Disordered eating, disordered thoughts | Emily's Story

On Halloween night in 2007, then-freshman Caitlin Hilton sat alone in her McCollum Hall dorm room, turned up her CD “Songs to Die to,” put a handful of anti-depressant and anti-anxiety pills in her mouth and washed the chalky tablets down with a shot of Everclear grain alcohol.

Hours later, she woke up in Lawrence Memorial Hospital with a foggy memory of an ambulance ride. On her tongue was the lingering taste of liquid charcoal, which emergency technicians used to flush out the toxins that Caitlin had hoped would end her life and the depression that plagued it.

Two months later, when Caitlin sought psychiatric treatment at the Menninger Clinic in Houston, she was startled to learn that she wasn’t being admitted for depression, but rather to treat an underlying eating disorder called EDNOS — eating disorders not otherwise specified.

For Caitlin, restrictive eating was always a way to cope with depression. For others, depression and anxiety can flow from eating disorders. That was the case with Heidi a KU senior and life-long dancer from Shawnee who asked that her last name be withheld. During high school, Heidi obsessed about counting calories and working out. Not only did she lose weight, she also lost friends and a sense of happiness.

Even though these women have different stories, their experiences of struggling with both eating and psychological disorders are strikingly similar — and common.

The National Institute of Mental Health estimates that up to 75 percent of people with eating disorders have additional psychological disorders, such as depression or clinical anxiety.

Regardless of which affliction comes first, these disorders can be a recipe for isolation, poor health and — potentially — death.

Eating disorders and psychological disorders

Merriam-Webster defines eating disorders as addictive psychological disorders that adversely affect the way a person’s mind operates.

Nationwide, an estimated 10 million women and 1 million men battle anorexia or bulimia, according to the National Eating Disorder Association. That’s more than four times the population of Kansas.

That figure does not include people dealing with EDNOS, which Caitlin was diagnosed with. This category includes binge eating, which affects one in five obese people, according to the Academy of Eating Disorders.

More than half of the people diagnosed with bulimia are clinically depressed and anorexics experience similarly high rates of clinical anxiety. People with eating disorders also have elevated rates of bipolar disorder, obsessive-compulsive disorder and substance abuse, according to the National Institute on Mental Health.

Steven Ilardi, KU professor of psychology and author of “The Depression Cure,” said people sometimes use disordered eating habits to ease their other psychological pains. Because of this, psychological problems can appear before eating disorders.

In the case of bulimics, binging on food and then vomiting it up releases endorphins. That temporarily numbs the emotional pain of depression.

“If a person is emotionally upset, the binge-purge cycle is particularly soothing,” Ilardi said.

For anorexics, the ability to control what they eat, how much they eat and when they eat provides a sense of comfort in a life otherwise out of control.

Control and coping

Caitlin first began restricting the food she ate as a way of coping with tragedy. She was 13 and her best friend had just been killed in a car accident. To avoid thinking about the loss, Caitlin instead focused on limiting the amount of food she ate.

“I couldn’t control the situations around me, but I could control my eating,” she said.

At first, restricting calories helped Caitlin mask her depression — but, it didn’t make it disappear. Meanwhile, disordered eating became a problem of its own.

On some occasions, she was so depressed that she would forget to eat for one or two days. Other times, she made a point of limiting herself to 650 calories a day, when her body weight suggested she needed 2,000 calories to be healthy. Those days, she ate a snack bag of Doritos and two strawberry Pop Tarts. In between eating, she weighed herself obsessively.

In those gratifying moments on the scale, it didn’t matter that she wasn’t getting along with her mom, that she was having trouble with a boyfriend or that she still missed her friend.

If her weight went down, she was in control and happy — at least at that moment.

Eating disorders: More than meets the eye

In some cases, psychological disorders follow an eating disorder. This was the case with Heidi, a petite blonde with an ear-to-ear smile that epitomizes the word “bubbly.” She is also a recovering anorexic who continues to take anti-depressant medications.

As a dancer, Heidi constantly worried about her weight. She couldn’t help but think that other dancers had thinner legs or tighter stomachs when she spent hours each day surrounded by mirrors and leotard-clad girls.

In eighth grade, she started skipping meals and swiping diet pills from her mother’s medicine cabinet.

The food deprivation increased during her sophomore year of high school, when Heidi went through a bad breakup. Instead of dwelling on her ex-boyfriend, she focused on losing weight.

