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


Moving from an Eating Disorder's Half-life to Your Full Life

January 9, 2012

NEDA asked me to write an article in advance of National Eating Disorders Awareness Week. I thought you might like to get a jump on reading it!

What happens to people with anorexia or bulimia who don't get treatment -- or who don't get enough of the right treatment? This is an important question because, according to the National Association of Anorexia Nervosa and Associated Disorders, only ten percent of people with eating disorders are ever treated. It's also a tough question because data in this field is collected primarily from those who have been treated. So when I began writing my book Gaining: The Truth About Life After Eating Disorders, I decided to take a different approach.

I knew that most of those who struggled with eating disorders when I was growing up in the 1960s and 70s did not get proper treatment. To a large extent that was because doctors at that time did not recognize these illnesses. I, for example, received neither a diagnosis nor treatment; only years later did I realize that I'd been anorexic from eighth grade until my junior year of college. So were several of my high school and college classmates. Others struggled with bulimia. And the strange thing was that because we were constantly comparing ourselves to each other -- what we weighed, how much we ate, how we kept the weight off, how we hid how much we'd lost -- we knew exactly who had which of these then unrecognized conditions. So thirty years later, when I decided to explore the long-term effects of eating disorders, I knew whom to ask.

What I learned from these interviews -- and from reexamining my own life -- was both comforting and sobering. Today, treatment for these illnesses is specialized and comprehensive, involving medical, nutritional, and psychological therapies, but forty years ago "treatment" often consisted of forced feedings and little else. The classmates I interviewed actually fared better than others who were hospitalized for anorexia back in those days -- at least one of whom died not long after I graduated from high school.

But did the fact of our survival mean we'd fully recovered? If so, how did we recover? My interviews suggested that most of us owed our physical health in large measure to the love of friends, partners, and family members who saw past the physical shape of our bodies and insisted on connecting with the person hiding inside. Not the person we were pretending to be or felt we "should" be, but the true self the eating disorder had eclipsed. Recovery was as much about restoring that true self and building healthy relationships as it was about rebuilding a healthy body, and the more we felt we were gaining full and meaningful lives, the less of a stranglehold our obsession with food and weight had on our brains. Unfortunately, few of us back then were conscious of this process, much less intentional about maintaining it.

Decades later, many of us appeared objectively to be doing quite well, with good careers and seemingly stable marriages and families. But on closer inspection, I discovered that many were also struggling with what I now call the half-life of eating disorders. That is, we no longer necessarily binged, purged, or restricted using food, but we binged, purged, and restricted in other ways. Some used exercise, others sex, drugs, alcohol, work, or religion. We still obsessed, still beat ourselves up emotionally, still engaged in compulsive behaviors. A few also cycled through periods of relapse into full-blown -- and generally secretive -- anorexic or bulimic behavior. This was especially likely to happen during periods of profound change or loss -- when a divorce, say, or death of a loved one triggered the old self-defeating distress signals.

Those most vulnerable were those who were most socially isolated; one such classmate died of an anorexic relapse just last year, at age 57. Those doing the best seemed to be those of us who eventually had sought counseling and discovered the missing link between eating disorders and other patterns of thinking and behavior.

To better understand this missing link, I turned to the researchers now investigating the roles of genetics and personality in eating disorders. Their studies confirmed what I had observed when interviewing my former classmates: people with anorexia and bulimia tend to share certain innate temperamental traits. Those who've struggled with anorexia tend to be highly persistent, introspective, and cautious. Those who develop bulimia are often impulsive by nature and drawn to novelty.

Perfectionism is common in people with all eating disorders. These traits precede the eating disorders, and they do not go away when you recover.

There is nothing inherently positive or negative about these traits. If recognized and steered in a positive direction, each can contribute to a fuller richer life. Perfectionism and persistence, for instance, can be a boon if you're an artist, architect, or scientist, so long as you don't confuse the quality of your work with your value as a human being. But if misdirected, persistence can cause you to overwork yourself, and perfectionism can cause you to fixate on meaningless or irrational ideals, such as extreme thinness or starvation, and then conflate them with identity.

Full recovery requires profound and honest self-examination, as well as a mindful approach to managing and directing your basic instincts. As psychiatrist and eating disorder specialist Joel Yager said to me, "Know thyself… What is your biology? What is your calling? Study your temperament. Be respectful of it."

Can you do this on your own? Theoretically, yes. But in reality, most of us need the help of an experienced professional who understands the true nature and complexity of eating disorders. Recent studies have shown that the earlier treatment for an eating disorder begins, the better the prognosis and the faster the rate of recovery.

The results can be breath-taking, as I learned from one young woman, just a year out of treatment, who recently wrote to me:
"Before starting recovery, I was afraid to go anywhere with people, especially anywhere there'd be food. Since beginning recovery, I've discovered that I'm a people person! Who knew? Also I found out I have a true passion for the outdoors. Rock climbing, rappelling, hiking, all of it. I thought I was supposed to be a dud. But that's not true. I'm supposed to enjoy living"

Note to everyone who's ever had an eating disorder: we are ALL supposed to enjoy living.

Fortunately, most eating disorder treatment programs today understand this. They move well beyond the initial and necessary focus on eating and weight to address temperament, identity, self direction, and other key predisposing or contributing issues. Qualified professionals in your area can be found through the Academy for Eating Disorders at I wish this help had been available when my classmates and I began our struggle to recover. If it had, we wouldn't have spent so many years caught in our eating disorders' half-lives.

By Aimee Liu
Author of Gaining: The Truth About Life After Eating Disorders and Restoring Our Bodies, Reclaiming Our Lives: Guidance and Reflections on Recovery from Eating Disorders
Member of the Advisory Board of the Academy for Eating Disorders

Enter your e-mail address below to subscribe or unsubscribe from the mailing list.

privacy policy

Read Past Newsletters -
just click the links below:

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