Starving for control

Complexity of eating disorders impacts community

May 14, 2019

Algonquin alumna Dayna Altman speaks with a bubbly personality and a confident smile — even when the topic is her difficult experiences with eating disorders.

“I never feel like myself more than when I’m sharing,” Altman said.

Altman works at Girls. Inc in Lynn as their Substance Use Prevention Coordinator. According to Altman, a big part of her goal there is “to inspire our next generation to feel good about themselves and how they look.”

But when Altman was growing up, she wasn’t confident with how she looked or who she was, similar to the 44 percent of Algonquin students who aren’t comfortable and happy with their current weight according to a Harbinger survey of 228 students March 26 to April 11 through Google Forms.

But when Altman was growing up, she wasn’t confident with how she looked or who she was, similar to the 44 percent of Algonquin students who aren’t comfortable and happy with their current weight according to a Harbinger survey of 228 students March 26 to April 11 through Google Forms.

Over time, Altman’s lack of confidence slowly developed into an eating disorder.

“I’m 26 and I think I struggled with an eating disorder for a really long time,” Altman said. “I can remember even in early elementary school always feeling not good enough, and just really sad.”

Altman was formally diagnosed with an “Otherwise Specified Food and Eating Disorder” (OSFED) during her first year of college. According to Licensed Registered Dietician Amy Gardner, OSFED is the biggest category of eating disorders.

“That’s when people just don’t fit nicely into a category,” Gardner said.

Other common types of eating disorders include anorexia, bulimia and binge-eating disorder.

Anorexia, sometimes called anorexia nervosa, causes people to obsess about weight and what they eat through restrictive diets and excessive exercise. Bulimia is characterized by binging, or eating large amounts quickly, followed by methods to avoid weight gain, such as purging, laxative abuse or fasting. Binge eating disorder is when individuals frequently consume unusually large amounts of food quickly, and feel that the behavior is out of control.

Six percent of Algonquin students report that they have been formally diagnosed with an eating disorder, and 38 percent of students have struggled with disordered feeding behaviors on their own, without a diagnosis. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), at least 30 million Americans of all ages and genders struggle with an eating disorder.

According to the National Eating Disorder Association (NEDA), one in three people struggling with an eating disorder is a male, and disordered feeding behaviors are nearly as common in men and women.

Treatment allowed Altman to be able to largely overcome her eating disorder, but it was no easy journey to get there, and sometimes she still finds herself tempted to restrict her eating.

“I think it’s always going to live with me to some extent to either compare [myself to others], or think about calories, but I’m in such a different place than I once was,” Altman said.

Types of Treatments

While eating disorders are sometimes lifetime struggles, there are treatment options and recovery is possible.

According to NEDA,  there are four levels of treatment facilities, and patients receive the appropriate treatment depending on the severity of their physical and mental health.

The most intensive treatment facilities are inpatients, followed by residentials, partial hospitals and intensive outpatients. Inpatients offer 24 hour care for both physical and mental health in a hospital setting, whereas residentials are in a live-in facility for people who are physically stable but still need intensive mental health treatment. Partial hospital care is a system in which the patient meets with a medical profession up to five times a week, and an intensive outpatient is a meeting with a health care program three days a week.

Algonquin alumna Angela Chen started to restrict her eating in sixth grade because she wanted to lose weight, although at the time she was physically healthy. She graduated from Algonquin in 2011, but had to take many years off of college to take care of herself mentally and physically after years of battling her eating disorder on her own.

“My eating disorder is an awful demon that has been intertwined with my sense of being for over half my life,” Chen said. “This is something I’m still working on every day. I think I have defined myself by my eating disorder for so long that it is hard to know who I am apart from it all.”

Chen says she has been in “residential, partial hospitalization programs, intensive outpatient programs, and regular outpatient appointments,” but her eating disorder is still something that affects her daily life.

“A lot of people I met in treatment who were in similar situations as me, [as in] taken out of school, were able to get themselves back on their feet and back to school within a year or two, but I ended up taking off a lot more time than that,” Chen said. “I know everyone says there’s no official timeline or anything and that I’m ’still young,’ but I am finally back in school [as an] undergrad after many years off, and I’m definitely quite a bit older than most of my classmates.”

Because eating disorders are so difficult to overcome, treatment focuses on coping skills and long-term recovery.

“[Treatment] is a long process,” Gardner said. “The average eating disorder lasts about seven years, so we’re looking for people to decrease symptoms and provide strategies towards long-term recovery.”

Causes and Comorbidities

While body image often plays a role in eating disorders, as it did for Altman and Chen, it is not the only cause. For some, it plays little or no role in the disoder’s development, and disordered eating behaviors instead appear as a coping mechanisms for other issues in a person’s life.