During every school day, she made a point of drinking three large Nalgene bottles of water so she wouldn’t get hungry. As soon as class let out, she headed to the gym for 60 minutes on the elliptical. The day ended with dance practice from 5 to 9 p.m.

She kept a meticulous calorie log, where she would write down everything she ate. At the end of a “good day,” which entailed meals of half of an apple or a chicken patty with the breading wiped off, she would scribble, “Yay! Good job!”

After months of a monotonously similar cycle that left her undernourished and unhappy, she gave into her family’s urging to go to Children’s Mercy Hospital in Kansas City for outpatient treatment. She didn’t think she had an eating disorder, but she knew she wasn’t acting like herself. She had withdrawn from friends and wanted to be alone in her room.

“You think that when you’re super skinny, you’re super happy,” Heidi said. “But that’s not true.”

During her first meeting, her counselor held up pictures of two women and asked Heidi to choose the one she thought she looked the most like.

Heidi chose a picture of a woman who weighed 40 pounds more than her.

“It takes over your brain and your body,” Heidi said.

She was diagnosed with anorexia and prescribed an anti-depressant medication. Slowly but surely, she began spending less time thinking about food and more time socializing with friends.

“The medicine was just a little push to get going,” Heidi said.

Six years later, Heidi is at a healthy weight and in a happy place. Still, she admits that neither the therapy nor the medicine were able to completely wipe obsessive eating thoughts from her mind.

She’s just learned how to stop negativity before it goes too far.

“Whenever I get the tendency to go back there, I think, ‘No,’” Heidi said.

She has also developed strategies for dealing with stress. Rather than obsessively working out, she listens to music to calm down. Instead of getting caught up in a chaotic day and winding up with a “good, empty feeling” in her stomach, she carries granola bars in her backpack so she’ll have something to eat on-the-go.

Where she once fixated on counting unwanted calories, now she appreciates healthy food that fuels her body.

“I’ve come so far to have a healthy relationship with food,” Heidi said.

For her, that means finding balance.

“There’s nothing wrong with being healthy. Just don’t go past that line.”

The problem is defining where that line is.

Unrealistic expectations

Society’s expectations play significant roles in why women with eating disorders drastically outnumber men. According to one study by Ohio State University, the majority of college men feel pressure to be muscular. In contrast, women think they should be thin.

Women’s magazines contain 10 times more advertisements for dieting and weight-loss articles than men’s magazines, according to the Media Awareness Network, a Canadian non-profit program.

Another study by the Just Think Foundation, which promotes critical consumption of media, showed that the average female model weighed just three-quarters of what an average woman weighed. Yet these models are often portrayed as ideal images of how women should look.

As dietician at Watkins Memorial Health Center, Ann Chapman meets with students about their nutritional habits.

“By the time girls finish high school, they are already indoctrinated with how to look,” she said.

With the abundance of skewed media messages, Chapman said it was no surprise that many young women had warped body images.

In many cases, disordered eating tendencies lie dormant throughout high school, when girls eat healthy meals provided by parents, play competitive sports and live in a generally calm and supportive home environment.

It’s not until a stressful or traumatic event occurs that disordered eating behavior manifests. For Caitlin, it was when her friend died. For Heidi, it was a devastating breakup. For others, it’s the move from home to college.

“The transition from high school to college is always stressful, even if you’re excited,” Chapman said.

According to the National Institute of Mental Health, the average onset age of anorexia is 17 and for bulimia it's 18-20 — the very age of college women.

Chapman said part of this might stem from students fearing weight gain so much that they move in the opposite direction.

“Girls often go into college already afraid to gain weight,” Chapman said.

Slippery slope

An additional one-third of college women don’t meet the criteria for anorexia or bulimia, but display disordered eating habits such as binging, taking laxatives or using diet pills.

These afflictions aren’t limited to thin girls. One study in the Journal of Obesity Related Mental Disorders found that overweight girls are more likely to develop disordered eating tendencies during their young adult years.

Even seemingly normal behaviors can be the beginning of a slippery slope.

A bad breakup? Eat a carton of Ben and Jerry’s ice cream.

Not motivated to get out of bed? Skip breakfast.

Worried about gaining weight? Count and cut calories.

Taken together, these behaviors can evolve into legitimate eating disorders. And, when combined with other psychological disorders such as depression, bipolar disorder and generalized anxiety disorder, eating disorders can be even more difficult to overcome.

