Expert: Jeanne Rust, PhD - 5/15/2011

Question
QUESTION: Hi there and firstly thankyou for providing this site, what an amzing facility, thankyou.
I am 28 years was old and have had eating 'issues' since I was 14. Previously i leaned toward anorexia but was not formally diagnosed in my teens. The situation worsened in my 20s and i was diagnosed and on 2 occasions was refd to the EDS where i had CBT first time and CAT second time.Over the past year I have developed an awful problem with exercise. Previously i controlled my weight through restricting food, and only did normal amounts of exercise. Over the past year i have increased my exercise such that i do 4 or 5 gym sessions a week, each usually 120-150 mins of hard activity (i sweat alot and HR about 150). On the days that i dont go to the gym I feel i have to exercise in some form -so this started as a 30 minute walk outside but has increased to 90-150 mins walking. It feels intolerable to miss exercise, and I now prioritise fitting it in over fitting in other things such as socialising or doing jobs that need to be done, or playing guitar/reading -things that i enjoy. I have again been refd to the EDS and was seen as a priority which confused me as i really sturggle to accept that i am ill.I know i am not normal but i dont believe them when they tell me im anorexic and that it is an illness - i feel this applies to others but not me. My periods have stopped (they became infrequent and then stopped-last one 12mths ago) and i have osteopenia. My mood became very low a few mths ago and i didnt seee the point in anything. I am now on an SSRI which i think is starting to kick in and help me motivate myself.

I am finding my main stumbling blocks are the exercise, and my eating routine. I find it so hard to reduce the exercise and wondered if you have any advice on how to do this.I feel intolerable guilt and stress if i dont do it. Also my food- i am scared of fat and carbs and so eat mainly lean protein, lots of vegetables,some fruits, and low fat yogurt.I try to tell myself to swap some of the veg for pasta etc and do a like for like swap (same cal value) but then i cave at the last minute and think 'just have whats safe'. I also tend to get throuhg the day on very little then have a huge evening meal -lots of veg etc.I know i should spread this out through the day but my fear is that even if i eat more in the day i will still want as much later on, and so would end up eating too much in total. I am unfortunately a bit of a thinker, and i like to think scientifically, and so when my therapist tells me that eating regularly is good for metabolism and will keep blood sugar stable and stop me eating too much at once i kind of want really good evidence. I also find i wake in the night craving food,usually sweet stuff,and sometimes end up eating fruit or something in the middle of the night, whcih makes me feel rubbish the next day. I really do want my life back,and want to be healthy again, but these set ideas and issues are proving to be a real sturggle and i wondered firstly have you come across these ridiculous behaviours before, and do you have any ideas/advice/evidence that will help me conquer them please?
Thankyou so very much for your time and help.

ANSWER: Dear Abi,

Oh my dear -- you truly are ill!  I'm curious, what is your height and weight?

You are not just anorexic but you're severely bulimic as well.  Any kind of compensatory behavior a person uses to use up calories counts as bulimia -- it's not just purging --it's taking diuretics, compulsive exercise, laxatives -- get the idea.  

I must say after having been treating people with eating disorders for over 20 years that compulsive exercise is the most difficult to treat.

Your behaviors are not ridiculous -- they are quite common -- particularly among dancers and athletes.

How often are you seeing your therapist?  A couple of times a week, I hope.  You are definitely severe enough for treatment.  I don't know your weight but I know that you're severely anorexic because you're not having your periods.

Please keep in touch with me and I'll help you figure out what to do!

Warmly,
Jeanne Rust, PhD
CEO/Founder
Mirasol, Inc.
www.mirasol.net
www.edrecovery.com
http://www.facebook.aom/jeannerust
888-520-1700

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

QUESTION: Hi there and thankyou so much for your reply, and for your warmth. Thankyou for reassuring me that I am not ridiculous.
I am 5ft 8 and between 49 and 50 kg at the moment.
I see my therapist once weekly.
I should also add i have some obsessive compulsive tendencies - these initially focused mainly around safety - eg checking over and over that i have locked the door, switched the iron off etc. These tend to influence the exercise now too, for example i may have been working out for 60 mins on the treadmill but then will panic that the counter on the machine is wrong etc.
Thanks so much once again

Answer
Dear A.,

You have a BMI (body mass index) of only 16.3 which is very very low!  Have you seen a dietitian?  Has your therapist recommended this?

Also another thing, are you on any medication for OCD (obsessive compulsive disorder)?  A low dose of some kind of medication for OCD could help you tremendously.  Many people who are anorexic are OCD as well.  It would be wonderful if you could also see your therapist twice a week.  My feeling is that you need more intensive therapy.  If twice a week isn't helping, the next step would be an out-patient program and then next a residential program, like Mirasol.

It is super dangerous for you to be at this weight --

Let me know what you and your therapist think!

Warmly,
Jeannie