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The Urge to Purge

Aldo Mazza Nurtured by self-hate, bulimics face a life of shame--and sometimes even death By Shelley Lawrence PULLING INTO the parking lot of the small restaurant where I am to have breakfast with an interviewee, I grow apprehensive. Is a restaurant really the best place to meet? For more than a year, a food addiction has controlled Jonelle Hayes, an attractive 18-year- old with a pretty smile and clear skin. She's not waif-skinny and not overweight, unless you're judging her by fashion-magazine standards, which she is quick to tell me that she judges herself by. Now, I wonder, will it be hard for her to eat and speak with me as well? If she runs to the bathroom, am I supposed to act unconcerned? Hayes (who has asked that her real name not be used) soon puts my qualms to rest. "I don't consider myself to be a bulimic anymore because I don't throw up-- bulimia doesn't control my life like it used to," she says as our eggs Florentine and coffee arrive. "But I still think about food constantly--how I can lose weight, what I'm going to do differently in order to accomplish that, how much I've already eaten today, how much I'll allow myself to eat for the rest of the day. "I don't even know what's normal anymore." Eighteen months ago, Hayes was controlled by the obsession that was an everyday part of her life. For her, the disorder began with a strict vegan diet to control the developing figure with which she was so disgusted. Hayes was obsessed with what she put into her mouth--and what she didn't. She would refuse food cooked by anybody else, paranoid that fats or oils would have been used in the preparation. She found herself refusing dinner invitations, becoming defensive and angry when she was offered food that wasn't on her diet. Hayes did lose weight on the diet, but couldn't keep up the strict regimen of food "dos and don'ts." "The first time I ate anything off my diet was when I had a bunch of girlfriends over for a Christmas-cookie baking session," she recalls. "I was snacking on the cookies all night and they asked me how I could be constantly eating and still stay so thin. It made me arrogant, I guess you could say, and then I stopped worrying about what I was eating because I had pretty much reached my weight goal. "Of course, when I stopped dieting I gained weight back and it completely freaked me out. I felt like I'd lost control." So Hayes started purging, forcing herself to throw up after eating anything she felt would make her fat. Unfortunately, this was almost everything. Soon her disorder started spinning out of control. Hayes continues, "Bulimia is an eating disorder that makes you feel horrible about yourself because you have this dirty secret. Bulimics are excellent liars; usually nobody realizes how they stuff themselves repeatedly and then throw it up again." Diary of a teen bulimic. HAYES, a Santa Rosa resident, is one of an estimated 8 million Americans--95 percent of whom are women--between the ages of 16 and 25 who suffer from bulimia nervosa, a psychosomatic illness (first diagnosed as such in 1980) in which the victim has a continuing obsession with food, weight, and figure, and an intense fear of "becoming too fat." Among public figures who battled bulimia were the late Princess Di, fitness guru Jane Fonda, and actress Ally Sheedy. But many women continue to suffer, spurred, in part, by social pressure to fit a slim Kate Moss ideal. While in recent years there has been little new literature that focuses on the disorder, Dr. Dierdra Price, a San Diego-based psychiatrist, recently published a self-help workbook for sufferers of bulimia, Healing the Hungry Self: The Diet-Free Solution to Lifelong Weight Management. "It's very complex," says Price, when asked what triggers the binge-purge complex. "What initially happens is that somebody will start dieting in an attempt to lose weight; to reach a standard or ideal. Because most people cannot maintain that stance, they binge on the foods they have been restricting themselves from. Because they are so frightened of gaining back the weight they have lost, they will learn to purge in order to control this." Typically, bulimics are white, college-educated, single, 20-something women whose weight is close to ideal. They have low-esteem; overdepend on the approval of others; find it hard to express anger; are often depressed, even suicidal; and perhaps have other compulsive behaviors (e.g., drug abuse, stealing). They spend much of their time buying enormous quantities of food and seeking private places to eat (they live in fear of their secret being discovered) and then purging. Changing the bulimic's attitude toward food, eating, and body size may involve psychotherapy, family therapy, medication, nutrition intervention, and/or medication. Because of erratic eating habits and vomiting, the bulimic can suffer from an electrolyte imbalance