Eating Disorders - Connecting the Dots : Part 6

Gaining: The Truth About Life After Eating Disorders
by Aimee E. Liu

(Page 6 of 7)

By junior year in high school, Kim wanted out. Her weight loss wasn't just about changing her social identity. She wanted to disappear. Christmas of senior year her older sister, Sarah, came home, took one look at Kim, and shouted at her parents, "What's the matter with you? Can't you see she's killing herself?" These were two excellent questions, which no one had ever asked before. At Sarah's insistence, Kim's mother took her to a psychotherapist.

"Intervention made a big difference," Kim recalled. "I felt safe there to tell the truth." Unfortunately, just as her husband would twenty years later, Kim's parents insisted she was "the sick one." Neither would participate in therapy.

The showdown came at the beginning of summer just before Kim graduated from high school. She'd invited a few close friends from the literary magazine staff over to swim one night around ten o'clock. Actually, they were skinny-dipping, but they kept all the lights off. They didn't make much noise. Kim's mother was asleep. Then her father came home. "He came to the door and took one look at us, and I knew there was going to be hell to pay. But he didn't say anything." Instead he went back inside the house, and a minute later they heard a scream from the master bedroom. By the time Kim and her friends got upstairs her father had thrown her mother across the room. She had curled into a fetal position against the wall to protect herself as he beat her, accusing her of raising a family of sluts. Kim screamed at him to stop, but her father just bellowed back, "Get those assholes out of here!"

She left then and never really returned. Neither parent ever acknowledged what had happened. Kim became inseparable from the friends who had been with her that night. They went off to college together. Her weight, though far too low, stabilized, and eventually she quit therapy.

Then she married a self-made older man who sounded suspiciously like her father. "We never stop trying to make our childhood right," she said.

Perhaps, I thought, but Kim's older sister seemed to have managed. And I assumed the point of treatment was to find a way to do the same.

I asked Kim if she was dating anyone now. She pushed the thought away. "My life is very quiet. I work at the clinic. I attend classes. I read a lot and see my sister occasionally. This"- she gestured to indicate my visit"- is a big deal." Her smile held a challenge. No self-pity allowed, she seemed to be saying. No regrets. And, above all, no self-indulgence.

I shivered, envying Kim her Polartec. The afternoon had turned brisk. "Will you call again?" she asked as we got up to leave. I took this as an invitation and promised I would, but when I phoned a few weeks later she wasn't home. I left a message but got no response. Twice more I tried. At Christmas I sent a card. No answer.

In The Noonday Demon Andrew Solomon writes, "Depression is a response to past loss, and anxiety is a response to future loss," but the two states often feel inseparable. One reason, he suggests, is that depression and anxiety share a single set of genes. These happen to lie close to the genes for alcoholism. All three of these genetic hammers seemed to have slammed Kim's family, and she was still fighting the reverberations. Yet out of four siblings, only she had responded by physically shrinking herself. As I tried to make sense of this I kept coming back to Kim's use of words like escape and safe, her social isolation, the careful blankness of her condo - as if she didn't dare commit to making a home for herself, even after three years.

Anxiety is a primal instinct in all of us and a basic necessity for survival. Fear prompts us to freeze before the grizzly notices us strolling down the trail, to flee that car rolling toward us before it gets too close, and to fight the kitchen fire that threatens our home. But more than two thirds of anorexics and bulimics have a lifelong history of anxiety disorders: they get stuck in either the freeze, flight, or fight mode, even when not under any actual threat. Some feel an overwhelming need to withdraw from society; some seize with panic at the slightest criticism; some become so tense they lash out at their best friends. Many never feel safe enough to relax yet find in eating disorders a perverse mode of escape.

Here's how this escape works: you flee anxiety by pulling into yourself; you purge your fear by vomiting it up; you become so obsessive about your body that nothing else in the world seems to matter. The result is that you feel you have this body- your contained world - under control. So while a different woman in Kim's position might have called the police on her father or cleaned out her husband's bank account and taken a lover herself, Kim instead exerted maximum control over her physical self.

What, then, determines how we manage anxiety? This question, it seemed to me, could be central to understanding not only who "gets" eating disorders in the first place but who successfully recovers - and how. For answers, I turned to Michael Strober, director of the Eating Disorder Program at UCLA's Neuropsychiatric Institute.

Now in his late fifties, Strober has treated eating disorders for more than thirty years. He has a global reputation as editor of the International Journal of Eating Disorders and, with his inkbrush eyebrows and barely audible voice, gives a somewhat daunting first impression. So as we sat in the cafeteria below his office, I tried to sound as if I knew what I was asking. "It seems to me," I fumbled, -that many of my lifelong habits -compulsive exercising, biting my nails, habitually apologizing for myself- may be related to my having been anorexic."

During the pause that followed, I was afraid Strober was going to dismiss me outright. Instead, he blew my suspicion wide open. "There's minimal cultural influence in anorexia nervosa," he said flatly. "It's not causal. It only contributes if the inherent risk is there."

Copyright © 2007 by Aimee E. Liu

About the Author

My past lives include early childhood in India; middle childhood, adolescence, and anorexia in the Connecticut suburbs of New York City; three years of teenage modeling through the Wihelmina agency; a major in painting at Yale University followed by turns as a waitress in New York and a flight attendant with United Airlines. Between flights I wrote my first book, Solitaire, a chronicle of my passage through anorexia, which was published in 1979, when I was twenty-five.