According to the NEDA, eating disorders almost always go hand in hand with other forms of mental illness.

“A lot of the people struggling with eating disorders, unfortunately, have tough histories,” Gardner said.

Anonymous senior girl Harper* suffers with what she calls “anxiety-based anorexia.”

“I get really anxious and I start to feel physically sick, so I don’t feel hungry and then I don’t eat,” Harper said. “Sometimes [I don’t eat] for weeks.”

According to NEDA, two-thirds of people with anorexia show signs of an anxiety disorder several years before their eating disorder appears.

“I didn’t really have a problem with my self-image,” Harper said. “[Not eating] was going on for such long periods of time I almost got used to it. It became a norm for me.”

As she got used to not eating, the eating disorder became a way for Harper distract herself from other problems in her life.

“Especially when I was going through a really hard time in my life, it became something to occupy myself with,” Harper said. “It became a game for how long I could go before I had to eat.”

The desire for control often plays a key role in the development of eating disorders. According to NEDA, a 2015 study of over 2400 individuals hospitalized for eating disorders found that 20 percent also had obsessive-compulsive disorder.

Anonymous senior girl Ivy* developed anorexia as a sophomore. The illness caused her to miss four months of her junior year, when she spent time living in various treatment facilities.

“Everything in my life felt really out of control,” Ivy said. “I was actually feeling pretty fine with my body, but strangely enough, as soon as I stopped eating, that’s when my insecurities with my body started. Because it’s actually a chemical thing where when you don’t eat, it makes you think you’re a lot fatter than you are…But initially it was just about trying to control something in my life, which felt really out of control.”

Chen initially restricted her eating to lose weight, but she has identified other disorders which impact her life since then.

“Eating disorders are often comorbid with many other mental illnesses, and I also struggle with depression and generalized anxiety,” Chen said. “I am not sure if it was more a result from the depression than the [eating disorder], or really they’re both so intertwined you probably couldn’t separate them anyway, but I was very numb.”

Biological Impacts

All eating disorders have physiological consequences, although the specific issues vary from disorder to disorder and from person to person.

Men represent 25 percent of the population struggling with anorexia, according to NEDA, and they are a higher risk of dying, in part due to the fact that they are often diagnosed later since many people assume men do not have eating disorders.

Restrictive eating disorders such as anorexia put the body into an “emergency state,” according to Gardner.

“What happens when somebody goes into starvation is their body needs to turn to alternative sources of fuel, which means that it’s turning to muscle tissue, fat tissue or whatever it can find in the body to maintain homeostasis,” Gardner said.

According to Gardner, as the body enters this emergency state, it gets to a point where “it needs to do whatever possible to preserve stored energy, so everything is slowed down.”

“The metabolism slows down,” Gardner said. “People often lose their period, and they’re not ovulating anymore, so that whole process gets shut down. A lot of times long-term patients that have struggled with an eating disorder for a long time may have fertility issues down the road, but I’ve also seen people not have fertility issues, so it definitely varies person-to-person with what their body can tolerate.”

When Chen was struggling most with her disorder, the physical effects of her anorexia were apparent because she felt “horrible.”

“I had no energy at all, as I wasn’t feeding myself properly, and spent most of my time lying in bed,” Chen said. “I was dizzy every time I stood up. This happens a lot with people with eating disorders, it’s called orthostatic hypotension and can lead to fainting. And walking around, I felt like I could fall over at any minute. I was very weak.”

As people become more malnourished, more serious, life-threatening issues may develop.

“What we will often see is a real disruption in heart rate or vital signs in general,” Gardner said. “Once the malnutrition starts to translate to electrolytes in the body, [it causes the person to become] really dehydrated, and that puts them at risk for cardiac complications.”

According to Gardner, liver and kidney issues are also common for individuals with restrictive eating disorders because those organs are overworked since they constantly have to “process and repackage” materials from the body into energy.

When Ivy was struggling with her disorder most, she weighed less than she did when she was 10 years old and her heart rate dropped dangerously low. Her parents took her to several medical doctors, but none were able to help until one finally recognized the eating disorder.

“That doctor took one look at me and told me, ‘I don’t know how your heart is still beating. You’re not leaving this room right now,’” Ivy said. “I was hospitalized for a week, and then after that I spent around a month in an in-patient which is near Boston, and then I went to a residential.”

Cognitive and Emotional Impacts

Alongside the physical symptoms, those dealing with eating disorders may also experience severe emotional effects.

According to ANAD, eating disorders have the highest mortality rate of any mental illness. One in five deaths related to anorexia is the result of someone intentionally ending their own life.

Altman said “the lowest point I’ve ever gone, and hopefully, will ever go,” was when she searched for a way to end her life after doing poorly on a test in college. After that, she took a medical leave from school to seek mental health treatment and focus on recovery.

