Eating Disorders: Battling Bulimia (cont.)
Brownell: Yeardley hit on an important point, in that bulimia typically starts as a way to manage weight, but can transform into a means of managing mood. For some this might mean depression, for some stress, and for others it could be loneliness. The cycles of overeating and vomiting can get out of control easily, but in a funny way they become reinforced because they are a way to manage stress. Hence, treatment involves addressing not only weight issues, but also other issues central to a person's life.
Member question: As a musician who uses her voice, and has witnessed the effects that bulimia has on it, I wonder if you think that bulimia altered your own voice drastically?
Smith: No, I wouldn't say so. I think one of the things that has always been true about me is that I have always been a perfectionist and refused to function at anything other than the highest level I could possibly function at. So my bulimia never interfered with my work. It only interfered with every other aspect of my life.
Member question: Is taking Ex-Lax to lose weight OK, and does it work?
Brownell: There are several types of compensating people do for taking in extra calories. The most common is vomiting, but over exercising and laxative abuse are quite common as well. Using laxatives to control weight is absolutely not a good idea, and can lead to its own set of physical problems. Some people, after abusing laxatives for many years, end up with severe stomach and intestine problems.
Smith: I was an extreme over exerciser, as well -- up to three hours a day.
Moderator: Do you think that your employment in the entertainment field allowed you to pursue an unrealistic body type without arousing suspicion?
Smith: Yes, I do.
Brownell: Sometimes people with eating disorders end up in professions or in recreational pursuits like athletics, in which the disordered behavior is hidden or even celebrated. People with an eating disorder who are in these social settings must struggle hard to get help for the disorder even though the extreme dieting may be reinforced.
Member question: Do you think Hollywood's unrealistic standards are changing and advancing, with such body types as Jennifer Lopez's and Queen Latifah's becoming more glorified?
Smith: We can only hope so!
Brownell: There are some signs that increasing body weights in high-profile celebrities are being accepted. But at the same time, the thin ideal is as extreme as ever. Joining that is the need to be physically contoured and sculpted. Terms like "abs" and "six pack" were not known 15 years ago, and one can appreciate how extreme the pursuit of physical perfection can be when an entire industry, like machines to improve your abdominal muscles, can spring up around a 6 square inch of one's body.
Smith: Dr. Brownell hit it on the head.
Moderator: Dr. Brownell, are eating disorders like alcoholism -- you are never really "cured?" You just learn how to overcome the urges to give into the disease?
Brownell: This is a good question. People have various levels of recovery. The unfortunate ones can struggle with the underlying problems even when the overt symptoms have been remedied. But for the most part, people can, if they get the right help, have major improvements in the quality of their lives and can put the disordered eating behind them.
Member question: So what are you doing now to move beyond this? Is there any specific treatment you are pursuing? And could Dr. Brownell talk about treatment choices for bulimics?
Smith: I am in an outpatient program that meets for four hours, twice a week, and it is essentially group therapy with the emphasis on eating disorders, of course. I, 29 days ago, stopped eating sugar, and for the first time in 24 years I have no urge for binging and purging.
Smith: I would like to say that generally the emphasis in my treatment has been on normalizing my eating versus going to extremes, such as cutting out all sugar, but in my case moderation was not working for me, so for the time being, no sugar.
Brownell: The first step for a person with an eating disorder is to realize they may not be able to solve the problem on their own. People sometimes perceive this as weakness, but rather it is a sign of strength to acknowledge one needs help and to go find it.
There are proven treatments available for eating disorders. The most common is called cognitive behavior therapy. It sounds as if Yeardley has received some form of this. It is important to find a therapist who specializes in eating disorders. A good place to find information is at www.nationaleatingdisorders.org.
Member question: Why no sugar? Was that a trigger for you to overeat and then purge?
Smith: Yes. My MO was to always binge and purge on sweets. I was not the bulimic who binged on salty snack foods or pasta; I always binged on cake, candy, cookies, you name it. If it was sweet, I wanted it.
Member question: Yeardley, did bulimia ever affect your dating life? If so, then how?
Smith: Yes. I have had periods in my life where I was extremely isolated by choice. I would choose to stay home and binge and purge rather than socialize. I have struggled a lot with depression and that also affected my social life. I was more dedicated to my disease than doing things that were good and healthy for me.
Member question: Would an anti-anxiety drug assuage binge eating or other eating disorders?
Brownell: Sometimes these medications can help, but in controlled studies, therapy tends to work better than medication. If the eating issues are so obviously caused by anxiety or depression, then medication may be in order, since these problems exist on their own. It is generally that therapy is the first line of intervention.
Member question: I have a question regarding health problems and bulimia. I am 36 years old and have been bulimic since 1993. I also have depression. I am afraid to go to the doctor to explain that I have been experiencing some physical problems (i.e. irregular heartbeat) as a result of being bulimic. Are there specific tests that need to be conducted on me?
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