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Dying to be Thin
By Ira M. Sacker Marc A. Zimmer
Warner BooksCopyright © 1987 Ira M. Sacker, M.D. and Marc A. Zimmer, Ph.D.
All right reserved.
Chapter OneTHE BASICS
Are you dying to be thin? If the question hits home, stop and think for a moment. How much time do you spend every day thinking about your weight? Maybe you diet in spurts, losing those 10 or 15 or 20 pounds, getting all that praise from the people who are important to you. And then maybe gaining that same weight back over a few months, a year, or more.
If you are like millions of Americans, you fight that battle of the bulge every day. You worry about your belly, chin, thighs, arms, or some other part of your body that you feel bad about because you think it's too fat. And you compare your body to the tight, supple bodies of men and women on television, in movies, and in magazines every day. Then you look in the mirror again, and maybe, just for a moment, all you can see is that part of your body that you hate. You forget that you are much more than a sum of your various body parts, that you do look good, and that you make other people feel good just for being yourself.
Then you move on through your day, thinking about all sorts of things, including food and your weight. You might have lunch or dinner with family or friends, or maybe you eat alone that day. In either situation, you enjoy the food-the taste, the comfort, the control you can exert as you eat just what you want to eat. You might even continue to eat long after you satisfy your hunger. Then, you might add a dessert to that meal, because you want it. After you finish everything you want to eat, you might feel bloated, annoyed, guilty, angry at other people for letting you eat so much, or angry at yourself. But you also might feel happy because you really enjoyed that food.
As you are feeling these conflicting reactions to the food you have eaten and the weight you might gain, you may think about other people you know who seem to be able to eat anything, in any amount, and still stay thin. At a moment like that, those people seem to have everything, because they seem to be able to have their cake, and eat it, too! And you might feel jealous of that ability to eat whatever and whenever they want, without ever gaining any weight.
Well, bulimia is an eating disorder that can develop from that very feeling of wanting to eat endlessly, without gaining weight. People who are bulimic binge on a wide variety of foods, including highly caloric foods, such as cake, candy, and ice cream. On a schedule that can range from once in a while to several times a day, people suffering from bulimia will secretly buy large quantities of food. Then they will systematically eat as much as they possibly can, until they are literally in agony, or until someone interrupts them. Then they feel an overwhelming need to get rid of all that food they have just eaten. So they may force themselves to vomit. Or they may take laxatives and other drugs to purge themselves of the fluid and solid waste in their bodies.
To eat an enormous amount of food is called bingeing, and to forcibly eliminate that food is identified as the act of purging. The cycle of eating vast quantities of food and then vomiting or using drugs to force that food out of the body is referred to as the "binge/purge" cycle.
WHERE IS THE HARM?
Maybe you think that bingeing and purging is a great way to eat what you want and stay thin. Or you may think that purging after a meal will help you lose weight so you can fit into a special outfit for a very special occasion. Before you decide that purging after a binge once in a while is a perfect solution to eating and weighing what you want, you have to understand the facts. Purging is habit forming. In fact, you will learn from bulimic people that bingeing becomes a mere avenue to purging.
Every bulimic begins with just one purge. And then just one more. Then he or she does it again, because it becomes easier with some practice. Bingeing, purging, or both can start as a once-in-a-while means of eating and still wear your prom dress or qualifying for an athletic event, but it can rapidly become a ritual to engage in once, twice, even a dozen times in a week or a day.
If that sounds hard to believe, then focus on this second point: Bingeing and purging can give a person an enormously satisfying feeling of self-control and gratification. After all, he has figured out how to eat whatever he wants and still be free of bad feelings that can come after he eats food that he thinks is "bad." Eventually, that first, wonderful feeling of controlling everything that goes into or out of the body gradually disappears, and the body takes over. The disorder then controls the person.
