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|September 3 - 9, 2009
Dying to be thin
A survivor shares the nuts and bolts of recovering from anorexia
by Dana Logan
When Paige Doughty was young, she moved around a lot. Now a 29-year-old environmental education teacher in Boulder, she calls her childhood “unstable” because of the frequent relocations. During her middle school years, her family was living in Europe, and she attended a very small private international school where she knew everyone in her class.
But then, when she was 14, her family moved again. This time, back to the United States to Apple Valley, Minn.
“My parents put me in a huge public school. It was incredibly overwhelming for me. I was having such bad anxiety in the mornings to try and get myself to school, let alone trying to find someone to eat lunch with. I started actually eating lunch by myself on the stairs. I remember walking into the cafeteria on the first day and just seeing hundreds of kids and being like, ‘I don’t even know how to walk in here, let alone ask someone if I can eat lunch with them,’” says Doughty.
Because she was having a hard time finding friends in a big school, Doughty’s parents pushed her to join a sports team, where she might find a social circle. For a while, she refused, but finally, on their prompting, she joined the cross country team.
“That was a huge turning point because that enabled a lot of my exercise,” says Doughty.
And while being on a team did lead her to meet new people, some of those people had more of a negative impact than her parents had hoped. She recalls being in the locker room and learning, for the first time, about nutrition information on food packaging.
“In Belgium, I had never seen nutrition information before. It just didn’t exist there, at least at that time. So [my teammate] was showing me the fat content and calorie content on a Snickers bar, saying, ‘Look, there’s 16 grams of fat in this.’ And it was a huge moment for me,” Doughty explains.
Doughty says that she had never thought about it before, but after that day, she started counting calories and counting fat and looking at the nutritional content of everything she ate. At first, it was just interesting to her. But then, it escalated.
“Slowly, over time, it was like, ‘OK, this has 16 grams of fat. I can’t eat anything that has more than 16 grams of fat. OK, this has 14, this has 12, this has 10.’ And over the course of the next year, that number got lower and lower,” she says.
Meanwhile, she was becoming obsessed with running. Her coach, who was eventually fired for pushing his runners too hard, was telling Doughty and her teammates not to eat certain foods and running with them, always pressuring them to run harder and faster.
Doughty says that by this point, she was starting to get really sick and her memories of the time are fuzzy, as often happens when anorexia takes a toll on a person’s body. But she says that her dad recently recalled to her that, during the time that she was running cross country, she came home one day and said her coach had told her that she needed to lose weight.
“And I definitely did not, at that time, and probably really never have in my life,” she says.
The following summer, Doughty was getting even sicker. She fought with her parents constantly as they tried to get her to eat. She says that she really shut them out and spent the summer trying to be home as little as possible.
Then, sophomore year started. She had injured her knee from over-running, which meant that she could no longer run cross country. “That sent me spiraling into another level of freaking out and feeling like, ‘I’m going to get fat,’” she says.
As a result of not being able to exercise, she says that she began restricting her diet to an extreme.
“It was to the point where I could not, I absolutely could not possibly put anything in my mouth. And when I tried, it was devastating, and I had panic attacks. I mostly had anorexia, but I did purge a little bit at that point when I started to get really sick because I’d get so hungry,” says Doughty.
Then, one night, after having a huge fight with her parents, she went out with some friends.
“I got to the party and someone gave me a beer. I was so dizzy, I started to faint. I started crying. One of my friends was there and I was just like, ‘I just need to go home, I need to go home, I need to go home,’” she recalls.
Her boyfriend drove her back to her house and she remembers thinking — knowing — that she needed to eat.
“I went to the cupboard and I remember trying to eat a fat-free Rold Gold pretzel and just imagining it manifesting on my thighs as a piece of fat. And I just broke down and went upstairs into my parents room and said, ‘Mom, Dad, I think I have a problem.’ And then I just started crying,” Doughty says.
Of course, this was not news to her parents, who’d been struggling with their daughter’s eating disorder for some time, trying to get her to eat, frustrated that they couldn’t help her.
