The Truth About Life
After Eating Disorders

Essays, Articles, & Nonfiction Works
by Aimee Liu

These treatment facilities offer specialized programs for eating disorders, including men and women over age 21.
Discover the many ways others are using their voices, talents, and passions to turn suffering into creativity and hope.
Links to websites and organizations that provide information and referrals.
References cited in GAINING
How do anorexia and bulimia impact life AFTER recovery? GAINING is one of the first books about eating disorders to connect the latest scientific insights to the personal truth of life before, during, and especially after anorexia and bulimia.
"I've read countless books about eating disorders, but I've never seen one like this. Combining the professional wisdom of leading experts with personal experiences from women and men all over the globe, this book fills a gap on the recovery bookshelf. Anyone who has been touched by an eating disorder needs to read this."—Jenni Schaefer, author of Life without Ed
America's first memoir of anorexia, and one of the earliest books about eating disorders, originally published in 1979

Biography of Aimee Liu

Aimee Liu is the author of Gaining: The Truth About Life After Eating Disorders (Warner Books, February, 2007). This sequel to Liu’s acclaimed memoir, Solitaire (America’s first memoir of anorexia, published by Harper & Row, 1979), draws on her own life as well as interviews with leading researchers and more than forty other women and men with histories of anorexia and bulimia.

Liu picks up her exploration of eating disorders where Solitaire ended, back when she was twenty-five. Then, she thought recovery meant eating well. Gaining proves that healthy nutrition is only a first step. True recovery requires a new understanding of the role that genetics, personality, relationships, and anxiety play in these disorders. Liu uses cutting edge research to dispel the myth that fashion is wholly to blame. She examines the real reasons eating disorders among all races and ages are on the rise, and how they can be prevented in future generations.

Aimee Liu also is a novelist. Flash House (Warner Books, 2003) is a tale of suspense and Cold War intrigue set in Central Asia. Cloud Mountain (Warner Books, 1997) is based on the true story of her American grandmother and Chinese revolutionary grandfather. Liu’s first novel, Face (Warner Books, 1994), deals with mixed-race identity. These books have been translated into more than a dozen languages.

Before turning to writing fulltime, Liu edited business and trade publications and worked as an associate producer for NBC's TODAY show. She has co-authored seven books on medical and psychological topics. Her articles, essays, and short stories have appeared in anthologies and periodicals such as Cosmopolitan, Self, Glamour, and Good Housekeeping.

Aimee Liu was born in 1953 and raised in Connecticut, received her B.A. from Yale University in 1975 and her MFA from Bennington College in 2006. She lives in Los Angeles with her husband and two sons and teaches creative writing at UCLA Extension in Los Angeles and in Goddard College’s Port Townsend MFA program.

Aimee's figure problem: "too thin" in CoEd Magazine, 1970

A Conversation with Aimee

Q: You’re an author of several novels. How has your struggle with anorexia influenced or impacted your fiction?

A: In retrospect, I realize that many of the currents running through my new book have also run through my novels. So, while none of my fiction has dealt explicitly with eating disorders, my stories have revolved around issues of identity and the quest for a solid sense of self. We write what we know! My main characters have had a variety of obsessions, but all have been temperamentally intense and persistent. These qualities, I understand now, are related to the same qualities that underscored my anorexia.

Q: How is GAINING a sequel to your first book about anorexia, Solitaire?

A: In GAINING, I trace my personal story forward from the turning point that concluded Solitaire. What I could not explain all those years ago was how one recovers. I could not explain it because I still confused gaining weight with gaining control over the psychological aspects of the illness. I didn’t realize back then that the process of recovery is much more complex – and interesting! – than eating well.

So, I not only pick up my story from the moment at 19 when I “decided to get better,” but I also follow up with my classmates from those days to see how their lives have unfolded and what aspects of their eating disorders persist. Most important of all, I met with some of the world’s leading eating disorder researchers to find out what science knows now that we didn’t know at the time of my turning point.

I consider my book a sort of nonfiction mystery: it reveals, finally, why my friends and I so willingly surrendered to our tormenting obsessions all those years ago, how we each freed ourselves, and what shadow effects of our self-destruction still lingered, even decades after the fact.

Q: What was your most surprising discovery during your research?