“Going to Algonquin, everyone goes to college, everyone follows this path,” Altman said. “There is no room for diverging at all, so I was really ashamed [when I left college] because I was seeing my friends, not only still at school, but getting ready for their formals and worrying about their grade point averages, and I can remember not even being able to brush my teeth. I was so depressed.”

Cognitive processes are also slowed while dealing with eating disorders.

“[People struggling with eating disorders] might talk a little slower, you might notice decreased assets, maybe they’re just not as animated as they once were and you might see that the creative thought and the ability to access one’s own thoughts get damaged,” Gardner said.

Chen reported feeling this loss of animation when she struggled most.

“Emotionally, I would say I felt pretty empty, very numb. I wasn’t in touch with my emotions,” Chen said. “I think everything felt a little dulled out, like my happy was never quite as high as it might usually have been.”

Unlike some other people with eating disorders, Harper grew self-conscious and insecure about losing weight when she struggled with anorexia. As a child, she was always muscular and “built,” and being underweight hurt her confidence.

“I wore a lot looser clothing when I was having a hard time,” Harper said.

According to Chen, Altman and Ivy, eating disorders tend to be very competitive illnesses and many patients become “attached” to their disorders.

“I wanted to have an eating disorder,” Ivy said. “It was my identity, really.”

The competitive nature of eating disorders can make patients struggle even more because they want to be as thin, or as good at restricting their eating, as someone else, according to Chen, Altman and Ivy.

“That is a big quality of eating disorders: they thrive on comparison and jealousy,” Altman said. “The competition was so in my head. No one ever said, ‘You need to look like me.’…We compare ourselves to other people’s bodies and [think] that somehow equals our worth; it’s just [messed] up. But it’s a huge part of our community.”

Treatment, Recovery and Resources

According to all of our sources, the first step in recovery is seeking help from close friends and family.

“Going at this alone can be really isolating and lonely,” Chen said. “I can remember my heart pounding every time eating disorders were mentioned when I was in high school, before anyone else knew what was going on. Like I knew what was being spoken directly related to me but I was terrified of speaking up, of having my secret revealed. I wish I had spoken up earlier because I do think that the sooner you receive help, the stronger your chances of recovery are.”

In addition to having the support of others, Harper and Ivy emphasize the benefits of having others looking out for them.

“It’s really hard to acknowledge it and fight it by yourself,” Harper said. “It’s hard to acknowledge that you’re doing something wrong so just having a friend to remind me to do things, to force me to acknowledge that I wasn’t doing the right thing, definitely was a big help for me and is a big reason why I am better at dealing with it today.”

“You need someone to hold you accountable,” Ivy said. “I was able to hold myself accountable for maybe a week and then I relapsed.”

According to Gardner, the best mode of treatment is a multidisciplinary team. This team includes a medical provider, a doctor, a therapist, a registered dietician and oftentimes a psychiatrist or a family therapist.  

“It’s really, really imperative to have all of these different components of the treatment team because it’s a really intensive illness and it requires looking at it from all angles,” Gardner said.

Gardner typically uses a meal plan or some sort of guide to begin to reintroduce food at around 300 calories per day before adding more. It is important to have professional help when reintroducing food, otherwise a person may experience refeeding syndrome in which one experiences the dangers of reintroducing food too quickly.

“The ultimate goal is to transition the responsibility of eating back to the individual,” Gardner said. “So ultimately what we would then do, is once the hunger cues are back and they start feeling confident…we’ll start to work more on intuitive eating, which is a model based on looking at hunger cues, really exploring what do you want to eat, what would taste good right now.”

While in treatment, Ivy also had difficulty re-defining her identity.

“[My eating disorder] was my identity, really, because it gives you a feeling of control,” Ivy said. “Junior year, I realized I wasn’t in control. It was controlling me. [And then] recovery became my identity. But that wasn’t fixing the problem because I was still so focused on the eating disorder itself that in a way I was still giving power to it, and that just led me to relapse. I almost ended up in the hospital again, twice.”

Ivy currently defines her herself as “a hardworking student, primarily.”

Students who may be struggling with an eating disorder can contact the NEDA helpline at (800) 931-2237 for information and support.

Project Heal is another organization that offers resources to any individuals who may be struggling with eating disorders through therapy, support groups and activism.

Within the building, students can also seek support from guidance counselors and adjustment counselors. According to Harper, her guidance counselor helped refer her to a therapist that she continues to see. Altman urges anyone struggling to take full advantage of these resources.

“You’re not a burden, you’re not annoying, you deserve help, and the right people will know that,” Altman said. “You’re worth helping and there is help; people don’t know that there are so many resources that are in our community.”

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