“My mom sat up in bed and looks at me and goes, ‘Really? Well, no shit, Paige.’ It wasn’t the best thing in the world to say to me at that moment. I just wanted her to hug me, but they were frustrated. They were so done.”
Once she reached that point, Doughty was done, too. She checked herself into the hospital for her anorexia and began a month-long inpatient program.
“I reached a point where I was like, ‘I don’t want to do this anymore.’ And it was terrifying for me to put myself in the hospital, but I did,” she says.
“It was a really good experience for me. I felt very, very safe there. I think the thing I got — and this is in retrospect — the most out of that hospital experience is that there were people there who would listen to me. It was like that was what I had wanted for five years.
Finally, someone was listening to me. And they cared, and there was time to talk,” she says.
But after a month there, it was time to leave. She was in outpatient treatment for a while after being released, but the time after she got out of the hospital was the next big challenge for her. And she says that she thinks it’s a struggle for a lot of people coming out of any rehab-type situation.
Alisa Shanks agrees. She’s the eating disorders clinician and program coordinator in psychological health and psychiatry in the Wardenburg Health Center at CU-Boulder.
“Inpatient treatment facilities are not real life. There are people monitoring you. There are people watching you. It’s such an intense, supervised environment that meeting your goal weight doesn’t mean that when you come out you’re recovered. It means that in a really heavily supervised environment, you’ve grown and changed. And then you come home and you have to figure out how to extrapolate those healthy behaviors in your home environment,” says Shanks, who has a doctorate and is a licensed clinical psychologist.
For Doughty, the time after the hospital was tough. She says she curled back into her shell and spent time with people who were not really helping facilitate her recovery. But she also ended up transferring to a much smaller high school for her junior year — a choice that definitely helped her in her recovery. And, she says, though she struggled during that time, she never went backwards.
“I never really starved myself again. I knew that I never wanted to go back to that level and that place. I recognized at least that much.
But what I didn’t deal with was the underlying issues of ‘why?’ Why did I do this to myself? Why are millions of people doing this?” Doughty says.
Felicia Greher, Ph.D., the university psychologist in Counseling & Psychological Services in Willard at CU, deals with that question every day.
“I think there is this myth out there around eating disorders that people are doing this for attention or that it’s all about looking good or looking a certain way. But from my experience with treating this illness, that’s so far from the truth. The last thing they want is attention,” she says.
Greher explains that eating disorders often begin as a preoccupation with food or a dissatisfaction with one’s body. But she says those things are symptoms of a much larger, underlying issue.
“It becomes a way for somebody to cope with emotions or stress that’s overwhelming to them and for which they don’t have a healthy set of coping skills to deal with. Or they don’t have a voice in which to communicate to themselves, as well as the people around them, that they’re dealing with a lot of really painful stuff. So turning to food, turning to their bodies, is a much easier, safer, controllable way to deal with that stuff,” she says.
Shanks says, for a large percentage of people, especially those struggling with anorexia rather than bulimia, control is an element.
“It may be that finances are out of control and family is out of control and, ‘I’m going to control this because I can’t control anything else.’ So that is an element. And it’s not the only thing,” she says.
Doughty, who’s spent the past five years working through the why, thinks that making an eating disorder about control is an oversimplification.
“I think it’s really easy to say that anorexia or any other eating disorder is all about control. And I think that, of course, there’s an element of that, but I think it’s missing the mark. That has been really frustrating for me through my healing process because I took a lot of that on. Like, ‘Oh, I’m a control freak, there’s something wrong with me, I need to chill out.’ Probably, on some level that’s true, but on another level, I don’t know if I really wanted control. I think I really just wanted someone to listen to me and value my life and the things I was feeling,” she says.
Doughty explains that a common thread among those who suffer from eating disorders is being highly sensitive.
“They tune into a lot of what’s going on and maybe come from a household where things are not great and they’re the ones who are saying, ‘Actually, Dad’s drunk again.’ And everyone else is saying, ‘Shhhh, shhhh. No, no he’s not. We’re not talking about that.’ So a lot of times a person with an eating disorder can play the role of the truth teller, and I think that’s why that comes out looking like control because, if you’re so sensitive to everything that’s going on, and your feelings are not validated, and you can’t handle everything that’s coming in at you, you try to control one thing. So I feel like it’s simplifying, and it’s doing women who struggled with eating disorders an injustice to say that it’s all about control,” she says.
