mental health

You May Not Ever Fully Recover From an Eating Disorder

I don't meet the clinical definition anymore, but my relationship with food is still fraught.
26 December 2017, 6:40am

This article originally appeared on Tonic

At the gym. That's where you could find me on many late weekend nights my freshman year of college. While my friends and roommates slid into skirts, applied makeup, and slammed shots, I sometimes sat nearby in my pajamas. When everyone left, I swapped my bedtime sweats for workout gear and took the elevator to the basement, a fitting place for a gym that often made me feel trapped. I would hop on the elliptical for hours and get off only once the machine told me I had burned 2,000 calories, often past midnight, in an effort to compensate for bouts of binge-eating.

I experienced many eating disorder-related struggles throughout my life until last summer, when I went to several months of cognitive behavioral therapy and learned to manage my anxiety. (Big ups to my boyfriend, who supported me and encouraged me to seek help.) I clock in at 115 pounds, a healthy weight for my short—or to put it politely, petite—5'2" frame, so my outer appearance may not match what you imagine when you think of someone failing with food.

"There are many people in very typical bodies who are struggling," says Lauren Smolar, the director of programs at the National Eating Disorders Association. "Eating disorders come in all shapes and sizes; they are different combinations of behaviors, and they are really serious across the spectrum."

As a varsity cross-country runner in high school, I ate much too little, became obsessed with my weight, and dropped to 100 pounds. But for me, the issue that spanned almost a decade was the binge. And man, is the binge a bitch. I've baked brownies and downed the pan faster than Trump at a red-state McDonald's . I once plowed through an entire packet of huge, dense maple-syrup sandwich cookies in one sitting. I've had day-long snacking sprees that became, essentially, day-long binges. I've eaten myself into oblivion, bringing the term "food coma" to life. I tried to compensate by exercising for several hours and restricting my food intake—an apple for lunch, an apple for dinner—for several days after a binge. My mood suffered, my relationships suffered, and my body, without a doubt, suffered too.

It's unclear exactly how many people in the United States suffer from eating disorders, since many people don't seek treatment. One nationally representative survey found that 0.9 percent of women suffer from anorexia nervosa, 1.5 percent from bulimia nervosa, and 3.5 percent from binge-eating disorder in their lifetime. (For men, the prevalence is 0.3 percent, 0.5 percent, and 2 percent, respectively). An estimated 20 million women and 10 million men in the US will have a clinically significant eating disorder at some point in their lives.

I've been there, but today I'm in control of my eating. I no longer binge, eat in secret, or beat myself up over one cookie too many. For the most part, I've learned to love food again—but ten years of disturbed patterns has certainly left its mark. I overthink my food choices, I order the healthiest items on the menu, and I still feel guilty if I overeat. The problem isn't necessarily what I'm eating, but what I'm thinking about what I'm eating.

And that's just it. Eating disorders are classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard classification of mental disorders in the US. That means they come with both a mental and physical component: To meet the criteria for a diagnosis, your condition has to "consume your life to the extent that it's impacting your daily functioning," says Rachel Goldman, a licensed psychologist specializing in eating disorders and clinical assistant professor at New York University's School of Medicine.

In the past, food and eating have commandeered my every thought and affected my daily life—but not anymore. Where does that leave people like me, the in-betweeners, the ones who don't meet a clinical definition but whose relationship with food is still fraught?

"I tend to think of any mental-health illness on a spectrum," Goldman says. "If it doesn't happen as frequently, it doesn't cause as much anxiety, and it doesn't impact your daily functioning, it's still a concern but it's more so a symptom in disordered eating as opposed to an eating disorder."

Disordered eating encompasses all unhealthy behaviors and thoughts surrounding food. Think of it as a mild case of an eating disorder that can lead to a full-blown disorder if the problem becomes more frequent or disruptive, Goldman explains.

Normal eating behaviors include "listening to your body, eating what you need when you need it, and stopping when you're full," Smolar says. That said, it's also normal to sometimes give in to cravings, eat more on some days than others, and restrict your food intake to a certain degree. "But the unhealthy relationship with food may have a guilt complex, or secretive and ritualistic behaviors, associated with it." That includes feeling bad about eating and cutting food groups out of your diet—like assigning a hard no to sugar, dairy, or bread—simply to mark them as off limits.

We know that childhood trauma, obsessive-compulsive disorder, and geneticsput people at increased risk of developing an eating disorder. But the media may also play a role in disordered eating thoughts and behaviors, not just by triggering body dissatisfaction but also by overplaying the health card.

"There's lots of attention most recently on health and wellness that has a lot of focus on extreme behaviors surrounding food," Smolar says. Think of the accounts laden with green smoothies, chia bowls, and raw food diets. "That really normalizes disordered eating as part of our culture."

In fact, a study published this year in Eating and Weight Disorders found a direct link between Instagram use and orthorexia, an eating pattern characterized by a pathological obsession with proper nutrition. (Think clean-eating gone bad.)

"I think those disordered eating thoughts and behaviors are starting to become more prevalent, so in a few years, perhaps we will see more of these types of disorders," Goldman says.

The way I eat today is relatively "normal"—I eat more consistently than ever and I don't feel out of control like I have in the past. It's the disordered thoughts, rather than behaviors, around food that give me some anxiety.

But the brain is a complex system, and we can't squash our negative thoughts with a simple snap of the fingers. I know firsthand that it can seem an impossible pipe dream to rewire your mind and change the way you think about food. That's exactly the goal with cognitive behavioral therapy, one of the leading evidence-based treatments for eating disorders. "The premise behind CBT is that our thoughts, behaviors, and emotions are linked," Goldman says, and if you can replace an unhealthy thought, behavior, or emotion with a healthy one, the others will follow.

One lesson you learn in CBT is to challenge negative "always" and "never" thoughts—like, I will always struggle with food or I will never learn to manage my disordered eating behaviors. Treatment and recovery are possible, with some effort on your part. "The goal in general is to have a healthy weight and a healthy relationship with food," Goldman says. "Eating disorders are not impossible to treat, and people can of course live a healthy life afterwards."

For ten years, I went to bed almost every night stressing about what I ate that day and woke up almost every morning worrying about what I would eat before nightfall. It was often a sad, discouraging way to live. Now, sure, I'm cautious around food and I probably think about it more than other people do—but for the most part, I spend my mental energy on the things that really matter. What's on my plate is not what's always on my mind, and that's a good way to live.

If you or someone you know is suffering from an eating disorder or disordered eating behaviors and thoughts, call the National Eating Disorders Association Helpline at 800-931-2237 for information about treatment options.