GAINING:
The Truth About Life
After Eating Disorders

Essays, Articles, & Nonfiction Works
by Aimee Liu

RESOURCES
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
Books
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

Newsletter

GOOD NEWS or BAD NEWS for 2009?

December 31, 2008

Happy New Year!
How often do we say these words without really meaning or even thinking about them? Worse, how often do we wish others happiness while silently despairing of our own? For most of us, the answer is, too often.

We do have a choice, you know. It’s that old glass half full or half empty thing. I’ve been thinking about this in response to a comment posted on my blog yesterday: “I would like to know where you got the information that the vast majority of girls with eating disorders eventually get better? I was in treatment two years ago and they told us exactly the opposite.”

Now, I’m not in a position to second guess the accuracy of this report, let alone speculate why any therapist ever would discourage hope in treatment. But I will say that the emphasis in statistics about eating disorders is almost always on the downside – highlighting the high prevalence, mortality rates, and relapse rates. These scary statistics are publicized in order to persuade the public that these illnesses are serious and widespread enough to warrant preventive education, treatment, insurance coverage, and research. Even one person who dies of an eating disorder is one too many.

On the other hand, those who are already ill don’t need to be told how dangerous these disorders are. They need to focus on the flip side of these statistics: the recovery rates. Those rates are difficult to come by, mostly because the vast majority of people with eating disorders never receive treatment and so never are counted. Patients, who are counted, at least until recently have tended to be those most severely ill. And those who are sickest have lower rates of full recovery. All this means that the true recovery rates are most likely higher than the published rates. But even if we consider only the official recovery rates, the outlook is generally positive.

Anorexia nervosa is widely considered to be the most difficult eating disorder to treat and the most persistent. Yet here is the report from Laureate Clinic in Tulsa, OK, published in 2003: “for the overall spectrum of patients with anorexia nervosa, approximately 75%–85% will completely recover. If patients who experience significant improvement are included, the rate of positive outcome rises to over 90%. Thus, a 75%–90% rate of recovery is a more accurate estimate.” http://ajp.psychiatryonline.org/cgi/content/full/160/4/798

Does recovery happen “spontaneously” or “perfectly”? Does recovery look the same in every case? Does recovery guarantee a “perfect” life?

The answer is no. There are no statistics on instant, easy, or perfect recoveries – because such recoveries do not exist.

Recovery takes time and is messy. It involves effort and hope and courage to change. Most of all, it requires acceptance of all the imperfections, all the unknowable truths and uncertain possibilities that life contains. Recovery means ignoring the numbers, whether on the scale or in statistics.

I remember years ago when my teenage son was angling for permission to go to a club in a dangerous part of town by saying that all his friends went there all the time. I replied that I really didn’t care how many of his friends went and came back safe; my sole concern was that he be safe.

When it comes to your recovery, the same rule applies. It doesn’t matter what the statistics say; it only matters that you grant yourself the permission, support, encouragement, and time that you personally need to reclaim your future and your health.
So fill your glass and raise it high, and this time really mean it when you promise yourself a happy and healthy new year!
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Anorexia's Red Herring

Too-skinny models may be a factor in spawning eating disorders, but they're just one of many.
By Aimee Liu

Published in the Los
Angeles Times,
September 22, 2006

THIS WEEK in Madrid, heroin chic was prohibited. For the first time, the organizers of a major international fashion show recognized that by showcasing emaciated models, the fashion industry promotes eating disorders. Under pressure from the Madrid government, medical associations and women's advocacy groups, the Assn. of Fashion Designers of Spain finally rejected morbidly thin models.

When selecting models for this year's Madrid fashion week, which ends today, the designers set a minimum body mass ratio (calculated on the basis of height and weight). Their required ratio was 18 — meaning a minimum of 119 pounds for a 5-foot, 8-inch woman. The bar was by no means high. For ordinary mortals, a ratio of 18.5 qualifies as underweight. Even so, five of the 68 auditioning models flunked.

To understand why they flunked, we need to look beyond the fashion industry to the true causes of eating disorders. These include genetic predisposition, temperament, family dynamics and personal trauma. I know; modeling fueled but did not cause my own adolescent eating disorder nearly 40 years ago.

Twiggy was my generation's Kate Moss. I fixated on her at age 13, and by the time I started modeling one year later, I'd dropped 30 pounds. Being skinny became my identity. At 5 feet, 7 inches, I didn't weigh more than 100 pounds again until I was 21.

My anorexia ultimately destroyed my career.

Models were — and still are — paid to make fashions look good, and that meant fitting sample wardrobes. Reigning teen cover girls Shelley Hack and Colleen Corby understood this. In dressing room lunches between shoots, I'd watch them wolf down tuna salad sandwiches while I pretended not to be hungry. They were lucky, I told myself, they could get away with eating. I began to lose jobs when I became so thin that stylists couldn't even pin dresses on me to look right. Still, I felt I couldn't eat.

Like many anorexic models, I was drawn to the fashion world because it reinforced my anorexia. I would be willing to bet that most, if not all, of the runway models disqualified in Madrid fit the same pattern — as do many emaciated gymnasts and ice skaters.

Three years ago, I began interviewing medical researchers as well as middle-age women and men with histories of anorexia and bulimia. I wanted to find out what we know now that we didn't know in the 1970s, when I quit my self-imposed hunger strike. I learned that researchers now are discovering genetic links between eating disorders, depression and obsessive-compulsive disorder. Genes also shape the temperaments of people who are prone to anorexia and bulimia, although the mechanisms for this are still poorly understood.

A landmark 2003 British study found that certain innate childhood traits, such as perfectionism, inflexibility and cautiousness, each increase an individual's risk for anorexia by a factor of seven. Someone like me, possessing all five traits measured in the study, is 35 times more likely to develop an eating disorder than a daredevil who happily wears mismatched socks.

Further, eating disorders are triggered not by pictures of Kate Moss but by sudden or cumulative experiences of intolerable emotion, such as shame or fear. Puberty unleashes a natural tidal wave of these emotions. Adolescence also happens to be the age when rates of sexual abuse soar, academic and social pressures intensify and parents become a source of embarrassment rather than solace. It makes sense that this is prime time for eating disorders. Obsession with weight offers a distraction. Extreme weight loss signals distress.

It also makes sense that rates of anorexia and bulimia spike in middle age, when many women again face emotional turmoil. Women over 30 now make up a full third of residential patients at the Renfrew Center, a Philadelphia treatment facility specializing in eating disorders. Divorce, grief, the empty nest — all can trigger illness if the individual possesses a genetic predisposition.

The onset of eating disorders is like the firing of a gun. Genetics form the gun. Cultural influences such as the fashion industry and familial attitudes about weight then load it. And intense emotional distress pulls the trigger.

Healthier figures on international catwalks may help to disarm the gun. However, of the more than 40 women I interviewed, only a handful had ever paid any attention to fashion. When they started starving, they were asking for help, not admiration. Those models who failed the test in Madrid need treatment, not rebuke.



Copyright 2006 Los Angeles Times