One woman's struggle with bulimia -- and how she's learning to heal
WebMD Weight Loss Clinic - Live Events Transcript
You may know her as the voice of cartoon character Lisa Simpson, but Yeardley Smith is now giving voice to her own lifelong struggle with bulimia. She joined us, along with eating disorder expert, Kelly Brownell, PhD, Director of the Yale Center for Eating Disorders, to discuss the emotional and physical effects of bulimia.
The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome, everyone, thank you for joining us. Yeardley, how long have you been dealing with bulimia?
Smith: 24 years.
Moderator: How did it begin?
Smith: I started dieting when I was nine and by the age of 14, I was completely weight and body obsessed. A friend of mine told me that if you eat and vomit you won't gain any weight, when I was 14. I did not take to vomiting easily or quickly. But I was determined to be as thin as I could, and I never did really get very thin.
Moderator: Dr. Brownell, is that pretty typical?
Brownell: Yes. This is quite typical. People start off with a desire to be thin and can easily fall into the trap of restricting their eating, then overeating, and then throwing up, as a way of controlling their weight. This is not generally an effective weight-control method and of course brings many psychological consequences.
Smith: It was not a very effective way to control my weight. I was always normal weight to about 20 pounds overweight. And yet the obsession continued.
Member question: You've been dealing with this for 24 years? How has it affected your health?
Smith: I have thrown up blood. I have very sensitive teeth. But I am extremely lucky that I never had any gastrointestinal ailments.
Moderator: Dr. Brownell, what other physical problems can bulimia cause?
Brownell: The problems that Yeardley mentioned are quite common, and in some people the problems can be even more severe, with the most serious being electrolyte problems, which can lead to heart difficulties. This does not include the psychological torment, which can include preoccupation with eating and body image, often to the exclusion of anything else.
Smith: I have had periods of rapid heartbeat and nothing has shown up on EKGs, but it seems pretty fishy to me.
Member question: Was it easy to hide your purging from your family? Did they ever express concern?
Smith: Yes, it was easy; no, they never knew. One of the characteristics of my eating disorder has been secrecy and what I would call lying by omission. Not telling anyone that I was doing it and when asked if I was still doing it I would say, no, if it was true that I had not done it that day. I was dedicated to acting out my disease.
Brownell: Secrecy is very common with people with bulimia, which in some cases allows the disease to go many years without detection. The good news is that there are quite effective treatments available and so if bulimics can come forward and ask for help, good help is there.
Moderator: Yeardley, why have you come forward?
Smith: I think I realized finally, after 24 years, that everything I had tried to stop was not working, and I needed to dedicate myself to my recovery. Though it was not actually my intention to come forward as a bulimic.
I wrote a show about my 20 years in show business as an actress and realized that part of that story was my being bulimic, and that that was a large coping mechanism for the throes of being an actress with some success and some disappointment and the whole animal that goes along with being in professional show business.
Member question: How about the people you work with every day on The Simpsons (my all-time favorite show)? Have they been supportive? Did any treat you differently when they found out about your bulimia?
Smith: Actually they have not seen my show because I've done it in New York, so few of my cast members know about my struggle. But I am sure that when, and if, they find out they will support me.
Moderator: How has your family reacted?
Smith: My family has been very compassionate and expressed their sadness that I have gone through this for more than half my life.
Member question: Do you feel that you've used bulimia as a way to manage stress?
Moderator: Dr. Brownell, what are some of the reasons people begin throwing up?
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?
Brownell: It is absolutely essential that you see a physician immediately and that you be completely honest about your eating patterns and any behaviors like vomiting that you may have been engaging in. Believe me, you won't be the first one to tell your doctor these things, nor will you be the strangest thing your doctor has seen. What is essential is that you be honest with the physician so you get the medical care you need and deserve.
Member question: Yeardley, do you see yourself as a person free from an eating disorder in a few years? Are you excited or nervous about that prospect? After all 24 years is a long time. Not being bulimic might be hard to picture.
Smith: That's a good question. There does seem to be a period of mourning as I deal with giving up the behaviors of binging and purging, which I did not expect. I hope to be free of the urge and the behavior of my bulimia in a couple of years, but I don't think I will ever be able to take my eyes off the ball, in the same way that alcoholics need to be mindful of their addiction to alcohol.
Brownell: Believe it or not, bulimia can seem like a person's best friend. After all, it becomes a means of coping with difficulties in life. If you take away anyone's primary means of coping, the grieving that Yeardley described is entirely understandable. The bulimia tends to have less prominence in a person's life as people develop alternative means of coping with what life brings us.
Moderator: Yeardley, what kind of coping mechanisms are you learning?
