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Anorexia Nervosa : Judy's Story
Frequently Asked Questions

For the sake of saving time and energy and providing website visitors with a prompt response, I have decided to construct this page of questions that people commonly ask me. A Question/Answer format will follow below. I hope that you find the information helpful. If you have additional questions, feel free to e-mail them to me and I will try to respond in a timely manner.

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1.) Did you get good grades in school?
Yes, I was a straight "A" student. My father is a professor, so there was always pressure to perform. If I got an "A," my father said that I didn't challenge myself enough. If I got an "A-," my father said that I didn't apply myself hard enough. I couldn't ever seem to "win" the approval I so desired from my parents.

2.) As a teen, did you feel as if you were not perfect compared to your peers, and if so did you do things to make yourself feel like you were better than them?
I guess you could say I'd always been a perfectionist (striving for perfection in everything that I did), but the pressure was internal (competing with myself and nobody else). In terms of my peers, I felt inferior. I had HORRIBLY low self-esteem. I never felt "better than" my peers, nor did I do things to make myself feel that way. In my minds eye, I knew that I was inferior. Socially, I felt like a misfit (even though I was on the cheerleading squad and outwardly looked like "I had it all").

3.) Have you always been concerned with what you ate and wanting to look perfect?
My family was a weight conscious household. My parents were both avid runners. However, I never really thought about my weight until just before the anorexia. I was into athletics (swimming, gymnastic, ice-skating, ballet), so I remained fairly "fit."

4.) Can you remember what, if any event, triggered you to develop anorexia?
I remember a few incidents that started the cycle rolling, but I believe that the foundation had been well laid prior to that point in time. The events were as follows:
a.) I was a competitive swimmer. My father used to weigh me and make negative comments about my increasing weight.
b.) I suffered from severe asthma and took a drug called "prednisone" which had a side effect known as the moon face effect. Kids at school used to tease me and call me "Chipmunk Cheeks." I used their teasing to confirm my belief that I was truly "fat."

5.) Abour what age did you notice that you were controlling what you ate, thought maybe you were anorexic, or people told you they were concerned about your eating habits?
I was 13 when I started to become concerned about my weight and developed some strange eating habits. At that time, I was 5 feet 3 1/2 inches tall and weighed an all time high of 114 pounds. By the time I was 15, my weight had dropped to 80 pounds and I was first hospitalized for anorexia nervosa. Within another couple of years, my weight was down to 65 pounds.

6.) Why did you decide to stop eating rather than something like become bulimic?
It all started as a simple "diet" (as part of my self-devised, self-improvement plan), but it snowballed out of control. Eventually, I became afraid to eat (and even, at times, to drink water). It was like a phobia (fear) of weight gain and food.

7.) Is there more anorexia nervosa in females than males?
Yes, although the number of males afflicted with eating disorders is growing. Eating disorders can affect men/women of all ages and socioeconomic status. It is no longer a "disease of upper middle-class adolescents and young women."

8.) How long does it take a person with anorexia nervosa (or an eating disorder) to recover?
Recovery rates are variable. Some individuals only suffer from a brief bout which resolves without treatment, while others go on to suffer for an entire lifetime. An estimated 10-20% of eating disorder sufferers will eventually die of their disorder. I suffered from anorexia nervosa for 10 (+) years before recovering.

9.) How does a person's family feel when they are anorexic?
I can't say from experience, but I would imagine that they feel as mine did ... helpless, frustrated, scared, and desperate to find a cure. My sister wrote a poem that nicely portrays her feelings during the time of my illness. You can access her poem at the following URL:Anne's Poem You can also get a family member's perspective by reading the Appendix written by my mother in my book, "The Long Road Back: A Survivor's Guide to Anorexia."

