Expert: Jeanne Rust, PhD - 6/2/2011

Question
Hi Jeanne,

I'll preface my question by saying I don't think I have or have had anorexia. However, in late December/early January I briefly partook in purging behavior. I didn't think that was healthy, and so around mid-January I began counting my calories and running three times a week, with some moderate strength training. I went overboard with how big of a calorie deficit I could create, and would eat lower than 1000 calories, while still exercising. The lowest I got was about 600 calories, I think. I didn't do this for long, and upped my calorie intake to a range of 1200-1400. I stopped running and instead did step aerobics and Zumba. It got to the point where I would go to the gym every day. I began seeing a nutrionist, who cautioned me about working out that frequently and eating below 1500 calories, but I didn't listen to her. I don't know why. I was losing weight, and I liked it. (Note: my highest weight was 162 lbs in late September of 2010, and in at the beginning of January 2011 I was around 145. I have always been chubby, and have always that this compromised my relationship with my parents).

I think I hit 124 lbs (1 lb lower than what the nutrionist had said should be my lowest weight) around mid March at the earliest, early April at the latest, but was scared to begin maintaining. I stopped seeing the nutrionist around this time, because it was getting too easy to lie to her about my eating habits. I was still counting my calories, following a predominantly low carb diet just because that was what I liked---nonfat plain yogurt, grilled chicken breast, lots and lots of veggies. I was trying to maintain, but kept losing---I hit 121.6 on 4/11, 120.8 on 4/18, 118.7 on 4/25, 117.5 on 5/8, 115 on 5/22, and around 113 on 5/30 (but I weighed in at the end of the day, at the behest of my mom). I was eating healthy food, and stopped going to the gym entirely starting late-April/early-May. I did have a dance performance I was rehearsing for at the end of May, but I don't think our practices were too strenuous. My caloric range was 1157 at the lowest and 1965 at the highest, with most days falling 1500 and above.

I haven't had my period since 1/26, and starting May I noticed my hair was falling out in larger volumes when I combed/took a shower. I used to have very thick hair; it isn't brittle now, but feels thinner and a little thinned out. Last week I finished the book Intuitive Eating, and tried the practice, but I found I would eat even less. I think I've lost my appetite/hunger cues. At any rate, I begin to perceive myself as well-sated after half a grapefruit or a yogurt parfait. These past two days I have tried eating beyond the sensation. It feels uncomfortable/hurts at first... I also eat a lot slower than I have, but I don't think this is a problem. This past weekend I noticed my fingernails had turned blue, and even the slightest wind feels uncomfortably (sometimes unbearably) cold to me.

My mom told me to stop working out for now, but I feel so guilty when my friends ask me to go to Zumba class---they all remember when I went to the gym every day, and it makes me wonder what they think of me now that I don't go anymore. I want to start going to the gym again---not at the intensity I was doing it before, but I want to start the Couck to 5k program, and build up my muscles. By the way, I'm in college, living in the dorms, and walking to class everyday. I would guess I get about 25 minutes-1 hour of walking, depending on the day. I don't walk slowly, and my campus is very hilly, so there are lots of inclines and stairs. I've begun doing yoga from YouTube videos, because I was told it might make me feel better. I'm going to see a doctor once I'm done with my freshman year (6/10, next week), but I'd really appreciate any advice you can offer.

Thank you so much.

PS: I don't know how comfortable I would be if I was told to gain weight. People are always commenting about my loss, and I don't know what they'll say if they see I've gained. My parents definitely seem prouder of me---prouder of my weight loss than my straight As in high school and the fact that I got into a really competitive school. I know it sounds stupid, but it is really true.

Answer
Dear Samantha,

I would love to know your height -- than I can effectively assess what's going on.  However, I think you might be anorexic because of your period loss and overall drop in physical health.  Over-exercising is a form of bulimia because it's meant to compensate for the amount of food you've eaten -- which has not been enough.  I can tell that your appetite continues to decrease which means that you've developed what's called lack of proprioceptive or interoceptive awareness.  That is the ability to tell when you're full and when you're hungry.

I'm glad you're seeing your doctor.  Make sure you get a complete physical and tell him the truth about the exercise and restricting.  You'll need a complete blood panel and an EKG.  I would think that you probably have some depression and anxiety going along with this.

Let me know your height -- and we'll continue talking.  Interesting comment about your parents -- so true -- the emphasis put on looks and weight rather than on what's truly important in life.

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