Striving To Be Perfect

Striving To Be Perfect: Surviving An Eating Disorder In A Perfectionistic World

By B. Imei Hsu, RN, MAC, LMHC, Artist

Recently former television news anchor Katie Couric and music and media superstar Lady Gaga were in the news about something that hits close to home for me. The experiences of these two women intersect with the  presence of three banker boxes with assorted papers on the floor of my home. There is  nothing special about the boxes.  Unmarked, ordinary, and crunched in the corners from overuse and stacking, the only reason I would mention them is that nearly every person who has struggled with an eating disorder (commonly referred to as an E.D.) will know exactly why sharing about these benign boxes has everything to do with understanding the underpinnings (and the signs of recovery) of one the most recalcitrant but treatable psychiatric disorders:

The boxes have sat in the same place, mostly unused, for more than three months.

While that might sound like laziness,  it is also a sign of recovery in the aftermath of nearly sixteen active years of battling anorexia, and an additional decade of struggles with body image that have shaped the way I think about the disorder and the pathway of recovery for the children, teens, women, men, and families who have sought my help over the years. Underneath the struggle which appears to be a fight about food is a person who struggles with the message to obtain the unattainable perfection of an appearance that is supposed to win love and acceptance from others. I’ll get back to the story of the boxes at the end this post. For now, let’s look at Eating Disorders together, and what the obsession with thinness is all about.

Everyone Of Us Knows Someone Who Struggles With An Eating Disorder

Caution: if you currently struggle with a diagnosed eating disorder, I caution you not to read the following section alone, as it contains details and numbers that you may find disturbing and/or  triggering. I share this with those who wish to understand this disorder from an ant’s view.. If you wish to read it, read it with someone who knows about your disorder and can discuss your feelings with you.

While walking along a busy street in Seattle, I passed by the figure of an extremely thin woman wearing leggings and a long sweater on a warm day. I couldn’t help it: I stared at her. The flesh of her face stretched across her cheekbones as if suckered upon them; her thinning hair and dull eyes gave a cast of death. While many large, overweight American tourists around her wore shorts and T-shirts to beat the heat, she walked slowly but steadily in clothing most people reserve for Fall or early Winter in order to keep her emaciated carcass warm. Her legs were the circumference of the largest part of my arms. I looked away and shivered with sadness.

Both this woman and perhaps a number of the tourists who passed her by struggle with eating disorders. Nearly 8 million Americans struggle with some form of eating disorder, with about 5-15% of those being male. Eating Disorders are no longer seen as disease state we relegate to the world of teen girls struggling with a changing body. We’re seeing the disease in its context: a body image-0riented, food-hostile world, with cultural pressure to appear perfect. There are now women who survive the earlier years of eating disordered behaviors who go on to become adult women with a family… and they still restrict calories, eliminate food through induced vomiting, laxatives, over-exercise, and a variety of other practices such as orthoexia, rumination, and eating foods that have little to no caloric value (ice, gum, sugar-free hard candy). There are men who still struggle with the desire to achieve body perfection in order to feel accepted, beginning with the high school wrestling team or cross-country running, and ending in a lifelong struggle with body acceptance. All of this occurs without their family member’s knowledge or concern until the person’s health fails. Eating Disordered people are living longer, and they are all around us. You may be one of them.  I am one of them, as I count myself an anorexic in indefinite recovery.

Each of us likely knows someone who struggles with an eating disorder or eating disordered issues. You just may not know that person is struggling; no one knew I was. Often our families, communities, employers, and socio-cultural milieu tend to reward thinness and punish or exclude larger people or people who don’t fit acceptable social norms for everything from piercings to sexual orientation. In an effort to dodge cyber bullying, school or workplace taunting, or teasing and threats from our own family members, many of us have turned to eating disordered behavior or ways to change our appearance to try to deflect the pain we feel when we’ve felt shamed or have felt unloved. What begins as a psychological reaction to shame results in a repeated physical cycle of calorie restriction, binging and purging, and the creation of disruptive social rules concerning one’s relationship to food that allow the E.D. person to continue their behaviors in silent suffering.