Shanks echoes that sentiment.
“Eating disorders, in and of themselves, are such a complicated mental health issue. In many ways, it’s different for everyone.”
She says one of the underlying components of the illness is our culture’s definition of beauty.
“In this particular culture, we’ve defined a perfect body as a size nothing. One of the other primary things is that, unfortunately, women in our society are acculturated into the myth that how you look is the very most important thing about you. So we have an American culture where how you look as a girl, a woman, is the most important thing about you, and then we have a beauty standard that is attainable by 1 to 2 percent of the population. And that affects self-esteem. That affects self-worth,” she says.
Shanks talks about an exercise she often does during outreach events in which two columns on a board are titled “fat” and “skinny.”
Next to them is a list of qualities and characteristics. The audience is asked to put each characteristic under the heading that society has taught them it belongs. Time and time again, she says, under the “fat” category, people put words like “lazy,” “unhealthy” and “depressed.” Under “skinny,” words like “pretty,” “affluent,” “happy” and “successful” appear.
Basically, she says, all the characteristics that society values are associated with thinness. So it’s no wonder that people think being thin will make them happy.
“The eating disorder whispers in your ear, ‘You are this fat, despicable, lazy, slovenly person, and if you could just lose weight, you could jump the line.’ And then, you’ll get the pot of gold that society promises you. And you’ll get the boyfriend, and you’ll get this, and you’ll have that, and everyone will respect and love and adore you.
“The problem is the pot of gold is empty when you get there via an eating disorder. Because an eating disorder takes away your relationships, your friendships, your health, your everything else. And so the continual message is: ‘Just a few more pounds. Just a few more pounds, just a few more pounds. I’m not thin enough yet.’ And that is the voice of anorexia. It’s this very explicit idea that when I get there, I will know because I will be happy,” she says.
But the Internet has brought a whole new face to the voice of anorexia in the form of websites that actually encourage eating disorders as a “lifestyle choice.” These sites, known as pro-ana (anorexia) and pro-mia (bulimia), have popped up in recent years as online communities that reject the idea that an eating disorder is a mental health illness. They give “tips and tricks,” such as how to hide weight loss from family and friends, how to suppress hunger pangs, and how to purge, among others. In addition, the sites have forums where people commiserate with one another about breaking a fast or binging, as well as post pictures and stats of their “progress.” Other areas of the sites have pictures of thin girls — ranging from slim to emaciated, known as “thinspiration.”
“Those pro-ana and pro-mia websites can be really toxic and have an effect on people who are already in a vulnerable state, looking for somewhere to go or some advice to glean,” says Natalie Murphy, a registered dietician at CU’sWardenburg Health Center.
Kamila Cass is now a clinical psychologist in the Denver area. But when she was a graduate student at the University of Missouri at Columbia in 2004, she, along with her mentor, Anna Bardone-Cone, became the first to ever test the effects of these websites.
“We connected a series of studies that have examined that. The first one was published in the European Eating Disorder Review. It was a pilot study and it was of a group of women in the University of Missouri at Columbia who viewed a website that we actually created (me and Anna Bardone-Cone). We looked at more than 200 websites that exist and then took all the different common features from the websites, like the bone pictures, the tips and tricks, the quotations, the thinspiration galleries, the forums. And so, it was a real pro-ana website. It tells you how to purge, how to hide food from your parents — just, completely disturbing stuff. It passed through our institutional review board, so it was deemed ethical to do,” says Cass.
In addition to the pro-ana site, they also created two control websites. One was a website about female appearance and clothes that featured normal-sized women. The other was a home décor site.
“People who saw the pro-ana website had greater negative affect, which means their mood was just blown out. They felt disgusted.
They felt very bad about themselves. They just felt very negative. They had lower social self-esteem. So it affected the way they felt about themselves socially. They had lower appearance self-efficacy, which means that they had a lower sense of being able to change their appearance to do what they wanted — which is ironic, given that the website tells you all about how to change your appearance. But it actually had the opposite affect, in that it made women feel very powerless about changing their bodies. They also saw themselves as being fatter than other women.