A: I’ve long observed that people with histories of anorexia and bulimia share certain core personality traits, but when I checked with UCLA researcher Dr. Michael Strober, I was astonished to learn that the reason for these similarities is genetic. I’d assumed the parallels were due to similar family dynamics, or cultural conditioning, or the physiological effects of the eating disorders. Dr. Strober pointed me to the wealth of new research proving that the reason these people have such similar temperaments lies in their DNA. One study, for instance, showed that traits such as perfectionism, inflexibility, self- doubt, cautiousness, and a need for rules and order had been prevalent among women with eating disorders for years before they ever got sick. Even more astounding to me, however, was the almost total absence of these traits among women who were matched for age and intelligence but had never had an eating disorder. Clearly, the causes of anorexia and bulimia involve more than fashion’s emphasis on thinness or fad diets.

Q: You interviewed more than 40 women – and men – of various ages, sexual preferences, and ethnicities. How did you get them to talk intimately about such a personal issue?

A: Not everyone I contacted from my youth was willing to talk, and few were willing to be interviewed on the record. There is still such shame associated with these illnesses. I find this very sad. It’s comparable to people with diabetes or a familial predisposition to cancer being ashamed of their illness. Eating disorders are biologically based illnesses, yet the common perception is still that the anorexic or bulimic is somehow at fault – as if she chooses to be sick. To get people to open up for this book, I promised anonymity, which included changing the identifying details of their lives.

They were further encouraged when they realized how many core habits, perceptions, and struggles we had shared throughout our lives. Even in their forties, some of my interviewees still suffered from the belief that they alone shied away from intimacy, or were terrified by conflict, or felt trapped by the compulsion to be perfect, or turned to weight loss as a form of comfort when under intense stress. Most of those I interviewed kept these tendencies secret because they were ashamed. The recognition that they were not alone was a powerful incentive to share their stories in GAINING, as was our shared hope that the book may help others.

Q: You also talked to researchers all over the world about their discoveries about eating disorders. How did you gain access to them? Was it a challenge to translate their work into layman’s terms for the book?

A: Eating disorder research is a relatively small but growing and fascinating field. I found most of these busy scientists eager to talk about their findings. They want to spread the word that our understanding of these disorders is dramatically changing. So I attended their conferences, interviewed them at their offices, studied their published papers. I was grateful for the years I’d spent co-authoring books on child development and other psychological topics! That background helped me decipher the sometimes daunting scientific language.

But what fueled me was my own need to understand how this new information related to my history and to the stories my subjects were relating to me. How did the new science change my old assumptions about eating disorders? When viewed through this new lens, what could my history of anorexia teach me about myself now? These were the questions that urged me forward in my work on GAINING. I was tremendously gratified by the endorsements of the researchers who reviewed my completed manuscript before publication, and particularly by my subsequent appointment to the newly formed Advisory Board of the Academy for Eating Disorders.

Q: Why should someone who has never suffered from anorexia or bulimia read your book?

A: Most of us have friends, colleagues, or family members who struggle with eating disorders. GAINING is an attempt to make sense of their behavior – behavior that, on the surface, makes no sense or is downright perverse. My hope is that the insights readers gain will empower them as friends, teachers, doctors, or relatives to get those who are suffering the help they need.

Beyond such specific relevance, however, I hope readers will realize that our culture’s preoccupation with superficial looks-based “perfection” has helped to create a psychological cage for millions of gifted and intelligent women and, increasingly, men. Society is deprived of the full energy and talent of anyone who obsesses about whether she is thin or fit or youthful enough to meet the artificial standards set by air-brushed celebrities and supermodels. By unlocking our selves, we unleash our power to change the world. This ultimate message of GAINING applies to us all.

Q: Do you consider yourself to be truly recovered from anorexia now? What are the key components of long-term recovery?

A: I do consider myself fully recovered. While I will always have a biological vulnerability, I have learned the warning signs and preventive actions to avoid backsliding. But it has taken me a long time to reach this state, so my first advice to those who are wrestling with active eating disorders is to seek help immediately from a doctor or therapist who specializes in treating these conditions. Reaching and maintaining a healthy weight is essential, because a malnourished brain cannot function properly.