I personally believe the incidence of Eating Disorders have increased over the past decade for a few of reasons:

1. Media images are highly over-produced with unrealistic standards for beauty and fitness,

2. The advent of Social Media makes it easier for people to curate their images and compare them to others who would not normally be in their natural cohort, i.e. Contender Syndrome,

3. The numbers of overweight people have increased enough to alert people to a fear of Type II Diabetes and other health problems associated with being overweight, and many are turning to disordered thinking about food as a reaction to that fear.

4. Many of us stand by and allow bullying of heavy people or people different than the established norm. Some of us knowingly and unknowingly perpetuate or support a type of “fatism”, where we subtly discriminate against those who are large.

I Work With People With Eating Disorders Because I Understand It

While a therapist does not need personal experience to help others with a particular mental health problem or challenge, I came to the conclusion years ago that my experiences with anorexia allow me to be both compassionate and firm in the way I approach the treatment of E.D.s. I also know that the number of therapists who have viable experience AND are willing to treat others with an E.D. are few. Many are uncomfortable working with a person whose BMI has dropped below 17. Others are not equipped to be able to take a heart rate, weekly weights, or recognize signs of electrolyte imbalance. I work with people with Eating Disorders because I understand it, I believe recovery is possible, and I practice a pathway to help look at the stubborn problem of body image and perfectionism that haunts those who have turned to an Eating Disorder as a secret solution to their anxiety.

For myself, it began at home. I had an early awareness that my mother favored the typical thinness and petite figures of Taiwanese girls. Girls who were athletic, with strong muscles in their calves and thighs, were not beautiful to her. On top of my awareness of her disappointment in my appearance as a young teen, I was assaulted with the usual magazine images of models who were 5’7 or 5’8, wearing insanely high-heeled shoes supporting stick-thin bodies sporting the absent curves of an adolescent body. To make matters worse, I grew up in America, surrounded by more children who did not look like me. I had no role models except the ones that were force-fed to me (no pun intended). I remember making a commitment to be thin no matter what.

By the time I was 13 years old, I had already progressed to restricting calories whenever one parent or the other tried to use the withholding of meals as a form of punishment for not being perfect. Instead of complaining, I simply learned to say, “I’m not hungry anyways,” to take the sting away from the punishment. I do not blame either of my parents for not understanding how detrimental using food as reward or punishment is to the growing body of an adolescent girl. For each time I was called “fat” by my mother, or told that if I didn’t finish my food, I should give it to my brother, I internalized a message that food was meant for those who were deserving, and by welcoming hunger, I might gain the possible coveted award of being loved and cherished on some future day. It certainly didn’t help that my friends in school kept telling me I was so “lucky” to be small.  I was 64 pounds at the end of 8th grade. How do I know? Because I started weighing myself twice a day, and some of the weights are recorded in a handwritten journal.

By the time I hit high school, I had already begun to force myself to vomit and over-exercise to control my appetite, eliminate intake, and quell anxiety. A slight 5’3 and under 80 pounds, a few friends teased me that if they just sneezed in my direction, I might be knocked down! We’d all laugh at the thought, but inside, I believed that it was better to be small and cute than short and large.  Meals were often followed by  sessions of leaning my head over a toilet, watching a handful of toilet paper saturate with fluid to prevent stomach acid from splashing back from the water and hitting my face. Can you imagine that? There was something profound about being painfully aware of every micro movement I executed to keep my anorexic behaviors in stealth mode.