As you might imagine, bingeing and purging requires elaborate and creative planning, especially when no friend or family member knows. Protecting the secret is as important as the binge/purge process itself. That means that bulimic people can spend days and hours planning strategies to acquire, consume, and then purge their food. While they work, play, talk, watch TV, make love, or accomplish ordinary daily chores, they may be planning when, how, and where to get hold of the food, eat it, and then purge, one way or another. And the people who live, work, play, watch TV, and finish those daily chores with a bulimic friend, colleague, or family member may not have a clue that someone they are so close to is going through this consuming, wrenching process in secret.
Maybe you can see by now that the first harm can come from the lying, manipulation, and secrecy that surrounds bingeing and purging. One of the earliest effects of that whole bulimic cycle is the damage done to relationships as the bulimic focuses on protecting that secret, instead of fostering trust in a friendship or an intimate relationship.
The harmful effects are not limited to the damage done to personal relationships, however. The other major area of harm is physical, and you can understand the basic dangers without knowing anything about medicine or human biology. The human digestive system is basically like a one-way street. In an emergency, you can go the wrong way down that street if absolutely necessary, but it's dangerous to try to go the wrong way on a regular basis. The human digestive process works on the same assumptions: In an emergency, when you have consumed some dangerous substance or spoiled food, it would be logical to force vomiting. Under ordinary conditions, however, the body eliminates liquid and solid waste in an orderly, regular way, so that nutrients are absorbed and waste is discarded. When the body is allowed to go through that digestive process at a normal pace, all the body parts involved can remain in good working order.
When the body is forced to accept vast quantities of food and then is forced to expel that food before it is processed, a huge physical burden develops. If you fail to allow your body to work the way it is designed to function, then the body parts you do not use can begin to show serious signs of trouble. And those first signs can be really ugly. For instance, many bulimics complain that their teeth blacken and begin to fall out, because the acid in their vomit actually corrodes the enamel on their teeth.
Problems with appearance and with dental health can also affect people who suffer from anorexia (self-starvation). On their way to becoming what they think is perfectly thin, they may find themselves losing their hair, even if that hair had always been thick and lustrous. So, young women who are anorexic can suddenly have to cope with getting bald. Then, eyelashes can fall out, and skin can get visibly blotchy, with red and yellowish marks all over. And those are just a few of the problems that can show up on the outside, while the individual person is struggling fiercely to keep that secret deep inside.
Other alarming, dangerous conditions can develop in response to the physical violence done to the body through the binge/purge cycle or through self-starvation. More detailed information is presented in Chapters Two and Three and in the personal accounts shared here by people who decided to tell their stories so that you could learn from their suffering and from their relief in recovery.
At this point, you know key basics about bulimia. People who suffer from bulimia binge and purge, and that binge/purge process can take over and control a person, just like any other addiction. There is one last critical aspect of bulimia that you must understand: People who are bulimic are not necessarily thin!
In fact, many bulimics can become somewhat overweight at various times in their lives. Their weight can vary by as much as 10 to 15 pounds over or under a level that is healthy for them, based on age, height, and frame size. Those people who do become very thin, so that they weigh approximately 25 percent less than is good for them because they have intentionally stopped eating, are suffering from anorexia nervosa.
FOOD AND FEAR: A DEADLY COMBINATION
Anorexia is like many other health problems: It takes time to develop. That means that early signs can be detected, and when those signs lead someone to get professional help as soon as possible, intervention can be very successful. However, anorexia can defy early identification for two very simple reasons.
First of all, the early signs of anorexia can give friends, family, and colleagues encouragement and pleasure. Everyone may be very happy that the person involved is dieting successfully or taking more responsibility for managing his or her food intake. That generally positive feeling can prevail to the point where it is very difficult to see that the person's eating habits are really not appropriate at all.
The second primary reason why it can be difficult to detect anorexia in the very early stages is that the outward changes may develop slowly in the beginning. The medical symptoms of this disorder can be associated with a wide range of disorders, and this fact can lead to a medical wild goose chase lasting weeks, months, even years.