Beyond the initial stage, however, long-term recovery depends on the cultivation of genuine self-awareness; friends and loved ones who see you accurately and accept you, flaws and all; the ability to laugh at yourself, or at least not take yourself too seriously; goals and passions that you choose not out of fear or obligation but out of a sense of interest and joy; and a willingness to accept the world’s complexities, imperfections, and contradictions without judging them good or bad, perfect or disgusting, ideal or intolerable.

Finally, recovery depends on our accepting the inevitability of change, through growth, experimentation, setbacks as well as progress, and ultimately through the natural course of aging. Without change there is no life. This is why that inflexible ideal of perfection is such a dangerous obsession.

Q: What advice would you give to mothers of pre-teen daughters, who are immersed in a culture that worships stick-thin celebrities?

A: First, model healthy body acceptance, eating habits, and self-awareness, and talk with your child openly and candidly about these issues – keeping judgment out of the conversation. Second, recognize that every child is different, with her own unique temperament and instincts. Respect those differences and, when necessary, adjust your responses. Children who are prone to eating disorders are often very stubborn and sensitive. They need to be gently helped to develop flexibility, resilience, and a sense of humor about themselves and the world around them. They need to develop the coping skills to manage anxiety and keep their problems in perspective.

These skills are especially critical during the emotionally turbulent pre-teen and teen years, when anxiety often leads to imitation of those stick-thin celebrities and other superficially “perfect” ideals. Remind your daughter as often as necessary that no one is perfect. Refraining from judgment, keeping the lines of communication open, and being available to listen accurately and honestly are crucial at this time. Finally, remember that your job as a parent is to help your child separate from you and survive on her own. Encourage her to make her own good decisions by giving her meaningful choices. Trust her to develop her own strong sense of self. This involves a gradual process of letting go while also being “on call” if she needs you. It’s a tender balance! You may need to remind yourself that there’s no such thing as a “perfect” parent, either.

Dear Reader...

When I first decided to write Gaining I was curious. I wanted to see if there was anything to my suspicion that certain personality traits, which seemed to set us up for eating disorders, might still shape our lives in distinct patterns even decades after recovery. I also wanted to learn what scientists know now that they didn’t know thirty years ago, when I was first recovering from anorexia. But I wasn’t sure how many other people would share my curiosity, and I didn’t know that the stories and research I was to study would be so fascinating!

By the time Gaining was ready for publication I knew that I had been profoundly changed by what I’d learned in my research, and I knew that I had never read a book like the one I’d just written. I hoped the stories I’d collected would help others to learn about themselves, as they had helped me; perhaps I was too close to the material, though. I feared the book might get lost among the new nonfiction releases. To be sure, the early review comments from experts in the field of eating disorder treatment and research were tremendously heartening, but what about the families and individuals who had actually wrestled with these illnesses? How would they find their way to this title, and what would they think if and when they read it?
What I didn’t fully appreciate was the hunger for new insight into the mysteries of anorexia and bulimia nervosa. Messages began pouring into my inbox as soon as Gaining was published. People told me their stories, shared their frustrations and fears, expressed their most urgent hopes. Most of those who wrote were not in the immediate grip of an eating disorder but were caught in the same “half-life” that had held me for nearly thirty years. They had gained control of their eating behavior but still were not free psychologically. They had never connected the dots between their compulsive dieting, bingeing, and purging and their compulsive fitness regimens or vegetarianism, their punishing work habits, problems with trust and sexual intimacy, and the deeply felt (if not necessarily conscious) belief that when the going gets tough, the tough punish themselves. This group shared a common assumption that suffering is an absolute requirement for perfection. And every one of them, to varying degrees, felt driven to be perfect.

I’d like to share a few of these letters with you here, because I think they reflect a range of perspectives and concerns that have been too long neglected. Also, I believe that we gain power by sharing our stories and experiences. Shame and denial too often perpetuate psychological disorders. By sharing truths that we experience as unique we often reach universal insights.
The following are just brief excerpts, but they indicate just how much we all have to gain as we become self-aware and “self-centered” in the best of senses.