By the time I reached college, my body was exhausted. Just a few pounds over the dreaded three digit mark of 100 pounds, I kept up a grueling pace of aerobics classes, running, and dances to make sure no one would ever think I was fat.  By the time I participated in my first scholarship pageant, I weighed in at 103 pounds and I thought that meant I had failed. If I hadn’t been so busy trying to get into the School of Nursing, I would have accepted an invitation to be a coxswain for the University of  Washington Women’s Crew team. The mailed invitation* from the team intimated that I’d get to bark commands to the crew and exercise with the team, but best of all my main job would be to be as light as possible.  But I had other plans.

Far beyond a compassionate routine of self-care, I waded through nursing school, hiding my body under a smock, sweats, big shirts and jackets, and loose and unrevealing clothing. My fellow nursing students commended me for being thin in an increasingly thick world. They told me how they admired my willpower to reject jelly doughnuts in the nurse’s station, and my close friends wondered why I didn’t drink alcohol when I turned 21 (I was afraid of the extra calories from sugar). None of them knew that even the taste or smell of food could trigger my gag reflex. I think they all thought I had a small bladder for how many times I excused myself to use the restroom during social events.

Graduating with my Nursing degree with an emphasis in Community Health and then sitting for the licensure exam, I knew I had a problem. A combination of events — the last time I vomited, a thready heart beat, a few too many times I felt faint and had to sit down — made me realize that I did not want to live and die this way.  I had to discover if there was another way to relate to my body without hating it for being less than perfect. There was no longer someone punishing me for not being perfect. I was punishing myself, and it needed to end.

I’ve come to understand that I could have picked a number of ways to have responded to the initial struggles I encountered. I chose Anorexia. And in a way, it “chose” me back as a  perfect fit, only it ends up having too many costs associated with this strange and consuming relationship. I thought I was in control and using “it.” Turns out, “it” used me.

How To Love The Body: Learn To Listen

My Kripalu Yoga Teacher Training in 2007 emphasized something they call Body Wisdom. Body Wisdom is your body’s mind-body understanding that comes forward as a Voice, telling you what is truly going on in your body when you tune-in with awareness. Unbeknownst to me at the point of my decision to be in recovery, I was learning to tune into my body by asking it what it needed, tapping into a part of Body Wisdom that had been suppressed in earlier environments of high control. Young people who aren’t encouraged to tune-in and understand how to meet their own needs often grow into adults who continue to be disconnected from this awareness of the body.

Fortunately, Body Wisdom awareness can be taught. In the years between 2000-2010, I began formally learning more about connecting with my body and its needs by taking Middle Eastern Dance lessons and continuing on with my Yoga teacher certification. I found that these principles matched well with the literature on Mindfulness meditation being introduced into Eating Disorder treatment.

I learned to ask these questions: “Am I truly hungry? Is my stomach content? Am I feeling stressed and need a break? Am I feeling sad or angry? Am I using food as way to moderate how I’m feeling? Am I using exercise as a way to control my body’s appearance as a means to earning love or attention, not just as a way to be fit and healthy?”

Eventually, I found my way to books with solid nutritional information in it. I read everything I could on building menus with protein, complex carbohydrates, fats, and decreased simple sugars to help control my blood sugar levels. I moved from trying to eat three balanced meals to four or five smaller meals, avoiding the feeling of fullness that triggered unpleasant feelings about food and body image. Throughout meals, I checked in with myself to see how I was feeling about eating, and I began to associate happier thoughts with the eating experience. I actually began to enjoy eating with other people at the table. I stopped weighing myself by giving away my scale, cut down my hardcore exercise routine to more measured and safer distances and times, and allowed myself tastes of foods I had once thought of as forbidden. Though most of the work I did on myself was done without the help of a professional, I eventually sought out a counselor to begin processing the pathway of recovery ahead in order to help me become a more effective healer in the same community.

I am so glad I learned a way out of an active E.D., yet as many of you know, there is a constant awareness that there are just some things I still have to do — tell that niggling voice to shut up, confront energy-sucking guilt, eat by the clock and pay attention to calories to prevent under feeding while I train for my races and stay fit for performance dance — that are part of the long-term recovery process. Which is the long form for, “We’re all in this together.” As long as there is a battle over food, appearance, and perfection, there will be people who struggle with E.D.’s. Period.

