Feast of Burden: Holiday Anorexia

An inside look at the culture of eating disorders-and how the holidays affect it

By Carrie Sloan

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Imagine that turkey and fruitcake are your worst enemy this Thanksgiving, Christmas, and New Year's. Or that sharing a bathroom, where you can't purge what you've just eaten without someone hearing, becomes your biggest nightmare while home for the holidays. And that one off-color comment you overhear about your weight at a party? That's enough to make you binge on the contents of your food-stuffed purse and throw it all up later, in the still of the night.

Such is what the holidays can be like, according to recovered anorexics who spoke to ELLE.com for this story. Another truth about anorexia and similar eating disorders: They are diseases that thrive on the power of suggestion, a fact that made some who stared down death as a result of anorexia or bulimia-or a combination of the two-have serious qualms about sharing their experiences.

"My concern is that women could read some of my-and others'-accounts of having an eating disorder and come up with ideas of their own. I pray that won't happen," says Lisa*, 26, a video journalist in recovery from anorexia, who claims that she, in fact, was "inspired" to starve herself by a made-for-TV movie about an anorexic. "It starred Tracy Gold, and I think the seeds were planted while I watched it," she says. "I figured I could do it too. I just wouldn't go as far-or get caught."

Lisa's experience should prove a cautionary tale. She quickly became an exercise-addicted anorexic who was 5'7" and weighed 93 pounds.

Ashley*, now 35 and also recovered, threw up everywhere: "the sorority house, bar bathrooms, restaurants, dorm bathrooms-anywhere I could be alone," she says.

Emily*, 22, was finally forced into inpatient care when-after a four-year downward spiral that included food restriction, bingeing, purging, and eventually a cocaine addiction-her weight dropped to 96 pounds and her heart rate to 30 beats per minute. Emily's doctor told her she was in grave danger of having a heart attack.

The point? Anorexia is a complex disease, with myriad causes that range from culture to environment to-as recent studies have shown-genetics. Having a predisposition for anorexia means that a simple decision to diet away those last five pounds triggers something (it's unclear as to what) that could lead you down a slippery slope.

If full-blown anorexia does take hold, it's hard to shake and has a high mortality rate. And for those who do make a full recovery with the excellent care that's now out there, the years of semistarvation can continue to wreak havoc on their metabolisms permanently, distorting the body's ability to know whether it's full or hungry.

In short, anorexia is anything but glamorous, and we're entering a time of year that can be particularly hard for anyone afflicted with it, recovered or not. "Thanksgiving is the worst," says Louise Ousley, PhD, a psychologist in private practice in California who ran the eating-disorder program at the University of California, Santa Barbara, from 1984 to 2004. "It's a national binge day. Eating is all people do when they get together."

It's also a time when a concerned family will, understandably, pay close attention to what an underweight person has on her plate. "A lot of my clients would pretend to eat and throw it up later," says Ousley.

When you're accustomed to consuming, say, a banana and maybe a packet of oatmeal in a day (as Emily was when she was at her most unhealthy), that close scrutiny can be excruciating because you're already doing so much of it yourself. Over and over again, anorexics will tell you that it's not about food, it's about control-a way to manage emotions, events, and whatever is uncertain in their lives. Food ceases to be seen as sustenance, and consumption has nothing to do with enjoyment.

"I was never really proud of being anorexic," says Emily, "but one of the sickest parts of the disorder is that you do get a sense of satisfaction and accomplishment from depriving yourself. To eat is to fail, and to starve is to succeed."

Consequently, she became obsessed with studying labels and nutrition facts. Anything she ingested was recorded on a Post-it note: "At the end of the day, I would calculate what I ate, then go to the gym to burn off as much of it as I could."

"Anyone with an eating disorder is a human calculator," says Kelly*, 31, a recovered anorexic from Raleigh, N.C., who works as a middle-school counselor. "A banana isn't a banana-it's 110 calories."

Emily's and Kelly's comments speak to what makes treating anorexia particularly difficult. "It's one of the few mental illnesses where the people who have it feel great about having it," says Joy Jacobs, PhD, a clinical psychologist based in San Diego. "The psychological term is 'ego-syntonic,' which means the behavior and results that an anorexic gets from the illness make them feel good."

