Expert: Jeanne Rust, PhD - 1/31/2011

Question
QUESTION: Jeanne,
 Hi. To give you a little background, I'm 27, 5'5.5" (Silly as it is, I'm proud of that extra 1/2 inch :P ), and currently weigh anywhere from 112-114 (lowest I've ever weighed is 103;highest, 130). I've never been in the hospital or even in a partial program, but for the last 5 months or so, have been in outpatient therapy for anorexia for the first time in my life (got sick when I was 17 but never received any treatment until now); at least, that's what my therapist says I have. (Sometimes I believe it, sometimes I don't although it just might be that I don't want to believe it).
 Lately, I've been really struggling. A part of me feels like my eating disorder is slipping as restricting as become harder and harder. Unfortunately for my health, I've resorted to abusing laxatives to compensate more or less- something I can't seem to stop doing. I know how dangerous they can be and how they have absolutely no  'real' affect on my weight at all, but it doesn't seem to stop me from acting on the urge/impulse to take them when I feel I've eaten too much, eaten the wrong thing, and/or when the number on the scale is higher than I can tolerate. (I put a HUGE emphasis on the number on the scale!!!).  At first, I took them here and there but now, it is happening almost every 3-4 days - sometimes, even a couple days in a row.
 I haven't increased the amount I take (4 pills) only because the two times I did (6 and 5 pills respectively), I got REALLY bad stomach aches. It hurt SO bad I thought I WAS going to die. But like I said, the frequency of taking them has dramatically increased over the last couple months or so. My therapist is aware that I'm abusing them, but being told to just stop isn't really working.
 Do you have any suggestions for me on how to stop this habit? I live alone and no one in my family knows that I'm struggling or that I'm in treatment for an ed. I'm getting scared. No, I am scared! Lately, my chest feels tight and I'm not sure if it's just coincidence that it's happening the same time I'm abusing laxatives or if it's because of having restricted for so long (It's been about 5 months of eating anywhere from 0-1000 calories a day with most days falling at or below 800). My current daily goals are usually to eat no less than, no more than 600-800 calories, but because I've struggled to do this lately (usually eating somewhere around 800-1000), I've now restricted myself solely to eating fruits and veggies. My only saving grace to getting at least some protein/fats (I still refuse to eat any grains!!) is the amount I allow myself to eat at dinner each night M-R at group.
 So yeah...any thoughts, suggestions, ideas would be much appreciated. Thanks!

ANSWER: Dear Marie,

"Good morning, Mr. Scale!  What kind of day am I going to have today?"  

I can't begin to tell you the number of years I lived like that!  I've been recovered for a long time now and I would hate so much to have the scale and food control my life again.  I was anorexic, and then turned into a pretty good bulimic.  
One question -- does your therapist specialize in eating disorders?  Many people become ready for residential treatment when they find they're unable to do some of these things on their own -- such as stop laxatives.
When I was in private practice, I would have my patients reduce laxatives 1 per week.  So instead of taking 4, take only 3.  Then begin to eat lots and lots of fiber. Fiber One cereal, fiber bars, make sure you get between 25-35 grams of fiber per day.
This will take some discipline on your part.  It's so hard because it feels so good to feel "empty" when you've taken laxatives.  You'll feel bloated for a month or so -- this is the hard part.  This is what separates the men from the boys!  You'll just have to gut it out -- everyone does this when they reduce laxatives and begin eating again.

Remember that you need to work on your underlying issues -- what is underneath the eating disorder?  What is causing you to use an eating disorder as a way of coping with stress in your life?

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

QUESTION: Thanks for responding and answering my question.

Yes, my therapist specializes in eating disorders. Actually, when I first sought out treatment, with the support from a friend, the recommendation was for me to participate in their partial hospitalization program(php). However, it just wasn't feasible for me, at the time to do so, nor is it now; so, that is why I went with their suggestion to see a therapist and maybe get into a night, group program that deals with eds. I hate to think that it'll all still be like this come summertime, but if it is, that might be a better time for me to re-explore the option of php.

I'm not sure that my therapist and I have figured out what's underneath the eating disorder. Maybe my therapist knows... I don't know. But I know that I don't have a clue. I'm so pre-occupied with the number on the scale, that it feels like it's just about weight for me.

Answer
Dear Marie,

Now is the time to talk with your therapist about the underlying issues -- PHP is something that sounds quite good for you.   Sometimes it's hard to know the correct thing to do when the eating disorder voice is so strong.  As long as you're focused on the number, you don't have time to think of anything else!  Let me know what your therapist says.  I assume that you're medically stable?

warmly,
Jeannie