Expert: Jeanne Rust, PhD - 8/23/2009

Question
QUESTION: Hi there,

Sorry to bother you I just I'm not sure about a lot.  I think I might have an eating disorder but I don't know what it would be considered.  Or if it is one yet.  Or if it really matters yet for that matter.  Here's a little bit about me though...

I'm 20 and at college now.  4 years ago I started purging, just when I overate.  But it kind of turned into me having to binge before I purged because I felt like if I was going to throw up I was going to make it worth it.  I started doing it more and more until I started purging if it was an unhealthy meal.  Then if I ate too much of a healthy meal.  

Then I started really losing weight, and I don't know I just loved the feeling.  I felt like I was finally doing something on my own and right. Like everything was going crazy but I was still ok.  I don't know. It's silly.  

I put myself on a strict diet after that and when my mom heard me a few times I told her I had developed some food allergies so my diet got even more restrictive.  Slowly I kept eating less and less, I think part of it was to make sure I didn't have to purge (I have like problems now with sensitive teeth and i burp constantly if i eat at all and like i think i might have something like acid reflux now, so i did need to stop.)  

Well, I rarely eat now, only when I have to because people are making comments or telling me to eat more, and even then I don't keep it down.

But the thing is I'm not underweight!  I've lost a lot of weight recently, like in the last 11 days I've lost almost 10 lbs so far.  But I'm 5 10 and 149 lbs.  

Also, I was kind of wondering if this is actually dangerous before you're underweight?

I've never been skinny.  Not really.  And even if I have to get help eventually because these things can be dangerous with time, I'd like to be skinny first.  And I'm worried that if I get help I'll have to start eating again and I want to keep losing weight.  I like losing weight.  It just makes me feel better.

Sorry this is so long...

Kate

ANSWER: Dear Kate,

I'm so glad that you wrote me!

You've gone from bulimia to anorexia.  Being anorexic is not always about weight!!  Being bulimic is not always about weight at all.  Most bulimics are normal weight -- they keep purging, feel good because they feel empty and endorphins are released.  The eating disorder is great at the beginning but then it doesn't work anymore -- then the medical consequences, anxiety and depression begin.  I've so many guys in college have to drop out because the eating disorder literally made so weak, they were unable to do their work or even hang out with friends.  Even though you're using some anorexic behaviors right now to lose weight,it would be good for you to start getting some help beefore you get really ill.

Remember a very important thing -- a good therapist or nutritionist will not fatten you up!!  A good treatment center will not fatten you up -- that's not necessary for anyone really.

You're really at a turning point.  You might want to at least line up a counselor at your student health so when you get to the place where you know it's time, you'll know who you're going to see right away.  You're walking a thin line right now, Kate --  eating disorders are progressive and extremely dangerous.

Please keep in touch and let me know how you do!!

Warmly,
Jeannie Rust, PhD
www.mirasol.net
www.edrecovery.com

---------- FOLLOW-UP ----------

QUESTION: Hi again,

This probably sounds so stupid but I am kinda scared to stop.  I fight depression and have for a long time, and when I'm heavy I just get uber depressed and my whole life stops.  

When I'm skinny and I'm losing weight everything seems to go better.  The depression goes away, I succeed in school, I'm a better daughter and friend, I even stop biting my nails for the most part.  

And I mean, my parents are so impressed with the way I'm taking control of my own life they bought me a car!  I just feel like I can't start failing now and if this is what it takes to stay successful then this is what it takes, you know?

I just feel like it might not be such a big deal.  I'm eating more now.  I'm controlling it again it's not controlling me.  Like, idk I guess as long as I just don't go down the path of not eating at all it's not a big deal.  

I think I overreacted.  Sorry, I didn't mean to waste you're time.  I was nervous for a bit there but as long as I keep it at a diet I'm fine.

Kate

ANSWER: Dear Kate,

I'm so glad you wrote back -- it sounds to me as if the depression and anxiety are still a problem.  I think it would be good if you saw a psychiatrist (no, you are not crazy!!) but you probably have some kind of chemical imbalance that causes the depression and anxiety.  A little medication for a short period of time could really really help.

You did not overreact at all, Kate!  I'm so glad that you reached out!  Your parents don't have to know right now about your struggles -- and you really can be in control of your own life!  You are in control with the decisions you make every day.

One thing that can be helpful as well is to write down your food and plan your meals first thing in the morning -- it doesn't have to be written in stone but planning helps!  

You have NOT wasted my time!!

Warmly,
Jeannie
www.mirasol.net
www.edrecovery.com

---------- FOLLOW-UP ----------

QUESTION: So, I tried eating healthier.  I was still under 1000 cals a day (which seems huge because I was down to 200) and I still exercise every day (usually 5 mile run, abs and legs or arms).

But I gained 6 POUNDS!!!!!!!!!!

I still want to lose weight!  I just want to do it in a more healthy way.  I had to stop b/p-ing because I brought up blood and that scared me to death!  But I don't know if my body can eat more than I was.  I'd only been eating well for 4 days!!!  And yesterday I did all my exercises and only had 155 calories and I still gained a pound!  I think my body just can't handle food.

Is there any way for me to eat better and NOT GAIN WEIGHT?  I mean I still want to get to my goal weight!  

And yes, I am seeing a therapist.  She doesn't consider my eating habits a big deal (mostly because I play them down a bit I think.  But she said as we work through issues it'll get better.  

I don't know.  I just really need to lose this weight.  I don't want to go back to not eating at all but I just can't keep gaining like this!

Kate

Answer
Dear Kate,

I hope you can hear me -- with purging blood, etc., you are definitely at a dangerous place in the eating disorder.  Please please please get some professional help right now -- do not wait!

Eating disorders are so dangerous -- they'll kill!  You can be any size you want to be when you're cured from the eating disorder.  You CANNOT do this on your own.  Therapist and nutritionist!!

Warmly,
Jeannie
www.mirasol.net
www.edrecovery.com