Laura was 19 when she first came to see me for help for anorexia, orthorexia and chronic dieting. She was wafer thin, and with the exception of her face and hands, every inch of her yellowed skin was covered in layers of thick clothing. It was June.
She sat across from me, arms folded, legs crossed, eyes firmly attached to a spot on the floor that seemed to have captivated her interest rather keenly for a tiny speck of lint. Her opening volley, which she directed generally towards my side of the room through clenched teeth, was something along the lines of:
“I’m only here because my mom thinks I have a problem and she said if I came to see you once she’d lay off and leave me alone.”
In her tone you could almost hear the “Harumph!” and the “So there!” and a few expletives thrown in for good measure.
And such was my introduction to Laura.
Her mother had made the appointment for her and I had been forewarned that she was coming under pressure from mom and in a personal state of resistance. I let mom know that while I was more than willing to meet and chat with Laura once, my philosophy for the treatment of disordered eating of any kind (anorexia, bulimia, binge eating, orthorexia or chronic dieting), or any other harmful coping strategy, centred around the client recognizing that something isn’t working in their lives and, at the very least, having a teensy bit of curiosity about what’s going on and what they could do about it.
My job is to walk my clients, as efficiently as possible, from their current harmful and confused response to stress to a solid state of peace and confidence in all areas of their lives. If a client is open to things being different in their lives, all they have to do is show up and follow the simple steps I lay out for them piece by piece.
Laura had shown up, it’s true. But it seemed that the curiosity piece was sorely lacking. Fair enough. She hadn’t freely chosen to be there.
So we talked a bit about what she thought it was that mom saw in her that made her think she needed help. Ultimately Laura admitted that she knew she was thin (At 5’8” and 79 lbs. I had to agree.) but asserted that she didn’t think she had an eating disorder. In her perspective she just liked to eat healthy foods and so she didn’t have any fat on her body. Mom was just a worry wart.
When I questioned Laura about life circumstances that might be stressful for her she insisted that everything was fine, she wasn’t stressed about anything.
When I asked her for a little snapshot of her life these days and in the past year she shared that she had dropped out of university in the middle of her first year because she was depressed about her grades. She’d always been a strong student and had found the transition to university life and living away from her family for the first time harder than she had imagined. Her grades had suffered as a result and she was mortified and filled with self-loathing.
I asked her a bit about when she began to focus on eating so healthily and she said it had started in grade 10 when her parents were going through a stressful time, the family had moved twice in 2 years and her new school was much more competitive academically than her old one. Her brother was going through a tough time as well then and seemed to need a lot of attention from her mom and Laura began to feel like there wasn’t any room for her to have a bad day or to need her mom’s support as well.
She began to focus almost exclusively on getting the best grades in her school, and on ignoring the needs of her body and eating as little as possible. In her mind she was doing a great job of being productive; taking time to eat was wasting time and unnecessary. A bowl of cereal here and there would suffice, or so she believed.
Soon she had lost a great deal of weight. She was chronically exhausted and anxious (two natural by products of starvation/poor nutrition and low blood sugar) and somehow had begun to monitor everything she ate with the same rigidity that she approached her schoolwork.
Because Laura didn’t really understand what was triggering her urgent need for perfection and for control over her body’s needs there truly was no way for her to find a solution. Instead she believed she just had to try harder and do more and then she would finally feel good enough and at peace and she could rest.
Of course there is no such thing as good enough. Without clarifying ‘good enough for what?’ ‘good enough for whom?’ there is no way to actually achieve the goal of ‘good enough.’
Laura had no idea specifically what the criteria of good enough was, she just had a strong belief that she’d know it when she got there and that as long as she was anxious she still wasn’t good enough. And round and round she went.
And so she found herself in my office, reluctantly acknowledging that she had lost her grip on her relationship with food; that she was constantly anxious; constantly cold; constantly uncomfortable in her body; couldn’t do her schoolwork and felt like a total failure. And worst of all, she felt like she couldn’t admit any of this to anyone because she believed that she had to be perfect; always strong; never needing anything from anyone so as not to burden the key people in her life whom she saw as already overburdened and unavailable.
Through that initial discussion Laura became increasingly more relaxed. Her arms and legs unfolded, she unclenched her jaw, she looked at me as we spoke and her tone became one of sadness and frustration rather than seething anger.
She said that if, together, we could find a solution to how anxious and insecure she felt and to help her be able to function well at school she’d be interested in meeting again. And so we did.
We met a couple of times a week for the first few weeks, then weekly for about 6 months and then every other week for a while until she felt truly ready to fly on her own.
At our last session, when we knew that her work around her restriction, anxiety, and self-esteem was complete, she took stock of where she had been 10 months prior, when we first met, and where she was now:
“When I first came to see you, I was in total denial. I wasn’t willing to admit at all that I had a problem and I certainly didn’t want help. I didn’t want to make it real and I didn’t want to seem week or like a failure. I also didn’t want my parents to worry and I didn’t feel deserving of the money it would cost to get well. I weighed 79 pounds! I was tired and cold all the time. I wasn’t menstruating. I was incredibly restrictive with food and so picky that I felt bad about eating anything at all. And at the same time I truly believed I was just really health conscious!” She chuckled and smiled at me, grinning at her own past confusion.