“Although there are exceptions to every rule, the longer people are engaged in unhealthy practices, the longer the recovery,” Chapman said.

If eating disorders are ultimately left untreated, they can carry grave physical and psychological consequences.

Anorexia has the highest mortality rate of any mental health disorder. One in 10 anorexics die at a young age from suicide, heart failure or other medical complications from low weight.

Bulimics are also at risk for permanent organ problems, such as esophageal tears or gastrointestinal damage. The suicide rate among anorexics and bulimics is 23 times higher than that of the general population, according to one study in the British Journal of Psychiatry.

“People don’t realize that eating disorders have very painful grips on these lives that can ultimately be life-threatening,” Ilardi, the psychology professor, said.

The problem for many with eating disorders is learning how to let them go.

Two-fold therapy

Chapman said it was important for treatment to address all issues that feed into an eating disorder. In addition to nutrition education, therapy should help patients come to grips with the underlying reasons why they feel compelled to restrict, binge or purge.

Watkins Memorial Health Center has a policy of automatically referring any student who seeks treatment for an eating disorder to a doctor, nutritionist and counselor.

Chapman said this multifaceted treatment was vital in helping patients recover.

“If they’ve just come to see me to get the eating disorder under control, it’s like putting a band aid on a problem,” Chapman said. “Next time there is a major stressor, they’ll revert back.”

Cognitive Behavioral Therapy (CBT), or “talking therapy,” has proven successful among people with eating disorders.

A 2003 study that tracked the recoveries of anorexic patients showed that fewer than one-quarter of the patients who received CBT and nutritional counseling had relapsed to clinical anorexia. In contrast, more than half of the patients who met only with nutritionists had reverted to anorexic behavior.

Even with therapy, one of the biggest obstacles to overcome is the co-dependency that many people have with their eating disorders.

Chapman said that she has seen KU patients who had “love affairs” with their eating disorders. These people were so attached to their behaviors and mindsets that they struggled to emotionally commit to therapy even when their lives were at stake.

In a few cases, Chapman quit providing nutritional advice to patients who were unwilling to confront underlying psychological issues. Otherwise, she said meeting with her was just giving them an excuse to justify their problem.

“They might say, ‘Well, I’m working on it,’” she said. “But this can go on for years if they feel validated for it.”

Changing views on healthfulness

Much of that validation goes back to the pressure that society puts on women and that women put on themselves.

College can be a particularly difficult time, as many women come in fearing the infamous freshman 15, the pounds that they put on when they replace nutritional meals from home with excessive alcohol and fast food.

For some, avoiding this issue is a simple equation: Eat less to weigh less. Chapman said this becomes a problem when people don’t recognize that there is more to overall health than food.

“I certainly see lots of students who obsess about food, but not really about their overall health,” Chapman said.

On the other hand, Chapman said there are many students who don’t worry about being healthy at all. Ultimately, neither obsessing about nor neglecting nutrition is healthy, especially when negative habits continue throughout life, she said.

“If you live in an apartment and have a terrible diet, you aren’t likely to eat much better after you graduate and get a job,” Chapman said. “Establishing healthy eating and activity patterns in college is really important.”

Chapman also stressed that part of finding balance was growing as an individual.

“Many students are very egocentric and constantly worried about their bodies when they could be devoting this energy to their church, a class they have a passion for, a community shelter in need or to a friendship,” Chapman said.

A lifetime of recovery

Even after committing to treatment, the road to recovery can be challenging. It requires changing how someone associates with food as well learning how to deal with emotions in a positive way.

For Caitlin, this hasn’t always been easy. After her stay at the Menninger Clinic, Caitlin continued to struggle with depression and was eventually diagnosed with bipolar disorder. Along with the mental highs and lows, Caitlin also dealt with bouts of disordered eating.

She is learning to recognize impulses to restrict her eating before they go too far. She likes going out with friends. She knows her dog, Giseppi, a small Yorkie who loves to snuggle, will be there to comfort her when she’s feeling sad.

Still, she admits to having a person-with-depression mentality. This reared its head in March, when she was admitted to the School of Social Welfare.

At first, she was thrilled. Then, negative thoughts set in as she told herself, “You’ll just screw this up like everything else.”

The difference is that, unlike three years ago when she felt hopeless about life, this time she’s determined to try.

“I’m finally getting to the point where I see improvement,” she said. “It’s trial and error.”

— Edited by Dana Meredith