What the hell does that mean? It means just what it says--if you're an anorexic, you will always have a sick relationship with food, just as if you're obese. What that doesn't mean is that you won't be a normal weight for the rest of your life. You can be, and you will be. But it's work, and hard work at that.
I was a chain smoker for nearly 40 years, I'm embarrassed to say. I'm a nicotine addict. I will always be one, and can never have even one cigarette until the day I die. One will lead to another one, and that will lead to two. In a week or two, I'll be chain-smoking again. I've made a pledge that I won't smoke today, nor any day, for the rest of my life.
An anorexic must make a pledge not to starve herself, and an obese person has to do without buffalo wings with a creamy dressing for the rest of his/her life. Food is a drug to a binger. A greasy bacon cheeseburger can lead to a 10,000 calorie binge, followed by intense vomiting to get rid of the pain and calories. Each leads to self-loathing. I knew a compulsive binge eater who was so low on money from buying her binge food that she had to borrow rent money from me. I lent some to her; couldn't afford any more. But I understood why she needed it. I knew I'd never get it back, and I didn't, but she had enough money left over the following months to prevent eviction.
She suffered all day, going to school, then work, all the while thinking of what she'd eat that night. She tried a different grocery store each shopping trip so that no one would notice. She bought enough food for a normal person's week, so her behavior looked normal to outsiders. A binge was usually around 12,000 calories. She got so good at vomiting that she no longer had to use outside help, such as sticking her fingers or a tool down her throat. She merely had to bend over and vomit, perfectly, with ease. Sometimes she'd break a blood vessel with the violence of it, and the toilet would look as though it were full of blood. She'd break blood vessels on her face (I do that) and have to hide them with foundation the next morning.
She wasn't too overweight, either. BEDs who vomit can be normal or somewhat overweight. They're rarely obese. COEs are the ones who end up in the obese category. Anorexics who binge occasionally often vomit, but of course they remain seriously underweight. They make up for a binge with vomiting, excessive exercise, laxatives (they don't work, btw), and fasting. About half of all anorexics are called the purging type, with these symptoms of bulimia in addition to the starvation. The rest of us are restricting types, solely restricting eating. I have had a few binges of late, to about 3,000 calories in one sitting, but didn't vomit. I wanted to, but held back. I detest vomiting. An AN's binge is never as big as a BED's.
What separates a binge from the simple overeating a normal person does on a feast day such as Thanksgiving? The loss of control. A COE feels powerless to quit eating. He feels forced into continuing to eat, long past the feeling of satiation, and even past the point of pain. Yet s/he can't stop until control returns. That could take an hour or an entire night. It could happen in stages, with 3,000 calories, a vomiting session; another 4,000 calories, more vomiting, and so on. This all could be followed by a laxative.
You can see the overlap with bulimia here. What's the difference? The BED isn't as terrified of gaining weight as the BN is. The BEDs vomit just as much to stop the pain as they do to prevent weight gain. The BN doesn't fantasize all day about binging that night. They rarely run out of money. Yes, the differences are subtle, and there are other psychological differences, but those stand out.
While obesity is a slow walk to suicide, AN is a sprint. AN has the highest death rate of all mental illnesses, including depression. It's usually from heart failure, and is more rapid in ANs who purge than ANs who solely restrict. The death rate for ANs is anywhere from a low of 6% to a high of 10%, depending on how severe the disease is.
The obese die of diabetes, heart failure and coronary artery disease, strokes, breast cancer, and liver failure, among other things. All of these are chronic, not acute, killers. That's why the suicide is slow. Which would you rather have--another piece of cake, or blindness from Type II diabetes? The choice is clear for normal people, but not so for the obese.
Still, with a willingness to be well, all of these people can return to health, or have good health for the first time in their lives, and feel good about themselves. They can free up the tenacious webs that tie them to sick food feelings and behaviors. However, they won't be normal in the way people without an ED can be. I did feel that way once, for a period of about three years. I never weighed myself--didn't have to, because my weight was stable. I could look at myself in the mirror and not be disgusted. I could shop for clothes without fear. I didn't count the calories of everything that went into my mouth. It was such a peaceful time.
But the old, faithful enemy had never really let go. I began to gain weight, which I knew from the way my clothes fit. I bought bigger clothes. This happened because of a medication I was prescribed and my doctor said it was more important that I take it than worry about a "little" weight gain. Little? I gained over 50 lbs. I could have refused to take the medicine anymore, but I didn't.
I'd like to say that the weight fell off me when I finally had a breakdown in his office over my weight and insisted I go off. But it didn't. I struggled to lose it, but it was so hard, so very hard. I stayed that weight for four years or so. Finally, I was able to take it off. I didn't do it by eating healthful foods or living a good lifestyle. I didn't like myself well enough to be gentle. Instead I ripped through the weight, and more, to get where I wanted to be. I done that before, but didn't think about that. I got down to 92 pounds. My doctor at the time said that two more pounds and she'd have me forcibly put into an ED treatment program. I didn't know at the time that she couldn't have done that--it would have been nearly impossible. So, in tears, I got up to 97, 98 pounds.
That was my second episode of being called eating-disordered. The first was when I was a kid. My family doctor told me he was disgusted with me because I was so fat and ugly. Yup, those were his words, to a child. That office visit is clear in my mind. I can still see his face, feel his loathing, remember what I was wearing, and smell the antiseptic in the air. But my mother had said the same thing, so I don't know why I was surprised and hurt. Maybe because it came from a doctor, a man I trusted.
So I've been fat and I've been skinny. Believe me, skinny is better. Strangers treat you better. When I worked for a gynecologist, he told me that when an obese woman walked into the office, he wanted to puke. This man was allowed to work with women--be responsible for their lives and deaths. He should have had his license yanked.
*Sigh* I've gone on today, with little information for you, just bad memories of my own. I'm feeling fat today. I'm convinced that if I lose about seven pounds I'll feel better. You know what? Once I weight 91, I'll be convinced that if I lose three or four or five more pounds, I'll feel better. Yes, that's what an ED is. It keeps you prisoner, or as the psychiatrist Hilda Bruch would say, a woman in a "gilded cage."
I apologize for this entry today, but warn you that things like this will happen again in the future. Skim them or skip over them if you want the informative stuff. I just had to talk about this.
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