Surviving Bulimia

Judith Asner, MSW, discusses the guilt and shame associated with having bulimia or any of the other eating disorders. Ms. Asner has been working with bulimics for over 20 years and says "many feel guilty about having bulimia; bingeing and purging."

We also talked about tools used in recovering from bulimia: food journals used to track hunger and fullness, meal planning, eating disorders support groups, and an eating disorders treatment specialist.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Afternoon, or evening, if you are overseas. I'm David Roberts. I'm the moderator for today's conference. I want to welcome everyone to HealthyPlace.com.

Our topic is "Surviving Bulimia." Our guest is Judith Asner, MSW. Ms. Asner is a licensed therapist in Washington, D.C. and specializes in working with bulimics as well as other eating disorder sufferers and their families. She also runs the "Beat Bulimia" site inside the HealthyPlace.com Eating Disorders Community.

Good afternoon, Judith, and welcome back to HealthyPlace.com. We appreciate you being our guest this afternoon. We, literally, receive dozens of emails every week from people talking about the shame, the guilt, and the deception involved in having an eating disorder like bulimia. So I'd like to address that first. How does someone cope with that?

Judith Asner: I think the first step is understanding that the eating disorders and the addictive disorders are based on shame, but the person who created this shame in the young person is usually the one who should be feeling the shame--the perpetrator, not the victim. Many eating disorders (ED) are often linked to abuse (sexual abuse, physical abuse, emotional abuse), in which a child is innocent and suffers early insult or irrational guilt, where there is really nothing to feel guilty about. This is just an illness like any other and one does not have to be ashamed of having these symptoms.

David: Unfortunately though, a lot of people do feel guilty about having bulimia and are ashamed to tell anyone about it. How would you suggest they handle that?

Judith Asner: You start by picking an empathic helping person, who has also been through personal struggles, one who understands what it's like to struggle against life difficulties--a teacher, a nurse a sympathetic parent or a loving sibling. It's helpful to find someone who will wrap their arms around you and offer you comfort; someone who has some psychological sophistication as well.

David: Judith, we get many people who write us saying that rather than telling anyone about their eating disorder, they want to handle recovery on their own. What do you think about that concept of handling bulimia recovery on your own?

Judith Asner: It's a stretch to tell someone and it's a risk. However, if you don't tell someone, you'll suffer deeply by yourself and I don't believe we are meant to suffer alone. I believe we are here to help each other. I think it's really tough because the mere act of unburdening your secret and heart to another human being is so freeing, and hearing acceptance from another human being without recrimination is so validating. If you try to do this on your own, you miss the opportunity to see that people are good and willing to help you. All studies show that friendship enhances health and the immune system and isolation increases mental and physical illness. We are interactive beings. As a psychotherapist, I believe that cure is easier when we help each other. The illness is already isolating, but if you are absolutely intent on doing this by yourself, then nothing can sway you. Try It. Every person has his or her right to do it their way.

There are wonderful self-help books out there. For example: Overcoming Overeating, When Women Stop Hating Their Bodies, Feeling Good, The Path, and Taming the Gremlin.

If you want to overcome an eating disorder, keep a journal and let your journal become your mirror and your friend. Stay in touch with your feelings, plan your menus, write down your feelings after you eat instead of purging. In other words, use your journal as your key to your own psyche.

David: That's helpful, Judith. Here are a few audience comments on sharing the news of your eating disorder with someone else and the idea of recovering from bulimia on your own:

recoverednow: I never could have done it on my own. My eating disorder had me. The only way I could break free is through inpatient eating disorder treatment.

gillian1: I have told my mum about my bulimia, but she handled it badly so I covered up what I said with lying. The problem is that I told my doctor before I told my mum. So I am seeing a psychiatrist. Mum is determined to stop me from seeing her.

nymphet: I always regret the day I told my boyfriend about my eating disorder. I also find it discouraging, the way my parents treat me since they found out about my eating disorder.

thingal: I still don't want to admit that I have a problem. I am disgusted with what I do.

florecita: When people know, they try to guard you all the time even though I'm not doing it.

recoverednow: Journaling is excellent advice!!!