10.)Do you think that parents may have an influence on the development of anorexia nervosa in their children?
I think that negative comments about a teenage girl's increasing weight can sometimes plant the idea into her head, but other factors also fuel the destructive cycle. I firmly believe that family patterns of communication affect the development of eating disorders. It is my personal belief that greater levels of stress placed on adolescent girls (and young women) these days (with the breakdown of many marriages, etc...) contribute to the increased incidence of these disorders. Families that function well and produce kids with healthy self-esteem are less likely to have family members develop anorexia, while less functional families are more likely to produce kids with low self-esteem. These kids will be more prone to develop eating disorders. One must be careful NOT to blame the families, though. I believe that families do the best they can in a given situation, using their available coping resources.

11.) What made you feel that you were no good?
I wouldn't ever say that I felt like I was "no good," however, I definitely had low self-esteem. I came from a family with very high standards, where whatever you did was never "good enough." I think it was instilled at a young age.

12.) Why did you become anorexic?
It all started as a simple "diet," a sort of self-devised, self-improvement campaign and quickly spiraled out of control.

The "core" reasons, for me, were probably these underlying issues [These are things that I came to recognize later, through years of intensive therapy]:

a.) Unresolved grief over the loss of my twin brother at age 4. ***
b.) Low self-esteem. ***
c.) Obsessive-compulsive / perfectionistic tendencies ***
d.) A feeling that my life was "out-of-control" secondary to my parent's difficult divorce. ***
e.) My parents' obsession with weight which only contributed to my own.
f.) I was a competitive swimmer and my father used to weigh me (something I found humiliating).
g.) My father used to tell me that I was "fat" and needed to lose weight.
h.) Kids at school used to tease me because of the moon face side effect of the medication, prednisone. They called me, "Chipmunk cheeks."

13.) At what age did you have anorexia?
From age 15 (started losing weight at age 13) to age 25.

14.) What made you look at yourself as not a thin enough person?
Contrary to popular belief, I saw myself as thin, although I told people that I was "fat." For me, the word "fat" took on a whole new meaning. I had a different standard for myself and for the outside world. For Example, I might see someone on the street corner who weighed much more than I did, but was still thin and say, "Gee, that person is awfully thin." When I looked at myself in the mirror, I saw the protruding bones and the greyish blue skin. In my mind, I was still "fat" because I was still less than perfect and still unhappy. For me, it became a "numbers game." The only way to "win" was to watch the numbers go down on the scale. I once told my mother that I wouldn't be happy until I reached "zero" (knowing full well that I would be dead long before that point in time). During much of my illness, the misery was such that death often seemed like a more desirable option (that way, the suffering would be over with). Anorexia nervosa is a horrible state of existence. Hopefully you can see by the reasoning provided above that it would be fruitless to try to "talk sense" into someone with anorexia and "convince them that they are really not 'fat'."

15.) Do pictures in magazines or models ever put a fake image of how women are supposed to look like in your head?
I believe that the media has a profound impact on young girls/women (and increasingly men) in our culture. Young people, in our society, are socialized to believe that the emaciated (starved) bodies of models portrayed in magazines and on television are the "American ideal." For most people, this is an unhealthy and unrealistic ideal and promotes the development of unhealthy eating patterns and psychopathology. The media is not doing our society justice. I believe that their influence has seriously affected the increasing numbers of young people that we are seeing afflicted with these dangerous, even deadly, disorders.

16.) How did your family and friends cope with the problem?
My friends quickly dissipated and then disappeared completely. The anorexia became all consumming. I spent hours exercising, and I avoided any social gatherings that had anything to do with food.

Most of my family distanced themsleves from me. My father didn't want to have anything to do with me. He used to tell me, "Why don't you just do what the doctors say and eat? (as if it were that easy). My parents were separated and then divorced, and my father moved to another state (effectively cutting ties) along with my sister. That left me and my mother to fend for ourselves. My mother was an angel and supported me through it all. I don't know what I would have done without her. In fact, I am certain that I would have died had it not been for her.