that leads to dangerously low potassium levels. This vicious cycle perpetuates itself in recurring "hunger attacks" during which the bulimic consumes large amounts of food in a short amount of time (under two hours), although not physically hungry. During a binge, the bulimic eats more rapidly than normal, eats alone owing to embarrassment by how much she is eating, feels a loss of self-control, and afterwards has intense feelings of self-disgust, depression, and guilt. These feelings cause the bulimic to purge by self-induced vomiting or with laxatives, exercise strenuously, or fast to rid herself of the calories taken in during a binge. The World Health Organization classifies bulimia nervosa as a disease in which the bulimic suffers from a binge-purge episode at least twice a week over a period of three months or more. Some bulimics can have 10 or more attacks a day. The number of attacks and their frequency can vary, and are usually provoked by stress, anxiety, or unhappiness. Many bulimics are also clinically depressed; the eating disorder can cause the depression or vice versa. The binge-purge cycle is the bulimic's effort (either conscious or subconscious) to avoid and/or release feelings of anger, frustration, or helplessness. The cycle is also a form of self-punishment or sabotage; if the bulimic believes that she has been "bad," she will binge and then purge to regain a feeling of control over herself. As do most sufferers of bulimia, Hayes started bingeing and purging when she faced a drastic life change--in her case, becoming an au pair overseas, far away from everything familiar. Other changes that can spark an eating disorder include the death of someone close, leaving home for the first time, marriage, or divorce. But bulimia is not a spontaneously occurring eating disorder. Most bulimics have suffered from child abuse, either physical, emotional, or sexual. "Yes, I was abused as a child," Hayes states flatly. "It's something that I've dealt with, that I've come to terms with. I went through extensive therapy when I was a child, and I thought that it was over. When I was researching bulimia in order to overcome it, I found that the most probable cause for my disorder was that I was abused. "It makes me furious all over again." BULIMICS ARE usually perceived by others as perfectionists, and at first they control the disorder in an effort to appear perfect to themselves. However, the disorder rapidly becomes an addiction and bulimia gains the upper hand. "It's actually a physiological push to eat a lot of food, to compensate for what the body has been deprived of," adds Dr. Mary Neal, a San Diego psychiatrist. "Another reason the bulimic may binge is because of emotional instability. Bulimics can't regulate their own negative emotions such as anger, tiredness, or guilt. Food is immediately accessible and comforting. The act of eating distracts from emotions, and the tryptophan [an amino acid] . . . actually has a sedating effect." "Since I've been back from New Zealand, I've been keeping it under control," Hayes explains. "I've only thrown up when I'm under a lot of stress, maybe if I'm nervous about something. I can honestly say that this is the first time in two years that I feel like I have normal eating habits, even though I don't feel that the way I think about food is normal." Hayes has been home for almost a year now. In that time, she says, she has made herself throw up only three or four times. "I'm still not happy with my body," she says, "but I try to improve it by working out a lot and eating healthy, not by throwing up. But sometimes I'll go through a phase where I'll only eat junk food for about three weeks. I'll get really depressed and start hating myself again. It's nuts how what I eat determines how I feel about myself. "For me, it was hard because I was such a late bloomer; my body really only started developing hips and stuff in the last two years. Because I thought I was already shaped the way I was going to be shaped, the changes completely shocked me." Hayes prods one of her thighs with a forefinger, then looks wistfully out the window. "This was at the same time that I went to New Zealand and I really felt like I was out of control. I couldn't keep a rein on my body, and I was in a different culture," she explains. "My host parents would get really upset if I refused food, and I didn't want to eat anything that they served me; it was all butter and cheese, and I was vegan. "So I decided that I would just eat anything that I wanted and then throw it up so I wouldn't get fat. I used to have to make myself do it, and I'd scold myself for acting like such a cheap soap-opera character. "But after a while I got into the habit of stuffing myself with so much food--I couldn't control how much I was eating--that even the throwing up part of it became an addiction. I needed to feel the reassurance of everything coming up again. I'd feel so much better