Judith Asner: A food journal and meal planning are 2 of the most important tools in overcoming an eating disorder. Changing your negative self talk, self-concept is also important. You can do this with the guidance of Dr. David Burns' book, Feeling Good.

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David: Could you go into a bit more detail about the food journal and what that is and what doing one accomplishes?

Judith Asner: A food journal brings order to a chaotic eating situation. Bulimia was originally called dietary chaos syndrome. A person with bulimia, as you all know, binges in an uncontrolled way. A food diary will do the following:

• it will allow you to plan your meals ahead of time.
• it will enable you to have the food you need at hand.
• it will serve as a map, just as road map serves on a trip.
• it will also allow you to track hunger and fullness on a scale of 1 to 10; 1 being the hungriest and 10 being the fullest - it will reacquaint you with that dimension of eating.

By using the food journal, you will begin to know when you are really hungry versus when you eat and are not hungry. It will allow you to track your negative thoughts before you binge. Instead of binge eating, you sit down with your food journal and you can say, "Hey what's going on. If I'm not hungry, why am I going off on a binge?"

And then you begin to explore your inner self. Are you bored, angry, insulted, tired, excited? You can explore these feelings.

David: We have a lot of audience questions, Judith. Let's get to them:

cassiana24: Do you really think I have an eating disorder if I only vomit once or twice a week?

Judith Asner: Cassiana, yes that is an eating disorder. That's bulimia.

fineanddandy: Earlier, you mentioned guilt and shame being tied to sexual abuse. But what if a person has grown up in a great environment. Is it your parent's or your fault, then, that you have bulimia or an eating disorder?

Judith Asner: It's no one's fault. It's just the way things come together. It can be a great environment with wonderful people, but they may have high expectations or it may be how you perceive what you see in the media. It doesn't mean that the people aren't wonderful. There are cultural and other influences, not just the family. TV, peer groups, and the fashion industry are factors also.

Usually there is some element of self-esteem, when a person meets cultural expectations and ideal body types and some sense of dissatisfaction with the self.

David: Here's a question from a concerned parent:

latlat: What do parents do who have teenagers who refuse help with bulimia? My 16-year-old daughter refuses counseling. How can I get her to a clinic?

Judith Asner: latlat, I think the parents need to get support or the parent will get very depressed. I suggest support groups for parents with eating disordered children. By going to a support group, the parents will typically get some distance from the illness that will allow the teenager to get some treatment eventually. I think the parents need to first get help for themselves.

You can't force an uncooperative person into treatment. You can only go to treatment for yourself and then hopefully the teenager will become curious with the process and want to join in. Now if the eating disorder, bulimia or anorexia, becomes life-threatening, a parent can force the teenager into treatment.

David: When a parent finds out that their child has an eating disorder, it's a shock to many. And, of course, they are scared and want to take immediate action. Judith, what do you think about a parent who tries to FORCE their child into treatment?

Judith Asner: I think it's a difficult position, but what do you mean by force?

David: Either literally drag the child into the counselor's office, or punish the child if they don't get treatment. Sort of a tit-for-tat type thing.

Judith Asner: Punishment doesn't help anything. A teenager is a child, so they need to be treated differently. I think you can appeal to their intellect and you can talk to them and have an interchange. You can present them with literature on the facts of eating disorders and talk to them about your concerns and try to encourage them to seek help, but punishment doesn't help.

Also an intervention is an option for a teenager. An intervention is a loving event, not a punitive one. It's a gathering where people say, "We're here because we care about you, and we're not going to let you die."

David: One final suggestion, then we'll move onto the next question. You may get a more positive response from the child by saying something like "if you don't want treatment now, that's up to you. But if things get worse, or you change your mind, we are here to support you and you can start treatment then." It leaves the options open, without setting up a standoff.

Judith Asner: Don't punish someone for being sick.

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David: Here's the next question:

Keatherwood: I've been anorexic and bulimic most my life. I've pretty much beat the anorexia, but the bulimia seems to be much harder to get control of. My therapist considers it a form of self-harm, but I just see it as a way to get thin again. I don't binge. I just do it when I feel I've eaten to much. Can't it just be a way to lose weight, not a psychological problem?