17.) What would you tell teenage girls (young women & men) today that would do anything to be thinner and who have considered being anorexic?
Anorexia nervosa is not really about losing weight, eating or not eating, exercising like a maniac or not. It is about self-esteem. It is about how you feel about yourself. True happiness comes from within, it cannot be gleaned from reading the numbers off of a bathroom scale.

I started losing weight, never dreaming that I'd become anorexic, that I'd lose control over my life and almost wind up dead. I began my diet as a simple self-improvement campaign, as an attempt to "feel better" about myself. Initially, I felt I lost more weight...quickly it became a trap and spiraled out of control. I was no longer controlling it, it was controlling me. Life with anorexia nervosa is a living nightmare. I wouldn't wish it upon my worst enemy. Physically, I was always horribly cold, it hurt to sit on a chair or to lie down, I couldn't sleep at night, my hearing became painfully acute, I became chronically depressed (even suicidal, at times), my bones became brittle (osteoporosis) secondary to chronic amenorrhea...leading to a broken foot, several surgeries and eventually a joint fusion when nothing else worked, etc... It was miserable. Several times, I went into congestive heart failure and was placed in the intensive care unit of the hospital. My parents were told by the staff that I wouldn't live to be 30 years old (I am now 31). I was hospitalized, 26 times (one lasting as long as 16 months)!! I was tube fed, tied to my bed in four-point restraints (all limbs), drugged, labeled "chronically schizophrenic," "hopeless," and my parents were told that they should just place me in a state hospital because "(I'd) end up there one way or another." Does this sound like something you would like for yourself? Anorexia nervosa DOES NOT lead to happiness. It leads to years of misery, depression, and sometimes a premature death. Three of my friends from treatment died from their eating disorders. Three promosing young lives, all prematurely cut short...for what...the pursuit of thinness. One of my friends, "Mary," had been in medical school prior to her death. People DO DIE of eating disorders and it's not just something that happens to SOMEONE ELSE. That person could be you! 10-20% of individuals with anorexia nervosa will eventually die of their disorder. That is 1 out of every 5-10 afflicted individuals !!!
I would encourage girls to think of these things and then encourage them to think again.

18.) Where did you find the help you needed to get better?
Recovery was a long and difficult process. Many people helped me along the way. I had several kind and caring physicians, psychologists, nurses, and dieticians that facilitated the process. I was hospitalized 26 times, and I can't even tell you how many therapists I saw in an effort to find someone who could help me. My mother and I ventured to some of the major medical centers across many different states.

I think that several things contributed to my eventual full recovery. They include:

a.) At some point, after years of resistance (and denial), I decided to become an active participant in the recovery process. I knew that I could not continue to go on living as I had been. My choices were essentially, get better or die. I've always been a "fighter." Once I re-channeled some of the energy that had kept me sick for so many years into getting well, much progress was made.

b.) Several factors that contributed to my "change of heart" included the fact that my insurance was quickly running dry from the numerous and often lengthy private hospitalizations. This made the possibility of ending up in a state mental hospital an increasingly viable option. I wasn't about to let that happen without a fight. I KNEW that it was NOT my life's destiny to become a locked up mental hospital patient.
I had also become increasingly aware of the fact that all of my peers had gone on with their lives (completing college, getting married, securing jobs, and having children) while my life remained static and unchanging behind the locked doors of various psychiatric wards. I believed that there must be some sort of higher purpose for my life. In addition, my younger sister was just about to complete college (an expectation in our family, follwed by graduate school or medical school). I've always been fiercely competitive, and I wasn't about to let my younger sister "out do" me on that one. Once again, a small part of the energy that had once been channeled into the anorexia was re-directed towards a healthier goal: the attainment of a college degree.

c.) My psychiatrist was a recovered anorexic herself. She understood the necessity of maintaining a certain minimal weight level (one that is conducive to psychotherapy). When my weight fell below that level, I went back into the hospital until my weight had been restored. I went in and out of the hospital several times until I saw that she was really serious. However, I fell certain that I would not be where I am today had she maintained the lax weight standards that some of my earlier therapists allowed. Weight restoration is ESSENTIAL to recovery!!!

d.) Finally, although many people helped to guide me through the recovery process, the work was something only I could do. For many years, I wanted someone to "cure me." Unfortunately, it doesn't work that way. Nobody could climb into my head and make the decision to "want to get well" for me. I had to do that for myself. There is no magic cure, no magic pill . . . the answer lies within (and it is different for each and very person).

