As a phase?
An illness?
A psychological problem?
A death wish?
Or something else entirely, outside of your realm of comprehension?
The truth is, eating disorders absolutely 100% are illnesses. Mental illnesses, psychiatric illnesses, yes, but they are also physical illnesses. As a sufferer starves their body, they begin to eat away at their muscle, weakening their heart, their eyes, their brain cells. Constant purging tears at the lining of the esophagus, the stomach, erodes the teeth. Hair thins and falls out, while a softer body hair grows everywhere else to keep the body as warm as possible. A sufferer will often layer on three sweatshirts in 70-degree weather. He or she will literally become consumed by and obsessed with food, as his/her starved brain kicks in the survival instinct. Some of the symptoms common to eating disorders, including an inability to identify emotions, are primarily caused by the starvation effect.
Eating disorder sufferers walk around in a starvation state, regardless of the type: anorexia, bulimia, orthorexia, EDNOS. We are all walking around, starved, mad, confused, empty. We need both medical and psychological intervention. We need food for both our bodies and our souls. The food alone will not fix the problem, as an eating disorder is also characterized by severe psychological issues, trauma, depression, etc, that also requires treatment. The food will take the patient out of immediate danger, but it's not going to fix anything in the long run.
My basic point is that eating disorders are illnesses. They require serious treatment, like all illnesses, whether mental or physical.
This is a hard thing for the sufferer herself to realize. Often, it can be hard for the parents or family members to recognize, or at least to recognize how severely sick their loved one is. Generally, unless the sufferer falls in the extremes of anorexia, with a BMI of 14 or lower, it's almost impossible for society to identify an eating disorder patient as a truly sick individual.
This is something that bothered me a lot when I was in the hospital. I didn't feel like I was "sick enough" to deserve to be there. Whatever the hell that means. That sounds absolutely ridiculous to me now, because I can look back and see how sick I was. At the time, however, I felt ashamed and angry and guilty for taking up a place on the medical floor of Colorado Children's Hospital. In the rooms around me, there were children as young as two with "real" physical illnesses. I could hear the young ones crying. Their families would walk past my room, and I told myself all of them were probably wondering what the hell I was doing here, a seventeen year old just lying in bed taking up space that much sicker children probably needed more.
I convinced myself that the nurses thought the same thing, that I didn't need to be there. I felt guilty for taking them away from their "real" job and "real" patients. It got to the point that I wouldn't press the button to go to the bathroom unless I absolutely couldn't hold it until the next meal time. I felt guilty that they had to eat dinner with me (just me alone by that last day on the floor) instead of taking care of patients or doing charts.
Now, I have to say, I'm sure a select few nurses did think that, although Colorado Children's has a fantastic eating disorders program and many of the nurses I feel had become accustomed to how to treat us. The majority of the nurses I had were exceedingly compassionate and understanding and comforting. I am forever grateful to those nurses. Looking back, I realize that they probably did know how sick I was. They wanted to see me get better, just as much as they wanted to see that two year old next door recover from her virus or fever.
I took this picture on my phone while I was in the hospital, and I've kept it ever since to remind myself that, yes, I was sick.
No healthy person has a resting/nighttime heart rate in the low 30s.
No healthy person has high levels of protein products in their blood.
No healthy person needs to be strapped to a heart monitor 24/7.
I hadn't menstruated in a few months, and I'm sure my bones were ridiculously weak. I could feel my bones as I continued to work out excessively. I knew very well I could suffer from a heart attack and yet I kept diligently working out for 8+ hours a day. I hid food in my room, my pockets, my purses, threw it into a trash can when a distracted school counselor was not looking.
I had severely orthostatic blood pressure and a dangerously low heart rate. I don't remember all of the details of my medical work (my mind was so dead at that point I didn't really know what was going on some of the time), but I do remember one of my doctors saying that both my blood and urine showed high levels of Nitrogen/products of protein metabolism. Simply, my body had begun to break down my muscles to survive when I wouldn't give it the food it needed.
And, of course, in addition to all of that, I was wracked with constant anxiety, self-criticism, depression, obsessive thoughts.
These are not the acts of a healthy person.
No one with an eating disorder is healthy. In a hundred different ways, we are very, very sick. No matter what our weight, we are sick. Our bodies are dying along with our minds. And we cannot fix this by ourselves, just as a cancer patient cannot merely wish away their tumor.