“We also tested their behavioral expectation, which means: What are you likely to do after you see this website? Are you going to go out and vomit? Are you going to go out and exercise? And they reported a greater likelihood of exercising and of thinking about their weight in the near future. And they also engaged in more comparing of themselves to the website images than anybody [who saw the control sites]. In a nutshell, it induces horrible feeling of mood, and it does effect body image and self-esteem” she says.
Doughty says she’s never looked at pro-ana websites. They weren’t around when she was struggling with her own eating disorder nearly 15 years ago, and she says she can’t even let them into her consciousness because they’re too horrible. But, she says, before she even got sick, something else played a similar role for her.
“When I was still in Europe, I loved reading Seventeen magazine and YM. I got obsessed, and those magazines absolutely influenced me. You talk to people about media influence and stuff — I have no doubt — I’m 100 percent sure that if those magazines hadn’t come into my life, I would have a different story. I don’t want to say [the eating disorder] would never have manifested, but I can remember reading those magazines and reading all the ‘How to do this, how to that, how to make yourself this, how to make a guy like you,’ and just really believing them. And being 12 years old and wanting so badly for these things to be true for myself and going out and starting to run,” she says.
Murphy says that this type of magazine can be almost as harmful as pro-ana sites.
“Just turning on a Hollywood movie or standing in the grocery store aisle looking at different magazines — those are also very toxic and much more prolific [than pro-ana sites]. You don’t even have to search on the Internet for that. Those messages are hundreds each day that our students or even ourselves face. And if we aren’t equipped with a set of skills and critical thinking tools to navigate that, then we all are pretty vulnerable to being influenced by it,” says Murphy.
In fact, Cass did another research study as part of her dissertation to see if looking at fashion images had the same effect as looking at pro-ana sites.
“Just looking at fashion images for about six minutes induces negative affect, hostility, guilt, feeling disgusted and body image dissatisfaction. So just looking at magazine ads is bad,” says Cass.
Murphy thinks that people are negatively affected because they’ve lost their ability to think critically.
“If people are constantly looking outside of themselves to be told what to do with respect to eating and weight, they lose their critical thinking skills, and they’re basically pulling themselves away from trusting their own bodies,” she explains.
“If they’re able to work with somebody to learn how to use their internal cues of hunger and fullness and figure out a way to get some sort of enjoyable physical movement that isn’t compulsive, then that person can be set with a solid base of skills to know how to navigate things on the Internet and to know that if something sounds to good to be true, it probably is,” says Murphy.
There are a few key points that Shanks considers most important for all people — whether they struggle with an eating disorder or not — to be healthy.
“If you’re nourishing your body, if you’re moving your body, if you’re accepting yourself, you’re going to be your healthiest self,” she says.
For Doughty, this philosophy makes perfect sense. She says that several years ago she had an “Ah-ha” moment.
“Food is not a number,” she says. “It’s not a calorie. It is a gift. It is from the earth. This food has been grown by humans, and the soil has nourished it. Now it’s going to nourish my body, and that’s beautiful. That’s a beautiful thing. And to eat, and to want to eat is the desire to be alive.”
Paige Doughty is currently writing a book about her experiences called Unwinding Myself Whole. She expects to be finished by the end of next summer. To find out more about her experiences, go to www.paigedoughty.com.
If you or someone you know is struggling with an eating disorder, please contact one of the following resources for help:
National Eating Disorders Association
toll-free helpline: 800-931-2237
Boulder County Eating Disorders Coalition
La Luna Center
3002 Bluff St., Boulder
Boulder Community Hospital: Outpatient Behavioral Health Program
311 Mapleton Ave., Boulder
Eating Disorder Center of Denver
950 S. Cherry St., # 1010, Denver
Eating Recovery Center
1830 Franklin St., Ste. 500
Denver, CO 80218
University of Colorado at Boulder resources:
Psychological Health & Psychiatry
Wardenburg Health Center
Counseling and Psychological Services
Willard Administrative Center, Room 134
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