19.) How do I know if I have an eating disorder or if I'm developing an eating disorder?
You need not have all of the "classic signs" of anorexia nervosa or bulimia to have an eating disorder. If you are using eating (or not eating) as a means of coping, if thoughts of food/weight/exercise get in the way of your everyday activities of daily living or start to restrict your activities, or if you merely suspect that you have a problem, then there probably is one and it is a good idea to seek professional treatment.

20.) What should you do if you think you have an eating disorder (or might have an eating disorder)?
Seek professional assessment and treatment. Reach out and talk to someone about it (a trusted teacher, a parent, a clergy member, a school counselor, etc..).

21.) What does "treatment" consist of?
Treatment for an eating disorder usually consists of a combination intervention that addresses medical, psychological, and dietary concerns. Contrary to popular belief, an eating disorder is not really about weight and eating (or not eating). It's about how one feels about oneself and it is about self-esteem. The key to recovery is in resolving the psychological conflict that is underlying the eating disorder.

22.) What should you do if you think that a family member/friend has an eating disorder?
I usually encourage people to voice their concern to their friend by saying something like, " ___ (name), I'm concerned about you. I've noticed that you've lost a lot of weight lately. I really care about you and I'm afraid of losing you. Would you consider going to get help?" Denial and resistance is common in the early stages of an eating disorder, so this approach may not work. If you are really concerned, you may want to take it one step further by sharing your concern with your friend's parents, a school counselor, or other adult person in a position of authority. If you are a family member, the situation may be complicated by the fact that your loved one is a legal adult. This places you, as a family member, in a predicament. It is possible to force an unwilling participant into treatment against his/her will. The process is known as legal commitment and can only occur when a physician and court deem an individual to be a "risk to him/herself." Although it is possible to force an unwilling participant into treatment using legal commitment, the treatment is often resisted and any "progress" is usually short-lived. That's not to say that legal commitment is not indicated, at times. Sometimes the process of legal commitment is life-saving. I was in a serious state of denial about my illness for many years and was legally committed to treatment (my mother instituted the process) more times than I can count on the fingers of one hand> If you feel the process is necessary, you might begin by consulting your family physician, or a psychiatrist. The professionals should be able to guide you in a direction to go from there. If you would like a referral to an eating disorder specialist in your local area, you might try contacting the International Association of Eating Disorder Professionals (IAEDP) at: 1-(800)-800-8126 or the Renfrew Center's National Referral Network at 1-(800)-332-8415.

Although it is possible to force an individual into treatment (as a life-saving measure) against his/her will, it is BEST if you can elicit her participation. Even though she is outwardly denying that there is a problem, inside she is probably in a state of turmoil (as I know I was). Perhaps another way to encourage her into treatment would be to address it from a different angle. Maybe you could encourage her to seek support during this "difficult time." This might be less threatening to her.

Finally, For those individuals out there currently struggling with an eating disorder:
Know that full recovery is possible. People go on to lead happy, healthy, full-lives. My own story is living proof that it can be done. You, too, can recover!! Although the road to recovery is long and arduous, it is well worth the travel. I know how scary it is to give up the eating disorder, the ambivalence. However, I pose this challenge to you. Try it for a while. What do you have to lose? If you don't like it, you can always go back. Clearly the challenge of anorexia is in recovery, not in remaining sick!! Don't ever give up hope, and don't ever stop believing in yourself. You have the ability to accomplish anything you set your mind to. A full recovery IS within your reach!!!

---------- Judy Tam Sargent, R.N., M.S.N.

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