Why, then, is it so hard to get treatment for an eating disorder?
An insurance company wouldn't refuse chemotherapy to a cancer patient because their tumor isn't big enough. They wouldn't stop radiation treatments because the tumor was mostly gone and they think it can fix itself now.
However, they often repeatedly do that exact thing for eating disorder sufferers. Many have a minimum weight requirement, which is ridiculous. The time to get help is not when a patient reaches 85% of her body weight or has been binging and purging for years. Similarly, you cannot kick a patient out of treatment once she reaches 85% or has been "free" of behaviors for a few weeks. Especially since most of us already think we are not "sick enough," these policies reinforce our self-degradation and push us back into our eating disorder. If the hospital/insurance company says we are not sick, then our eating disorders will damn well grab on to that and convince us we're perfectly fine.
Personally, I believe inpatient/residential treatment is incredibly valuable. Sure, I wouldn't have said that when my doctor first told me I'd be put on the medical floor of the hospital for as long was necessary. But I came to realize how much that time was saving my life, even as I hated being stuck there, unable to engage in behaviors, being forced to talk and eat and come face to face with the reality: I am a deserving, kind person who has been ravaged by this disease. It is powerful, but I have the power to defeat it.
Let me say that again, to all of you, anyone suffering:
You are a deserving, kind person who has been ravaged by this disease. It is powerful, but you have the power to defeat it. You are powerful. You are beautiful. You have this disease, but it is not who you are. You are so much more than you know and are allowing yourself to be.
Eating disorder treatment, a combination of inpatient, residential, day treatment, did far more for me than individual outpatient therapy ever did. And while each person is different, I think that's generally true for most people, especially if they've been suffering for many years, as I had.
Treatment saves lives. Treatment is expensive, but what if we did it right the first time? What if we didn't push out patients teetering on the edge between relapse and recovery to make room for other patients? What if we understood the importance of creating a unique treatment plan, allowing patients to stay in each level of treatment for as long as necessary to truly begin the long walk to recovery?
Well, I would argue that if we did treatment right, if the insurance companies allocated their money in this way, then overall the process would be far less expensive. Patients would relapse less, for one thing, and be less likely to need further hospital stays. Unfortunately, this isn't the way businesses think.
How do patients get treatment, then? How do families ensure that their loved one is getting the patient they need?
Fight for it.
This can be an exhausting process, yes, but it's the only way to fix the system. We have to convince the public and the insurance companies that eating disorders are illnesses. Complex illnesses, ones that require intense treatment. Food alone cannot cure them, nor can psychotherapy, nor can medicine. Patients are quite literally dying as they wait for treatment, simply because we have a convoluted system that only the "sickest" are worthy of intense treatment.
This is why NEDAwareness Week is so important. We need to spread awareness, share our stories. We need to raise support, raise money, and tell the truth. We need to break through the cone of silence and start discussing what eating disorders really are.
That, of course, isn't much comfort to you, I'm sure, if you are struggling to get treatment for yourself or a loved one. You/they need it NOW, not when we finally raise enough money/awareness.
In that case, I'd say this: call as many hospitals as you can. Call as many treatment centers as you can. Get in contact with many therapists, and don't be afraid to question those therapists about how they would treat someone with an eating disorder. Keep calling. Don't give up.
Visit NEDA's website for a complete list of treatment centers. If your insurance company will not cover it, then at least that center can give you the names of qualified therapists in your area that may be able to help and may accept your insurance. Some treatment is always better than no treatment. Intervene as early as possible, and don't stop fighting.
One day, I hope that NEDA walks like the ones I've organized in Colorado Springs will attract just as many people as the Race for the Cure. You'd think that since more women in the US suffer from an eating disorder than from breast cancer, we'd be working for a cure for this terrible illness as well.
We're not. But we can. We need to.
Because I was very sick. Because everyone suffering from unhealthy eating habits is very sick. Don't fool yourself into thinking otherwise.
Get the help you need. Don't be afraid. It's the only thing that will save your life, or the life of a loved one. And there are always people willing to support you, offer help and support and empathy.
You are not alone, despite what the insurance company may say.
You can do this, and get well again.
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