“I had very low iron and potassium. I was incredibly perfectionistic and so chronically anxious that I couldn’t function. My self-talk was always critical and nothing I did or said was ever good enough. I had no concept of moderation in any area of my life including food and the thought of paying attention to my body or my feelings felt like a total waste of time and completely wimpy and stupid.”
“I couldn’t talk about my weight or my body with anyone and if a doctor or my parents started talking about what I weighed or about me needing to gain weight I’d yell or cry or just shut down and we’d get nowhere.”
“Now, I weigh 120 pounds and gaining and I’m so comfortable with that! I like feeling healthier. I love having energy and having a period again! Because I’m not binging or restricting and I trust myself to really listen to my body I feel safe eating anything, anytime, anywhere. In fact, I’m even having fun baking cookies and it’s so enjoyable to have one or two each day! I don’t feel the need to binge and I don’t feel the need to restrict, it’s just so easy and it feels so natural.”
“I am so much more comfortable being honest and communicating about what I’m feeling and what I need and my relationships are so much easier and more deep and fun than they ever were before. I am doing much better at letting go of my perfectionist tendencies and find that I get more done and have more peace and enjoyment in my schoolwork, and, interestingly enough, better grades!, than I did before when I was 24/7 obsessed and anxious about it.”
“I notice when I’m making assumptions about how things are going to go, or about what someone is thinking or doing and I check out those assumptions. That in itself has been life changing in how it’s helped me to let go of old beliefs I had about myself and to really get to know the people I’m relating to. I trust myself now to deal with things respectfully as they arise and I feel so much more confident all around, it’s amazing!”
“And lastly, I can talk about my weight and my body freely and comfortably with anyone now. It’s not at all triggering to have my mom ask me about it or to chat with my doctor and that is just awesome. And I know that’s because I trust myself to only do things that feel right to me and because I see myself eating well and exercising moderately and I know I’m doing my best. There is no reason for me to be defensive or to avoid the conversation because I’m really comfortable with how I’m behaving. I’m not ashamed or judging myself at all and that is so freeing. I truly feel like I can start living now.”
It may interest you to know that throughout our work together Laura and I rarely discussed food. She was never given a diet or nutritional plan to follow.
Her parents made frequent calls/emails to me expressing their concern in the first few months about her still very low weight. I did my best to reassure them that it would come in time and that Laura needed to wrap her head around the underlying pieces before any change she made to food would be solid and lasting. I also acknowledged to mom and dad that I understood that, as a parent, they wouldn’t be able to truly relax until they saw that physical manifestation of health. I let them know that their work in this situation was around ensuring Laura heard from them often that she was loved and that they were scared for her health but that they believed that she wanted to be well and that they saw her efforts to learn and grow and change those old patterns.
It was hard for mom and dad to step back and wait and trust. And of course it would be. We can only have complete confidence and trust in things we have already experienced and they had never been through this and didn’t know me from a hole in the ground.
I was happy to offer them a place to share their fears and provide them with reassurance as needed. We had a number of meetings, mom, dad and I, as well as with Laura to create as much transparency as possible and to create solid communication skills in the family dynamic.
All in all the family did beautifully. Laura is well now and truly done with disordered eating. She’s moving on in all aspects of her life. And, mom and dad have a greater connection with her than ever before.
From time to time I will connect with Laura as she feels the need for a little guidance around certain events in her life; things that are happening with her career and with friends or her boyfriend or mom or dad for example. She says she knows she needs to touch base with me when she feels anxious and, even though she can identify the trigger, she can’t seem to put her finger on a solution.
I tell her that that’s a normal, healthy, human experience. I tell her that I do believe she can figure things out on her own, as I believe I can in my own life. But I also believe that if I don’t know how to do something or why something is happening and there is an expert I can ask who can tell me in 50 minutes and give me tools to change the situation, it makes the most sense and is the greatest gesture of self-care to reach out and move through the situation with the greatest speed and ease.
In truth, there will be many new experiences as we go through life in which, simply because we’ve never experienced them, we’re not sure how to proceed. One of the greatest benefits of living in a community/society is that we have support and resources we can turn to when we need information, support or reassurance.
Human begins are meant to learn from each other, not to struggle in reinventing the wheel and figuring everything out for ourselves. That’s unnecessary and quite inefficient and usually a sign that in our early years we were lacking safe and consistent people to go to and admit we didn’t know something. And so we suffer, feeling anxious about a problem and believing we can’t admit we need help because we’ll be shamed or rejected or burden someone.
Personally, if I come up against a new thing in my life that I don’t know how to handle but it is important for me to handle well (parenting issues come readily to mind in this moment….), I don’t languish in forcing myself to figure it out; I don’t feel ashamed to ask for help or admit I don’t know. I cherish my peacefulness; I cherish my self-esteem; I cherish the relationship in which I’m struggling and so I reach out, fast, for some guidance and lickety-split, problem solved.
Laura is free of the food – stress connection and can now put all of her focus and energy into creating the life she wants. She’s doing a great job and taking care of herself and creating great relationships. That’s a pretty good outcome I’d say, and what’s most important, is that Laura thinks so too.