Judith Asner: Keatherwood, considering the history, it seems like it's the last part of a longstanding disorder but it's gotten a lot better over time. Maybe working carefully with a registered dietitian can help you lose weight without purging.

David: Here are some audience comments on what's been said so far:

Christian: I am all for living in the solution. I was one of ten children and my parents did the best they could. Yet I hid the bulimia for a long time; I was so ashamed of having such a gross coping mechanism. I have always been afraid of my older siblings and of not being perfect. I have been in recovery a long time but recently relapsed. I am a grown woman with a happy marriage and 2 babies that I had thought I might not be able to have because of the damage done in my teens and twenties.

margnh: I will never admit it because people think you have horrible control and will act differently around you.

Lindsey03: I'm scared. My fake parents now know about what happened before and I'm afraid they will punish me like my real parents did. They also don't let me purge and I guess that's good, but that's scary too.

margnh: My doctor told me I should never plan my eating.

recoverednow: Yes, I did the meal planning also - following hospital staff advice and followed the meal plan they provide me.

gillian1: That depresses me, seeing how much I have eaten.

nymphet: I tried keeping journals, but never liked the idea at all and gave up.

eccchick: Today, I feel so scared, sad and depressed because I ate something and kept it down.

latlat: I've done that. Got treatment for myself. My daughter doesn't care and is not affected by my actions. How do you force them?

willy: What do you think a person should do when they think they have an eating disorder? I mean, is there anyone special to go to and how do you start out the conversation with the person?

Judith Asner: Willy, you should find out who specializes in treating eating disorders. If you go to my website, in my last newsletter, there are some resources that can help you find an eating disorders treatment specialist in your area.

Once you find an eating disorders treatment specialist and call them up--it's very easy. They know why you are there and help you. You'll find that you won't be uncomfortable because they are familiar with what's going on. Chances are the eating disorders treatment specialist has had anorexia or bulimia too.

David: One thing you can do is call the local psychological association and get a referral in your community. You can also call your family doctor or a local psychiatric center for a referral.

Judith, what advice can you give a teenager who wants to tell their parents, but may be afraid or doesn't know how to break the ice. What, specifically, could they say?

Judith Asner: I think a teen has to do it. Just say it, "I have an eating disorder." You just have to bite the bullet and say the words.

hungrygirl: What do you do when you feel like you have dealt with the underlying issues as much as you can, and you are still addicted to the behavior of self-harm with food or just addicted to eating in a self-destructive manner.

Judith Asner: That's a very tough question. Very often, therapy will address underlying issues and there will still be residual eating disorders that have not gone into remission. I wonder if you saw a general psychotherapist or an eating disorder specialist for your treatment, because that's a very common occurrence.

awiah: I am a 37 year old SWF. I have been bulimic since I was 11. I have tried almost every known antidepressant (and many other types of prescription drugs) and am still very actively bulimic. I understand the need for family and friends' support. I understand the use of a food journal to control the amount of food intake and educate one on their level of hunger. But what does one do when they have outlived the patience of their families and everyone else?

Judith Asner: How about going to daily meetings of Overeaters Anonymous or eating disorders support groups that deal with bulimia specifically? By doing this, you'll find a sponsor that will not get tired of you and you'll get support from the group and by working through the program. Also, there is information in the HealthyPlace.com Eating Disorders Community.

awiah: Yes, I have been at Renfrew for 3 months and have had years-and-years of out-patient therapy with different doctors - both eating disorders treatment specialists and generalists.

Judith Asner: Awiah, I'm really sorry. I know how frustrating that could be. Maybe coaching could help you.

Monica2000: What are we supposed to do when people think our ED is for attention. What are we to do if we get really depressed and just want to purge more?

Judith Asner: Monica, stay away from those people. Tell them you don't need there opinions. Stay away from any negative people as much as you can and be around supportive people. People with bulimia are highly sensitive.

