time. Then I reached a stage where I was trying to beat my time each day.
At this time I also became more focused on what the amount of food I was eating.
No one had made comments about my weight, but I started to view my appearance differently. I had a boyfriend at the time but felt I wasn’t looking good enough for him.
The monster in the mind
I moved to Auckland to start a career. Being away from family and livingly alone I felt isolated. I had only myself to focus on and exercising became more of an obsession with me.
It was three months before I found a job. My lack of work experience meant facing a lot of rejection from job interviews which added to the stress I felt.
Any young girl will be focused on their weight at some time but as an anorexic I had what I call a “monster in my mind” – a disease of the mind. It was like a voice telling me I needed to lose more weight. I wasn’t allowed to eat. If I ate something I was going to get fat. Eating was bad.
The downhill cycle of food deprivation
Over the years I hid being anorexic from my family and friends, but I was constantly depressed and also suicidal.
Before we were married, my husband he had seen photographs of me with my weight fluctuating dramatically. He did confront me, and over the years with my family tried to get me help. I went through stages of seeing several doctors and counsellors. Doctors knew I was anorexic but their job was to keep me medically sound. They would carry out the blood tests and ECG scans as I was having heart pains, and place me on antidepressants. There were counsellors who would weigh me and want to focus on my past history with food.
As soon as I started to put weight back on I would start on my downhill cycle again. Slowly starting to cut down meals, first with no dinner, then no lunch and then restricting myself with less and less food each day. I would allow myself say half a banana, some nuts or a couple of plums a day and that was it. Eventually my hunger would go away.
Holding down a job
I’m a very determined person by nature, so had the will power to continue working. I loved my job in retail sales and had been a top salesperson for the store I worked at.
I was under the impression that none of my colleagues knew what I was going through. It was hard keeping up appearances. I certainly didn’t want to be labeled an anorexic so at times I would make myself eat something to please them. But for most part I couldn’t eat in front of anyone and ate separately. Where for everyone it was such a normal thing to do to share a meal, I simply hated it and felt like a pig.
Over time it was apparent to everyone at work that I had a serious problem. I was literally hanging onto furniture from feeling so weak on certain days. The days where I couldn’t muster up any energy I would have to take time off work.
Things coming to a head
I came across the Weight Watchers calorie points systems. In my mind it gave me permission to allow myself a certain number of calories each day. I stuck to the minimum points for abut six years, but this didn’t rid that monster in my mind. I was still running six kilometers daily and monitoring my weight.
In 2004 I started training for a run. It was an intensive training program and I found that I lacked the energy needed from the minimum points I had allowed myself. My husband was seeing a nutritionist, so I her to put me on a strict food program. I still felt a lack of energy and started to lose quite bit of weight, but thought I looked really good.
My weight dipped into the 50s and that’s when things stated to turn to custard.
Running my legs would feel like jelly. I would have to stop and walk, but then tell myself I was useless and I should be able to do this without stopping. I didn’t consider that I wasn’t putting enough fuel into my body to sustain this energy spend and my body was running on empty.
On one particular day I could only make it half way through the day at work. I was exhausted and went home early. My husband was working night shifts so hadn’t realised to what point I had got to with not eating. The next morning he was shocked when he saw what state I was in. I tried to drink water, I was dry retching, and I couldn’t even drink tea of coffee.
Getting specialist help and involving my family
Feeling like couldn’t seek out help unless someone did it for me, I was referred to GP Dr Susan Smith. She understood anorexia and was the first doctor after all these years that referred me to a specialist in eating disorders, Dr Charles Fishman. I had seen numerous counsellors over the years so I wasn’t hopeful.
From the first meeting, Dr Fishman was completing different from anyone I had dealt with.
His approach was to have total involvement from my family, which terrified me. He also set conditions I had to follow and wanted to address the issues of conflict in my life that I was avoiding.
My parents came to Auckland to live with me and be involved in the weekly sessions I had with Dr Fishman. The sessions also included my husband and sister and brother in law. We didn’t spend a lot of time focusing on my past history but focused more on my future – family values and general life and the good things I had.
He set conditions about weight gain and work, which were really to establish new patterns with my eating. By being told I had to put on weight it gave me permission to eat. I had become to scared to eat at work as I wasn’t eating at work for so long, that I felt I couldn’t even if I wanted to as I would l look like a hypocrite because I was sick. With the conditions I had permission and everyone knew this.
The effort my family went to and their direct involvement in the therapy made it harder for me to focus just on myself. As an anorexic you don’t care about anything else, and the focus is just yourself. You forgot about family and friends and what you are putting them through.
Seeing my family suffer for what I was doing and everyone putting there time and energy into getting me better made it harder for me to continue to punish myself. I didn’t want to let them down there was responsibility on me to get better.
A professional understanding the monster in my mind
Dr Fishman has a fantasist personality and he’s non judgmental. I didn’t feel he was ever putting me down. Here was a specialist who really understood anorexics, having dealt with patients for so long he knew how we thought and how anorexia consumed us.
When I was sick I was getting fathered in some ways. My husband had to tell me when to eat and tell me not to run. Dr Fishman taught us to communicate better and how I could become more assertive. He was able to pick up on any body language between family members. For example if my husband and I had had a fight about food he would be able to detect this and make us talk to each other about it.
The conditions that were set and having my family involved in the therapy is what has worked to make me better. Also he didn’t say I would be in therapy for years. Thee months of session and I felt anorexia was no longer controlling my life.
Overcoming anorexia
I’ve been telling everyone 2006 is my year. For the first time I feel strong and have a voice. Therapy ended when I had put on weight and no longer had this guilty feeling or need to run each time I placed something into my mouth.
Going back to work after a break and completing therapy, everyone commented on how bright my eyes were and I had colour back in them. Hearing how much better I look has helped.
Eating in the lunch room at work has been a big step forward. Now I can take a salad or a sandwich into the lunchroom and don’t mind people seeing me.
I went on a holiday with my husband and it was the first time I was able to enjoy myself and not have food control my holiday. I ate when I was hungry, didn’t feel the need to exercise compulsively and was able to eat cake without feeling guilty! Comparing this to a holiday a year previously I’ve come a long way. I was taking up to three carbohydrate blockers after lunch and dinner meals, running constantly and missing out on the entire holiday.
There are still some issues I need to work through but no longer does anorexia have a stranglehold on my life. The days I feel low I focus on the values I was taught in therapy, be assertive, keep my family and friend involved in my life and not get to the point where I’m overly stressed.
