National Alliance on Mental Illness
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Living Life On a Scale

By Dina Al Qassar, NAMI Intern

Abby LewisPhoto courtesy of Abby Lewis.

"I measured my life by the changing number on the scale. Everything else crackled faintly in the background like a TV stuck between channels." That's how Abby Lewis described her life with eating disorders; no rebellions, late night parties, or teenage romance—all that mattered was the scale.

Abby's journey with eating disorders started when she was 14 and developed anorexia. Although she had therapy, it wasn't effective. She managed through high school, and then the anorexia morphed into bulimia. Realizing that her parents were in denial, paired with having to take care of her father and other problems at home, she felt alone and knew that she had to take matters into her own hands. Abby kept trying to handle things on her own and coped with her eating disorder; occasionally saw a therapist throughout high school. But in college, her eating disorder worsened, and things started to spiral down. "Even once you escape the trauma it comes back and bites you. It was so scary. I was a great person in high school, I kept it together but when the bipolar disorder hit, I lost faith." Abby had to take a medical leave for two years and spend it at a residential treatment facility where they provided her with meals, therapy, group therapy and medication.

Eating disorders are "serious mental illnesses and not lifestyle choices," says Susie Roman, the Director of Programs at the National Eating Disorders Association (NEDA). To bring awareness to eating disorders, Feb. 23 - March 1 has been set aside as National Eating Disorders Awareness Week.

The specific reason why eating disorders develop is still an unanswered question, but Roman says that "recent research has shown that genetic factors create vulnerabilities that place individuals at risk for acting on cultural pressures and using food to feel in control or manage overwhelming emotions."

Eating disorders therefore become a coping mechanism for many, which explains their co-occurrence with other mental illnesses. "There's always an underlying issue," says Danielle Cox, Director of the Renfrew Center in Bethesda, Md., "eating disorders are the product of someone's mental health. It's when an underlying issue affects the person's behaviors and the emotional consequences come out through eating habits, whether it's restricting, purging, binge-eating, etc…"

The other contributing side to the development of eating disorders is the cultural and peer pressure. In a society where having an ideal body is an obsession, and the ideal body is often portrayed unrealistically, it creates a lot of pressure to live up to those ideals. "Body dissatisfaction and thin ideal internalization are both significant risk factors for the development of eating disorders and behaviors like restricting and binge-eating," says Roman, "while eating disorders may begin with preoccupation with food and weight, they are about much more than food."

The most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. Anorexia nervosa is a severe eating disorder with life-threatening consequences. It is defined as the inability to maintain one's body weight within 15 percent of their Ideal Body Weight (IBW) and is characterized by excessive weight loss, an intense fear of gaining weight, self-starvation, distorted body image, and a preoccupation with weight loss. According to NEDA, around 90 to 95 percent of people living with anorexia nervosa are females. Anorexia nervosa also has one of the highest fatality rates amongst mental illnesses.

Bulimia nervosa is a serious eating disorder that is characterized by self-destructive life patterns such as binge-eating and then followed by purging. Individuals living with bulimia exhibit a great concern with body weight and image and engage in detrimental behaviors, in order to maintain ideal body weight and self-image. Binge-eating is the act of eating large amounts of food in a short period of time, unlike overeating, people who deal with bulimia are often unable to stop and feel out of control during these episodes. Following an episode of binge-eating, purging often occurs. Purging is the act of trying to get the food out of one's system either by induced vomiting, abuse of laxatives, over exercising, and fasting. Bulimia nervosa, albeit being under-diagnosed, affects more people than anorexia (up 3 percent of the population).

Previously not officially recognized as an eating disorder, binge-eating disorder has been included in the DSM-5. Binge eating disorder, also known as emotional eating or compulsive over eating, differs from bulimia and anorexia because the person is not concerned about weight or body image. Binge eating disorder can almost be seen as an unhealthy coping mechanism. It is characterized by periods in which the person feels out of control, consuming large amounts of food in a short period of time. It affects 5.5 percent of the American population (3.5 percent of women and 2 percent of men).


When it comes to therapy, each disorder is treated differently with the appropriate medications and therapy. Most importantly, each individual is treated differently. Like other forms of mental illness, eating disorders are the product of many factors, meaning no two eating disorders are the same. "There is no one face to an eating disorder," says Cox, "each person is different and unique."

At the Renfrew Center, they provide support for women only, and their patients are provided with two programs: a Daily Inpatient program and an Intensive Outpatient program. The daily inpatient program is a residential program that provides patients with two meals a day and three therapy groups, patients are seen by registered dietitians, clinicians, nutritionists, and psychiatrists. They educate their patients about eating disorders and moderation, in addition to healthy lifestyle. They are big advocates of family therapy and group therapy. The center employs group therapy a lot because the patients develop a bond and then work together in their journey. "Coping skills gaining support, and normalizing eating (no matter why you are here) are very important," says Cox.

The intensive outpatient program on the other hand is not a residential program. Instead it is usually what women go to after they've gone through the inpatient program. It focuses on case management and collaboration where they assist the patient in establishing a treatment plan and a support community outside the center. During the program the patients meet three times a week in the evening, they are given one meal, and have two group therapy sessions. This kind of program allows the patient to be more independent, yet the Renfrew Center continues to support them. The most important thing when it comes to therapy is individualization, "it's important to recognize that they are not all the same, they are all unique individuals," says Cox. When therapy is individualized and customized to meet each person's own needs it becomes more effective.

Other than therapy, awareness plays a big role in recovery and prevention. This year the theme for National Eating Disorders Awareness Week is "I Had No Idea." Roman says that the the theme for this year's awareeness week attempts to "stress the need to address eating disorder misconceptions, as many individuals, families, and communities are not aware of the often devastating mental and physical consequences of eating disorders. The week also highlights available resources for treatment and support."

By bringing attention of both the public and the media to the seriousness of eating disorders, it helps people understand and therefore help and support those struggling with eating disorders. "Education and direction to resources can lead to earlier detection, intervention, and help-seeking, ultimately improving likelihood of full recover," says Roman, "so while the overall outreach effort is directed to the general public it is also an opportunity to guide people to help by providing our online screening tests and hotlines to those who may be concerned that their attitudes and behaviors around food and weight are a problem." 

When it comes to awareness the most important thing according to Roman is to convey the seriousness of eating disorders, that they have the potential to becoming life-threatening illnesses but at the same time, to show that recovery is possible. "The participation of the many people who make NEDAwareness Week the largest outreach effort on eating disorders in the nation, truly make a difference," says Roman.

The last nine months have been great for Abby; she's in recovery and back at school completing her bachelor's degree in chemistry. "You will get to a point in life where you are more about your life and where you care about what you want to do in life instead of food. It's not going to be easy. You will have bad days, but if you keep trying you will get it."

What helped her most in her recovery was her belief in herself. "I never believed that God had a plan for me or any of that. I never had faith. I just always had an idea of myself as a person who was waiting to for me if I could get through this. Having an idea of who I was, or who I wanted to become kept me going. Imagining my future identity helped me through this."

"Sometimes I freak out about my weight and food, but then I think about how it won't help me in classes, I wanted to prove to myself that I can do this, I didn't want to lose this second chance. There comes a point in life where there's something more than obsessing about food. I don't know what I want to do after college or with my life, but I know that there's more for me. I know that there's a 'me' waiting for me in the future."