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David: Apparently, some of the things being said today have struck a chord with the audience. Here are some comments:

florecita: My stepmom cooks a lot of food all the time; pork and those kinds of meals. We live with her, but I don't know how can I tell her because that will make it harder for me.

nymphet: My mum never does anything more than yelling at me all the time. I don't really feel so much ashamed, but people who know about this think I should be ashamed.

hungrygirl: It was a general person, but I work on the issues, feelings, etc. a lot on my own. The eating behavior seems to have a will outside of myself; like I'm doing it and don't even realize it anymore. Maybe I just didn't make the connection between the eating and the emotions? I don't know.

gillian1: That's easier said than done. I tried to tell my parents, but I had to think of a cover story when she was far from happy.

eccchick: Sometimes I feel like I don't want to get better. Most of the time I like the attention my friends and family are giving me. They are showing me they care. I want to know they love me. I want them to tell me I am horrible.

dreamer05: I agree with the fact that the parents need to get help themselves. If they really want to help, they need to educate themselves about this disease. Granted, they many not want to because it may be hard. Parents may not understand why the sufferer is doing this to themselves. Oftentimes, people think that we have control over this disease because it's not cancer or aids.

David: Here are a few more audience comments, then onto more questions:

eccchick: I know it sounds horrible, maybe I am, but sometimes I feel like I don't want the help. I like the attention it gets me, my friends and family show me they care

margnh: Planning makes you think about the food all the time, as with the journal. It is not entertaining enough to preoccupy me.

recoverednow: Changing the negative self-talk is extremely difficult. Eating Disorders tend to feed the negative self-concept. It isn't always abuse that leads to an eating disorder. My disorder was "based on" fear of abandonment and the need to please.

AmyGIRL: Can bulimia cause you to have a violent temper?

Judith Asner: It can certainly be upsetting and make you feel out of control, angry with yourself and others. There is a lot of self-rage in bulimia.

David: Some people have asked for additional information about bulimia. Here are the bulimia symptoms and how to diagnose bulimia.

hungrygirl: How does the coaching work exactly? Specifically, what kinds of interactions can you expect to have with a coach?

Judith Asner: The coach is there to ask you important questions to help you look at what you are doing with your life, how you may be lying to yourself, what your real truths are, and how you can live your truth and live the life you really desire. It's usually by phone. There is also group coaching by phone, where a group can talk together in a conference call. For example, a group of 20 people over a conference call can be talking about meal plans, shame, etc. It's similar to what we are doing now, only it's over the phone instead of inside a chatroom.

dreamer05: You mentioned something about talking to people about it and telling them that you have a problem. What happens when you do that and they leave you? Essentially, they're telling you that they can't handle it. I see that as them not loving you because they are giving up on you when you finally ask for help. What do you see it as?

Judith Asner: Dreamer, they just can't handle it and you should let the person leave, let that person go. That would not be the person for you. You could never be your true self with that person and that person can never love all of you because the eating disorder is a part of you at that moment.

eccchick: Does it make me horrible because I like the attention I get from people. My family and friends know that I am sick. I want to know that they care. I want to know that I am loved. I am scared of losing my friends. Maybe I'm not really sick. In a way, I like what I am doing. Losing the weight is something I have become good at. Am I horrible?

Judith Asner: That does not make you horrible. It sounds like a desperate cry for attention and love. Are there other ways to get love? Do you have to be sick to get attention? Do you feel that you are not lovable unless you are sick? Are there some positive ways to get attention? What you are speaking of is "secondary gain" and that's the attention that one gets from having the illness. But there are certainly healthier ways to get attention. Can you think of some? Maybe you can be the best tennis player, or the greatest friend, best writer, sweetest person; anything else but sick. It sounds like you doubt your worth, eccchick. If I were you eccchick, I would start a campaign for a charitable cause and get your picture in the newspapers. Doing something for someone should make anyone feel good.

David: Here's the link to the HealthyPlace.com Eating Disorders Community. Thank you, Judith, for being our guest today and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large eating disorders community here at HealthyPlace.com. You will always find people interacting with various sites.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Judith Asner: Thank you for inviting me. I hope that some of the people who were writing about their shame will realize there is nothing to be ashamed about. It's just a symptom of a problem like depression, etc. There are many people willing to help and many resources. Most importantly, never give up on yourself.

David: Have a good evening everyone. And thank you for coming.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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