* "I am sixteen years old, soon to be seventeen and since the age of twelve I have struggled tremendously with my weight. I dealt with severe to moderate anorexia until I was fourteen. Then I nearly lost my mother, and could no longer function without physical strength so I began to eat again. I was successfully "recovered" for several months, but I found the weight gain so hard to bear I slipped into severe depression. I was forced to transfer out of my prestigious prep school to public schooling after my Freshman year. It was then that I began my battle with bulimia and have been at if ever since... I had no intention of devouring [Gaining] as I did because in truth, it's been nearly a year since I've read anything aside from Vanity Fair in full (I am unable to focus due to my inconsistent diet and depression). When I read the first few pages my heart leapt to my throat. To find someone… that emphasized with the true emotional torment of ed's but had learned to live despite it--you gave me hope."
- Connecticut

* "After pregnancy had, I thought, cured me of eating disorders, my anorexia resurfaced shortly after Hurricane Katrina. I stopped eating when it became clear that we were going to be displaced for a while, and I lost more than ten pounds during the six weeks of our evacuation in Houston. Your book is really helping me to see that many things I thought were completely unrelated to my food issues are connected… I've already spoken with one of my aunts about the history on my mother's side of the family and have a call in to another aunt to discuss my father's side of the family. My mother's sister had no idea that I'd experienced eating disorders, and it was very liberating to talk about it with her."
- Louisiana

* "When you spoke of nail biting and anxiety and hiding behind a computer so you didn't have to speak to your husband, it was if I was looking in the mirror. My major conversations with my husband take place via email. I love the man to death and I know he loves me, but I am afraid to talk to him about things that bother me. My fear of his disapproval is so strong that I
can't fight through it. I want to have the perfect household, where everyone is content and happy. I stuff my anger and frustrations and eventually end up punishing myself for them… I need to move on with the better half of my life, because I know the alternative to that is death, and I do have too much to live for. I will tell myself this everyday for as long as it
- Michigan

* "My wife has started to read your book... She grew up in a good home, with good parents, yet found herself to be the only one of three kids who went down the path of Drugs to Anorexia to Bulimia to defeating all of those actions years later… We were married three years ago and I knew nothing about eating disorders or the psychological issues that promote them… Everything was fine while we were dating, then when we got engaged things started to slide and continue to slide up to today. By "slide" I mean that she has gradually pulled further and further away from any form of intimacy…Being married to someone who can't enter into intimacy is really, really tough and I often think about divorce, not because I don't love her, but because she won't let me be her husband and she won't let herself be my wife… I find myself reaching out for her only to be rejected with a blank stare."
- California

* "I'm 59 years old. I appear successful at a writing vocation, marriage and emotional health. I have accomplished a lot coming from the family I came from but anorexia has returned to nip at me. Eating disordered thinking with all the different behaviors had been a part of my life since my teens. I've never been hospitalized but I was in out-patient groups and spent years in therapy. I thought I was over it though I recognized how rules and believing in 'perfect' still dominated my life. I overcame so much to get where I am. My husband's health began to deteriorate several years ago which he has faced quite bravely and I also got breast cancer (which luckily was caught in the early stages). My anxiety kept growing and my restricting grew a pace. I felt crazed--what was going on? How could I be so troubled at my age with all the luck and goodness in my life? I found a therapist, highly experienced… I've been seeing her privately and in a group too. The group is composed of women 45 and over and breaks my bewildering isolation... Now, at last, I have real evidence that I can feel my feelings, make mistakes and be at peace with less than sublime--even be 'ordinary'."
- Washington

* "Our son, 18, has been struggling with AN/​BN for almost four years, has been hospitalized multiple times, has done partial hospitalization programs, residential programs for emotionally fragile adolescents, etc. -- He is supported by great people in school, great ED physician, psychiatrist, therapist, nutritionist, family therapist, you name it. I've realized that all of this "therapy" has not addressed what you described in the introduction as the knowing yourself stage but instead focused on the second and third stages... I thought that you expressed so well what it is that has held [my son] hostage all this time and helped me to define a path in my own mind for recovery that makes sense."
- Massachusetts

These letters remind me just how important it is to “connect the dots” not only within our own private experience, but also in our experiences with each others. Eating disorders act to isolate us, but in fact, none of us is isolated. We all have partners, parents, children, friends, and colleagues who are deeply concerned and affected by our struggles. Many of them are eager to help, if only given a chance. I hope this book will help to forge those larger connections, as well as helping us each to better understand ourselves.
-- Aimee Liu