 

Letting Go Of Perfectionism

Let’s face it: it’s tough letting go of some of those lofty expectations we have for ourselves! Like I mentioned at the beginning of this post, the three banker boxes on my living room floor are a reminder of my own recovery from a disorder that could have easily taken my life. These boxes drive me a little batty when I look at them. I think, “Gee, they’ve been there for awhile! How come you can’t manage to find time to clean them up and put them away?” But the Body-Wisdom voice kicks in. It says, “You have never been more happy in your life. The boxes say nothing about your level of happiness.”

The effect of perfectionism is to convince the E.D. person that these behaviors will bring you closer to being physically perfect and acceptable. It is a never-ending stream of criticisms, pokes and prods, and harsh beliefs about oneself that egg on the E.D. sufferer. If I could give you one suggestion to help yourself or another person who struggles with an E.D., I would tell you to ease up on perfectionism, and consciously tell that irritating voice in your head to go and shut it.

The banker boxes are currently serving as a reminder that I can be an awesome person without being perfect. I can still sleep. I can still cuddle my kittehs. I can still present solid information to my community that helps them do what they do best. I can still meet my clients and care about their lives. When you free yourself from perfectionism, even the flaws become things of beauty. [Editor’s Note: I was just notified of extra storage space that I’ll be assuming soon. I think I know where the banker boxes will be this time next week or so.]

Finding A Way Out

The way out of an E.D. can often take as long as the way in, but with help, the process can be faster and less painful than if you try it alone. Generally, Eating Disorder treatment programs use a combination of similar elements:

– physical assessment by a physician and/or nurse, including heart rate and rhythm, weight, and blood work

– a psychological evaluation, including assessment for depression and anxiety, and possibility of using medications to help clients comply with treatment

– individual and/or group therapy <— I personally don’t believe group therapy is entirely effective for younger girls, as they have a tendency to copy each other’s “best” anorexic/bulimic behaviors to see who is the best at it. 

– nutrition counseling, including menu planning and cooking classes

– family therapy

In some cases, those who are extremely underweight or have heart damage may need to be hospitalized to receive tube feeding, or to enter an eating disorder treatment center for a month or longer.

At SDC, I add three more components:

– meditation and intuitive eating: awakening a person’s ability to listen to their body and to learn to meet its nutritional needs to eating more intuitively; self-soothing techniques to address the underlying anxiety and negative messaging

– when a person has reached a body weight and level of health to increase their activity, I help them introduce safe movement in their lives (with their doctor’s supervision): gentle Yoga, social dancing, running short distances at slow speeds (if it is not a triggering activity), other low-impact sports in a non-competitive format

– restructuring the home: no fashion magazines, eliminating food-hostile words from everyday usage, removing the scale from home,  establishing new sleep-work-play schedules that honor your body’s needs

As a part of my Fall 2012 focus on feeling great, please take a look at a fantastic nutritional service that I have used and referred clients to for almost five years: Passionate Nutrition.  These are professionals dedicated to helping everyone learn a new relationship with food, and they have experience with those who have eating disorders.

We would be honored if you would share this article with friends and family members who struggle with eating issues and Eating Disorders.  My plan is to roll several of my past blogposts on the topic of Eating Disorders into an eBook format and make it available on Amazon in the hopes of helping more people. That version will contain more resources for help and treatment options, as well as an entire section on the role of the parent and family in the life of an E.D. person in recovery.

*It took me awhile to realize that other women who received the same letter of invitation were all small and lightweight in physique. How did they know who to send the letters to? You were either referred by someone who knew you, or your weight was a piece of data owned by the school when you applied as a student. I did not know anyone on the crew team and had never trained for such a sport. Think it through.