Eating Disorders in Mid Life – Learning to feed me instead of Ed

Eating Disorders in Mid Life – Learning to feed me instead of Ed

If you are an adult with an eating disorder, or an adult you care about has an eating disorder, come and listen to Prof. Cynthia Bulik at the At Home with Eating Disorders - Australia's first national conference for families and carers, and people who suffer an eating disorder. Brisbane, May 23-25, 2013. See you there!

If you are an adult with an eating disorder, or if you are an adult and someone you care about has an eating disorder, come and listen to Prof. Cynthia Bulik at the At Home with Eating Disorders . Brisbane, May 23-25, 2013. See you there!

As a wife and mother suffering bulimia in the 1970s, the same tussle of thoughts preceded every meal – the mere thought of eating three meals in one day triggered debilitating anxiety.

I was as yet unaware of the importance of eating three meals and three snacks a day in recovering from an eating disorder but, as the main caregiver in the family, always made sure my husband and children ate their three balanced meals a day.

Secretly, I yearned to be in a confined and restricted situation, where my meals could be supervised and would be provided at regular times. For instance, for the few days in hospital after the birth of a child, or after an operation, I was able to eat ‘normally’. In such a controlled environment I could eat the meals, as someone else had prepared them, and they would be served on a tray.

Somehow, this was acceptable as I was not responsible for deciding what food would be on my plate. Having been allocated a certain amount, I could eat it without feeling overridden with guilt. The restricting and bingeing symptoms of my eating disorder would subside and I would think: ‘This must be what it is like to be NORMAL’ and would fastidiously plan to continue eating three meals a day when I returned home.

Another advantage of being in a controlled environment like a hospital was that there was no opportunity to binge. So when I ate breakfast, I did not think my usual  ‘well, I have stuffed up my day already, I might as well make a glutton of myself until 10pm, and start a fresh diet tomorrow’. I knew that morning tea would arrive about 10am, lunch at noon, dinner at 5.30pm, supper at 9pm, and so on. I was able to allow myself to eat what was on the plate without feeling guilty. Amazing. I so wanted to be normal!

But when I returned home, without support structures in place, the eating disorder behaviours screamed and shouted, sabotaged the vulnerable me, and within days resumed their domination. Back I would go to the bingeing, starving cycle. The brief respite and sense of control when starving was swiftly followed by self-loathing for being ‘weak’ upon discovering I had succumbed to yet another binge. I felt deep distress at my inability to recognise let alone stop the urge to eat; mood swings and severe depression would ensue. I did not understand each binge effectively numbed my feelings. I was completely out of touch with me.

At home, for more than 30 years, I fed and prolonged these illness behaviours. What would have helped? A recovery guide in my kitchen, who would take charge in preparation, serving and eating of the meals. I needed a guide to confront my illness until I was strong enough (had regained sufficient of my identity) to confront it myself. But the knowledge was not around then. I am sure my husband would have taken on the role, if only he had known.

For decades I lived a part-life with my illness – even though I knew it was not good for me. I simply did not know any other way. Anorexia had developed in my brain at age 11 and transitioned to bulimia in adolescence; 20 years would pass before a correct diagnosis was given. Eating disorders held the reins to my mind, to my thoughts and my feelings. I often felt like a fake – aware I was not being true to my self but hanging on to the illness for this seemed less terrifying than confronting it. Besides, as a full-time working mother of four, it was easy to pretend I didn’t have time to stop and focus on rebuilding my soul from within (that would be selfish). Others needed me. This meant I often remained in unsuitable, chaotic and dangerous situations, much to the despair of family, friends and colleagues, who had no idea of my inner torment.

Recovery from an eating disorder is initially a full time job in itself. Adult women – in their roles as carers for young children or ageing parents or as professionals in demanding careers, are easily persuaded by the eating disorder thoughts to give only token attention to the recovery challenge. Recovery requires us to put ourselves first. The illness ‘voice’ will always try to convince us to put ourselves last so that it can maintain its hold. Listening to that ‘voice’ destines us for a part-life whereby we may go through the motions of life, but never become fully engaged.

Day after day I created nourishing dishes for husband and children and, while they tucked into their hearty and balanced meal, loaded my plate with green and yellow vegetables (so that it seemed a lot). Or if I had been upset and binged, I would pretend I had eaten already, and eat nothing at all. My body missed out on a lot of essential nutrition.

A recovery guide at meal times would have helped recovery immensely – someone to confront Ed on my behalf until I was recovered sufficiently to eat the same meals as everyone else.

More home-based support for adults who are suffering eating disorders is essential, and crucial.

When you are your own carer – strategies for meal times

  • Confide in someone you trust – a parent, sibling, friend or partner – and ask them to be your meal recovery guide. Honesty is imperative. Write down the meal times, and what you will eat for each meal. Share this menu with your meal recovery guide each night, for the next day, and report on your progress.
  • No avoiding your meals, OK? Even if you have binged on ten packets of cookies. Eat your next meal. You will be amazed at how you gradually lose the urge to eat ten packets of cookies or two litres of ice cream. Why? Because you are not going to punish yourself with starvation any more. You are breaking the ‘feast and famine’ cycle. Remember, food is our medicine. Three meals a day are ESSENTIAL to breaking free of Ed. Do not miss one meal or snack!
  • Choose a recovery guide, or several, who can be with you 24/7 to jump-start the refeeding process. Your partner could take medical leave from their job for a few weeks, or another family member or friend could come and visit.
  • When you need to resume work or go home from hospital, invite other relatives, neighbours and friends over to help with some meals. Take steps to guard against relapse.
  • If you have children, they could go and stay with their grandparent or another relative for a week or so, to give you a break and allow you to fully focus on recovery.
  • With your recovery guide, plan meals in advance, writing down exact foods and quantities that you will eat (non-negotiable).
  • Ideally, and to deny the eating disorder’s crafty knack of convincing you to have a smaller serving, or to leave food on your plate, arrange with your recovery guide to have them or someone else sit with you for every meal until your will is stronger than Ed’s voice. If that is not possible, another option is to have a phone or Skype conversation with your recovery guide while you are eating the meal. Let your support team share the responsibility. They can help to weaken Ed’s resolve by diverting your thoughts off the food and on to far more interesting topics.
  • Be honest with yourself (as distinct from your illness). You will require the recovery guide’s assistance until you have regained sufficient ‘self ’ to be able to ignore the illness thoughts.
  • If suffering bulimia, have someone sit with or communicate with you for at least half an hour after each meal.
  • If you go to work or are studying, confide in a trusted colleague or friend and ask them to sit with you while eating your lunch. Text messages from the recovery guide can provide encouragement and keep you accountable for the eating of snacks.
  • Every time you start to feel scared or anxious, dial a trusted family member or friend.

Several evidence-based treatments offer support – the Maudsley Family Based Treatment approach is showing promise in being adaptable for young adults, and there are special programmes for couples, including Uniting Couples in the treatment of Anorexia Nervosa (UCAN).

  • There will be feelings to sort, and skills to learn, as you rebuild your identity free of Ed. Getting the three meals and three snacks established as your daily ‘medicine’ provides the best foundation on which to recover your life and explore its full potential.

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