afterwards." She looks uneasily at the hollandaise sauce on her eggs, pushes a bite around the plate, and then swallows it. She smiles. "This is good, though," she offers. "I just won't eat anything else today. "I do try to stay healthy," she adds. "I'm afraid to go to the dentist, though. I know that my body is pretty healthy because I generally eat right and I do sports, but my teeth hurt a lot. I hope they didn't rot from stomach acid. I can't even afford to have them cleaned right now, much less have root canals or something." BULIMIA DOES take its toll on the body. Induced vomiting can cause enlarged parotid glands (in the neck), inflammation in the esophagus, dental cavities and erosion, and injuries to the inside of the mouth. The bulimic's low potassium level can cause urinary tract infections, kidney failure, and heart irregularities. Laxative abuse can damage the colon and slow the intestinal tract. Abuse of diet pills can cause dehydration and low potassium. A bulimic may suffer from indigestion, facial puffiness, sore throat, constipation, muscle weakness, irregular menstrual periods, and fatigue. To those that are suffering from bulimia, and to the families of bulimics, Dr. Price offers some tips. "First of all, the bulimic needs to stop dieting," she emphasizes. "She needs to practice eating three meals a day. The human body gets hungry about every four to five hours. If the bulimic goes beyond that time frame without eating, it will be that much easier for her to binge out of hunger." Bulimics should also stop weighing themselves, says Price, and get rid of any clothing that is too small that they are trying to fit back into. These are obsessive behaviors, and obsession is the root of bulimia. A sufferer of bulimia should practice changing one behavior at a time. For example, if she knows that her difficult period--the time during which she is most likely to binge--is in the late afternoon, she should have some kind of high-carbohydrate food like a baked potato that will take away the urge to binge while leaving her craving for food satisfied. "I had a five-gallon jar full of suckers," observes Hayes. "When I was trying to overcome the urge to binge, I would grab a sucker so I'd have something in my mouth, and I'd try to leave the house. It's really important to get away from food when you know you want to binge." Dr. Neal also urges bulimics to seek help. Most bulimics will not tell anyone about their disorder because they are ashamed and afraid that others will reject them because of it. Until the disease has completely taken over their life, she says, they will not seek help. "Often a friend will notice that someone is bulimic, and it's very important for the friend to confront the bulimic," notes Neal. "The bulimic will become very defensive, but the friend [or family member] should persist with the expression of their concern." She also advises that in the case of a younger bulimic, a family member, school nurse, teacher, or school counselor should be made aware of the problem. "Sometimes it's easier for an adult to intervene," Neal says, "and the sooner you nip bulimia, the sooner it can be taken care of." FOR HAYES, recovery was not a cut-and-dried process. After making the conscious decision that being a little overweight was better than being a bulimic, Hayes stopped purging. The binges were harder to control. "After I stopped throwing up, I gained about 10 pounds because I would still binge. I'd eat like a gallon of ice cream and five cheese sandwiches, but I wouldn't let myself throw up," she says. "I'd lie on my bed and groan and suffer. I wanted my body to see what it felt like to have all of that food inside of it. It took a few months of about twice-weekly binges"--Hayes had been bingeing and purging four to five times a day--"but I finally stopped bingeing." When asked how she feels her disorder is doing today, Hayes replies, "The worst thing is that every day, although I don't have to worry about bingeing and purging anymore, I still analyze everything that I put into my mouth, and most of it I feel guilty for eating. And if I feel too badly about it, or try to deprive myself of a food because I'm afraid that it will make me fat, that I won't be able to stop eating, and then I'll fast the next day. "I hate it," she says angrily. Then she adds, "I've talked to some of my girlfriends about it and a lot of them have the same problem. It's just ingrained into women of this culture that no matter what height you are, you're supposed to weigh 125 pounds. I used to model, and I think that's part of what messed with my head. I did it when I was 16, and I still feel like I should look that way now because that's our cultural standard of perfection. And even though I know it's wrong and that women in magazines are too skinny et cetera ad nauseam, I still push myself to look that way. "It's really fucked up." [ Sonoma County | MetroActive Central | Archives ]