The third basic reason why it can be difficult to identify anorexia in its very early stages is that the first signs are not difficult for the anorexic individual to hide. Weight loss can be concealed in fashionable clothes, and virtual self-starvation can be confused with a short-term diet.
Even though anorexia becomes entrenched only over time, it gathers force as the disorder takes hold. Suddenly, the young girl who was your best friend, your favorite most outgoing student, your most obedient and dependable child, can seem obsessed with food. She might like to prepare it elaborately. She might love to see you eat it. But she no longer eats in a way that can possibly be healthy for her. Her eating habits seem to be the whole focus of her life. And you cannot seem to change her mind, no matter what you do.
Maybe you thought dieting was a good idea at first, because you felt it was good for her to lose a few pounds and to stay away from all those fattening foods. But the good idea is out of control, and this person who is so important to you, who always was there to do what was expected, seems less and less willing to be the girl you always knew. She seems to have undergone a profound and private change.
That change actually took place right in front of your eyes, and she might seem to enjoy your reaction when it finally becomes clear to you that something is seriously wrong. She may point out that she lost weight because she's supposed to be thin, and she still has more to lose, because she thinks she has a fat face or fat thighs. It may seem that she is fixated on that part of her body and puts all her incredible, boundless energy into dealing with food. In fact, she may appear to be very much afraid of getting fat, even though she is so thin that you cannot find any fat on her body at all. You cannot pinch even a fraction of an inch.
She may let you think that she has eaten something, showing you that she has gained a few pounds and allowing you to feel victorious as a friend, parent, teacher, spouse, or coworker. But in reality, she has not eaten anything substantial at all. She certainly has avoided eating any food that could stay in her body and provide adequate nourishment. She could have sat at the dinner table, proudly pointing out that she ate everything-that she's an official member of the "clean plate club"-while she really fed most of her meal to the dog waiting under the table. Or folded the food into a napkin in the split seconds when no one would notice. Then, she could quickly drink large quantities of water before getting on the scale, so she can point proudly to the weight gain you might start to demand out of concern for her health.
HOW DANGEROUS IS ANOREXIA?
Very simply, anorexia nervosa is self-starvation. It can be effects of starvation, right in the middle of a family that has always had more than enough food to keep everyone healthy and happy. Anorexia can cause extensive, damaging medical problems that can be highly visible-or very difficult to see. These problems can start with loss of hair and teeth and can move rapidly to discolored skin, chronically swollen glands, kidney dysfunction, liver trouble, heart disturbances, hyper active behavior, and hypotension (low blood pressure).
Can all this start with a simple diet? Yes, if three conditions are in place. First, the individual involved identifies the diet as being absolutely crucial to life success. That means that the person feels nothing good can happen in life until she or he becomes thin enough. So that person concentrates extraordinary energy on the diet, which can become more important than anyone or anything else in the world.
Second, the person persists in stringent dieting, even after achieving a goal that might be considered a healthy weight for that particular individual. And the third early warning sign is the development of very special food rituals. The person may eat but may choose only broiled chicken. Or peanut butter. Or specific, measured amounts of asparagus. Day in and day out.
Does this particular eating disorder affect only girls and women? No. Although the problem generally affects women and pubescent or teenage girls, it does develop in men and boys. Even so, female anorexics outnumber their male counterparts by about 15 to 1. And if they receive good, timely treatment, male anorexics tend to have just one major bout with the illness. Female anorexics are more likely than male anorexics to start a pattern that can dominate their entire lives.
As you absorb the lives of the people affected by anorexia who chose to share their experiences with you, it will become easier for you to get to know the fears and hopes inextricably tied to this particular eating disorder: How hard it is for anorexics to trust, and how they can persist in their efforts to recover. Among those who have contributed their insights here are some who have yet to begin substantive recovery.
Excerpted from Dying to be Thin by Ira M. Sacker Marc A. Zimmer Copyright © 1987 by Ira M. Sacker, M.D. and Marc A. Zimmer, Ph.D.. Excerpted by permission.
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