Not eating, in particular, makes anorexics feel victorious. So rather than seek out help, they'll take drastic measures to protect the coping mechanisms they've put in place-especially when the holidays pose a threat to their carefully constructed routine.

Jacobs has treated clients who would run for hours and hours prior to leaving for holiday celebrations, burning calories in anticipation of anything they might eat. Some anorexics, though already scary-skinny, she says, would binge and purge. "They'd hide it and eat secretly during the night," she says.

One very ill patient refused to put lotion on her skin because she was convinced it contained calories. And thin skin-or not being comfortable in the one you're in-is a calling card of anorexia. Which means that something we as American women engage in quite often over the holidays can send someone with disordered eating into a tailspin.

The term "fat talk" was first coined by anthropology professor Mimi Nichter, who wrote a 2007 book on the subject called Fat Talk: What Girls and Their Parents Say About Dieting. Simply put, it's that conversation that tends to play out ad nauseam whenever a group of females (interestingly, usually white or Hispanic, but not black) get around food.

"Oh, I can't eat that. I'm so fat!"

"No, you're not. Look at you in that dress. Now I'm the one who really needs to get to the gym."

"You? You're so skinny! I'd kill to look like you."

And so on.

Fat talk definitely picks up in November and December, and for an anorexic, hearing it can be akin to being force-fed doughnuts. "That's what bothers me the most," says Kelly. "It starts right around Halloween with the candy, and then on through January, with the newscasters going 'Lose those last five pounds!' You can't escape it."

When anorexic, Kelly says she would spend all day thinking about a holiday party she was going to. Moreover, she had so much anxiety surrounding food that the thought of eating around other people practically paralyzed her. "If I challenged myself to do something out of the ordinary and got a plate of food-usually vegetables-and someone talked about what a certain dish would do to their hips, I'd have a meltdown," says Kelly.

The behavior seems insane to her now, she admits, but Kelly-who today travels the country lecturing about body image-is right to be concerned about the phenomenon. A research study Ousley conducted showed that fat talk was positively related to eating pathology and body dissatisfaction in college students.

"Negative fat talk," she says, "was highly correlated with other diagnostic indicators of eating disorders, for both men and women." Which raises another interesting point: There's no such thing as a "typical" profile of an anorexic anymore because the disease now impacts a wider range of genders, ethnicities, and ages.

"Even though there is a greater amount of prevention and education, we're seeing a more complex picture," says Jennifer Nardozzi, National Training Manager for the Renfrew Center, the country's first residential treatment facility for eating disorders. "Before you would think it's a young person who's maybe Caucasian. And that's not the picture we see anymore. There are different ethnicities and other demographics."

Case in point: Ten years ago, Nardozzi saw maybe "one or two" thirtysomething anorexics admitted. In the past three to five years, however, women in their thirties and beyond have come to make up just under one-quarter of Renfrew's patients. In fact, the center recently created a separate treatment track to accommodate the growing need.

Nardozzi chalks late-onset anorexia up to a combination of factors: later-in-life stressors like divorce and the unrealistic cultural pressure of expecting thirtysomething women to look like twentysomethings ("You're having to defy the normal development of aging," she says).

Despite anorexia affecting more women today, Nardozzi says that-on the flipside-more women are also aware of treatment options. "Someone may have an eating disorder that was under the radar and now they think, Maybe I can get treatment," she says.

Pam*, 59, came of age-and came down with full-blown anorexia-well before the era of enlightenment. "By the time my doctor got me to the hospital, I weighed not much more than 100 pounds-in the winter, in a coat, boots, and clothes," she says. After years of existing on black coffee and not much else, she had developed irritable bowel syndrome. Then it got to the point where she simply couldn't eat; the stomach cramping and diarrhea that accompanied digestion was just too severe.

"I went through all the tests for colon cancer," she says. "There was no anorexia intervention per se, because they didn't seem to know that much about it back then." Still, she considers herself one of the lucky ones: "I'd be dead if I had kept it up," she says. "I wrecked my metabolism and now have a hard time with my weight because it takes almost nothing to gain it, but I'm happy to be here."

And perhaps that's a good thought for anyone-eating-disordered or not-to remember when life gets trying this time of year.

*Names have been changed to protect identity

Feast of Burden: Holiday Anorexia