Adults with anorexia or bulimia face a unique set of challenges and must balance family with their own internal struggleswo refrigerators always graced my family’s kitchen: one for my mother and one for the rest of the family. Ours had regular salad dressing and Creamsicles while hers was packed with fat-free this and sugar-free that, a lot of bulk but hardly any calories. She was so afraid that something she was comfortable eating would be discontinued that she hoarded enough to last through a long flood. Anything in the back fridge was Mom’s. If you knew what was good for you, you left it alone.
My mother has struggled with an eating disorder my entire life. I’ve seen her stress level skyrocket every time we went out to a restaurant, and I’ve watched her mealtime rituals, from weighing slivers of bagels to carefully measuring out portions of fat-free ice cream. Our kitchen was like a chemistry lab at times; everything had to be reduced to exactly the right amount and mixed with precisely the right number of something else.
Now 46, she has used food to exercise a sense of control over a life that seemed out of her hands. It started a few days before Thanksgiving when she was 19, as preparations for the feast were just beginning. She and my grandmother joked about a contest to see who could lose 5 holiday pounds the fastest.
When the meal came, my mother barely touched her plate. “It gave me such a sense of control,” she recalls.
“I felt really powerful.” Winning the contest gave her a sense of pride that she hadn’t found in her stellar academic record or horseback-riding ribbons.
Most people associate eating disorders with adolescent girls because the majority of cases emerge in two age groups: 12- to 14-year-olds and 18-year-olds. A significant number of males also develop eating disorders, but girls are five to 10 times more likely to do so, according to estimates by the National Eating Disorders Association. Research shows that more than 75 percent of anorexics recover within seven years of receiving treatment and go on to lead healthy lives with healthful eating habits. But 25 percent don’t recover and instead continue living with the disorder indefinitely or die. “The longer it goes on, the more entrenched it’s going to be, and the harder it’s going to be to recover from,” says Dr. Denise Lensky, director of the eating disorders program at the Belmont Center for Comprehensive Treatment in Philadelphia. “The prognosis is worse the older you are.” Like my mother, these adults are the hardened veterans of the disease; for some reason, they haven’t been able to escape the self-destructive lifestyle.
Mandy Mainini, 27, didn’t ration her food; she gorged herself on it — bags of chips, pizza, junk food — and threw it all up afterward. Her husband, Dave, would watch her order the greasiest food on the menu and eat until she was stuffed but would stop himself from suggesting she slow down, that she was overdoing it, because that was a sure way to end any fun they were having. Then he’d watch her walk into yet another bathroom, knowing full well what she would do once the door shut.
Doctors classified Mandy as an anorexic-bulimic because she had the behavior of a bulimic but a body weight 15 percent or more below normal on the actuarial tables used in doctor’s offices. She traces the source of her struggle to self-esteem issues, as well as a dysfunctional family and childhood sexual abuse. The bulimia began with a trip to Daytona, Fla., when she was 17. “It just started out as a diet,” she says. “I don’t know where I got the wild notion to stick my finger down my throat.”
Anorexia and bulimia followed Mandy through adulthood and to her wedding three years ago. It was a beautiful Catholic ceremony, she says, with seven bridesmaids, three flower girls, two ushers and ribbons on the pews. But she wasn’t really there for it, spiritually or emotionally. The night before, Mandy decided she didn’t want to make another secret trip to the bathroom during the wedding, but willpower wouldn’t be enough. So she took speed to quicken her metabolism and suppress her hunger the next day. “I feel pretty gross about that,” she says now. “It was a really special day, and I was messed up. It was just like I was numb and dead. I just kind of faked a smile.” When she watches the wedding video, she can see the telltale signs of the drugs: dilated pupils and a quivering jaw. “It disgusts me.”
My mother never resorted to drugs, but the disease manifested itself in more subtle ways. In 1990, her therapist and my father took her to Walter Reed Hospital in Washington, D.C., against her will. At 5 feet 5 inches, she had dropped to 76 pounds, and the staff said she was in danger of dying. On the way to her room, she passed by a mirror. The woman in the reflection who looked back, for once, was not fat but emaciated. My mother was horrified. Her heart beat so fast she didn’t sleep all night. And, with no body fat to keep her warm, she was freezing cold.
Unfortunately, this wasn’t the last time my mother required hospitalization because of the disorder. Last November, she entered her fourth, and maybe her last, round of inpatient treatment at a facility in New Orleans when her weight again dipped dangerously low. In the fall of 2002, Mandy gave recovery another try, too, and entered an inpatient program at La Montagne Residential Treatment Facility for Eating Disorders in Crystal City for five months. She was placing all her hope in the doctors and the program. Her marriage was on the verge of collapse, and she had never felt more desperate. “I wanted to die,” she says. “It had gotten to the point where I didn’t need my fingers anymore.”
Oftentimes, the level of intensity offered by inpatient treatment is necessary for people who have tried outpatient therapy without success, Lensky says. The good centers work through the core issues at the root of an eating disorder rather than simply getting a patient’s weight up to a healthful level. Specific treatment plans vary by facility and by individual, but supervision and structure help patients begin to rebuild their lives. At Lensky’s facility, treatment focuses on nutritional rehabilitation and psychological support. Patients work with dietitians to develop individual meal plans. Everyone is expected to eat 100 percent of their three daily meals and snacks, and bathrooms are monitored. Exercise is prohibited. As patients adjust to regular eating habits and regain the weight they have lost, they attend meetings with individual therapists and therapeutic groups to work through emotional issues. “It’s a very intensive experience,” Lensky says.
Since completing inpatient treatment (my mother last November and Mandy early this year), both women have enjoyed successful recovery. Mandy and Dave have relished the simple things that she was incapable of enjoying before. She talks warmly of nights spent talking on the porch, eating dinners together and having a real relationship. Part of her growth process includes a return to school. “It’s amazing that I’m going back to school, something I never thought I’d do,” she says. “But I never thought I’d get better either. Dave and I plan to have a family. Things are going great. Little steps, you know?”
My mother’s outlook on life has improved with her weight, too. She is no longer shockingly tiny when I hug her. Everything that was muted before — her smile, her skin tone, her personality — has color now. She has given up some of that control she used to fight so hard to keep, and most importantly, she seems happier.
Despite the improvements, her relationship with food is a continuing battle. Simply ordering a pizza with the family can be a struggle. She’ll still reach for the smallest slice or supplement a sliver of pizza with a large salad, but I know that she’s trying, and it gives me hope. Like Mandy and Dave, my family and I worry about the eating disorder coming back full force, but we live appreciating the times when it is out of our lives. We understand that we will do what we can if it returns, but we also know that at its core this will always be her battle to fight.
Story by Erin Eggers