Smith: When I first got into treatment, one of the things they tell you to do is make a list of alternative activities that you will do before you indulge the urge to binge and purge. I had seven things on my list, which included:
- Calling a friend
- Going for a walk
- Reading a book
- Writing down my feelings
And there were others, but I almost never used my list. My point being that a lot of tools can be laid out in front of you, and I find that some of them work most of the time, but none of them work all of the time. Mostly, I am just trying to sit with whatever discomfort, anxiety, and feelings of worthlessness that may arise, and not act on them. It's really, really hard.
Member question: Dr. Brownell, are there resources out there for spouses, friends, etc., of people suffering with eating disorders? A support group for supporters of loved ones who are suffering?
Brownell: My recommendation would be to go to www.nationaleatingdisorders.org. There are many books written about every aspect of eating disorders, only some of which can be trusted. But the web site I just mentioned is quite helpful. It can also be helpful to visit the message board that I head up on eating disorders on WebMD.
Moderator: Why you think it's important to speak publicly about having an eating disorder? And do you think it's helping you to deal with it?
Smith: I think admitting to myself that I needed help has been the most important step. As I said earlier, it was not actually my intention to go public with my eating disorder, although I was aware that as a public person there would probably be some interest, but that was not a primary function of my recovery.
Moderator: Tell us about your play.
Smith: My play is called The Good Life and it's a darkly comic journey through the ins and outs of my career in show business, and in it I discuss --in great detail actually -- my bulimia, because it has been such a large part of my life. But I wrote the play because I decided I wasn't allowed to keep complaining that I wasn't getting more work if I wasn't going to do something about it myself. And I'm going to do it in New York City off Broadway in the spring of 2004. It's a one-woman show.
Member question: Lisa Simpson is such an amazing and well-rounded character. You bring a great weight to her two-dimensional world. Is it a stretch to think that your struggle with depression and your eating disorder have given your performances an edge? Would Lisa be different if you had been happy and well adjusted?
Smith: I can say that I, Yeardley, would be a different person if my circumstances had been different, but there is actually a large team of writers on The Simpsons that are actually responsible for that marvelous little character. I am only a portion of that collaboration.
Moderator: Do you have any advice for us parents of little girls? Is there anything we can do to help them avoid becoming bulimic?
Brownell: It is important for parents to place eating and exercise in the proper context. Focusing on diet and activity in the service of body weight or appearance can lead to major problems.
Encouraging your children to eat well and to get regular activity can be presented as a means of a child's accomplishing what is important to them at the time. For some, this may mean to be better at sports, for others to be better at music, for others just to have more fun with their friends. This way, eating gets transformed from a fight with food, where you have to eat less of things, to thinking of food as a friend, where you eat more of healthy things to nurture your body and your overall well-being.
Smith: I think for me, one of the things that has been most helpful and effective in my treatment has been a safe place to express whatever it is I'm feeling, whether it be sadness or excitement, that whatever it is I have to offer and wherever I am emotionally is OK and then I don't feel like I have secrets to keep. I do think one of the most nefarious aspects of my bulimia has been secrecy. It's one of those things that feeds off of itself and perpetuated my disordered eating.
Member question: The frequent rejection that is a part of show business (unless you are Jack Nicholson) -- has that aggravated your bulimia?
Smith: I would say any time you're a high achiever, rejection isn't really a part of the equation you make for yourself. So my bulimia served as the ultimate coping mechanism when nothing else worked.
Moderator: How are you feeling today? Smith: Today I feel great. Today I do not feel the urge to binge and purge, meaning I'm not having a white knuckle day, of which I have had many during my recovery. So I happily embrace those gifts for today and don't even think what it will be like tomorrow.
Member question: Now that everyone knows you have an eating disorder don't you find you are watched and judged more, like if you go to the bathroom after dinner?
Smith: I was actually never the person who would get up from the dinner table and go binge and purge. If I was going to binge and purge I would set it up myself. So people may be watching me now, but that was not my MO. I would set aside time, go buy my binge food, binge and purge for sometimes up to four hours, and then be done. But I would not excuse myself from the dinner table and go take care of it in the bathroom.
Moderator: We are almost out of time. Do you have any final comments for us today?
Brownell: I'm delighted that Yeardley could join us for this conversation. Hearing from someone who has lived the problem and expresses herself so clearly and so powerfully can motivate people to take action with their own problems. I'm pleased to have been part of this conversation.
Smith: Gosh, I am so blown away by your kind words, Dr. Brownell; thank you. It's a very new experience to have one's struggle validated like that. You always think that you're the only one, and it gives me great comfort and hope to know that there are people like you out there studying this disease and other eating disorders, because it tells me that other people who need it will get the help they very much need. Thank you for inviting me this morning.
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Moderator: We'll have Dr. Brownell back with us again soon to talk about his new book.
Brownell: The book is called Food Fight, and it is about the national nutrition and obesity crisis and what might be done about it. Moderator: Thanks to Yeardley Smith for sharing her experiences with us in order to better understand bulimia from a first hand point of view. And thanks, as always, to Kelly Brownell, PhD, for sharing his expertise with us. Goodbye and good health!
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