An RD Confesses: "I Had Bulimia"
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An RD Confesses: "I Had Bulimia"

Jessica Setnick's obsession with having a perfect body turned into a life-threatening eating disorder.

Battling Bulimia

The moment I realized that "perfect" wasn't all it was cracked up to be, I was kneeling on the carpeted floor of my mother's bathroom. The remains of my dinner bobbed in the toilet basin, a floating testament to my dedication, determination, and sheer willpower. Here was proof that I could do whatever it took to be, well, perfect. But as I leaned against the wall, reality closed in around me. This was perfect? Swollen, bloodshot eyes. A throat so inflamed it was difficult to swallow. My self-esteem in tatters. Where just moments before, I'd felt relief -- pride, even -- suddenly there was only despair. Sitting there, wasted from the effort of forcing myself to vomit for the umpteenth time that week, I was tired of doing this. Tired of hating myself that much. That night was the beginning of the end of my battle with bulimia.

The ironic part is, today I'm a registered dietitian with a master's degree. That night in the bathroom was a week before I started graduate school, planning to become a sports nutritionist for athletes. And there I was, literally flushing the subject of my education down the drain.

The Perfect Child

As a nutrition professional, I know that bulimia is a potentially life-threatening condition, affecting at least 1.5 million women in America. It can cause heart damage, osteoporosis, and all kinds of digestive dysfunction, like permanent constipation. Bulimia can even be deadly if it causes your esophagus or colon to rupture, your heart to stop, or your body's electrolyte balance to veer out of control. But like me, many bulimics are aware that what they're doing is harmful. The sense that they "should know better" only makes them feel guilty and drives them to secrecy, perpetuating the binge-purge cycle.

Secrecy, Obedience, and Perfection

For me, the secrecy started in kindergarten. I was usually the last to be picked up at the end of the day, so while I waited -- feeling alone, bored, and a little unloved -- I would go through the cupboards in the classrooms until I found snacks to eat. When my mom finally arrived, rushed and frazzled, I was too relieved to tell her how mad I was or how lonely I had been. I also thought I needed to be perfect for my mom to pick me up. Besides, I didn't want to get in trouble for sneaking food. I was 5 years old and already ashamed of eating.

I continued to hide my feelings throughout childhood, trying to be the perfect daughter, spending much of my time alone, reading. My favorite book was a children's cookbook; the illustrations accompanying the recipes showed a happy '50s family making fudge and other sweets together. I "read" it over and over. At school, where I couldn't be alone, I'd occasionally go to the nurse with a stomachache or throw up on whoever was around (sorry, Mrs. Hogue). But it usually garnered sympathy rather than reprimands. Quiet and obedient, I appeared to many as "the perfect child."

Perfection took on even more meaning as I got older. My father, who put himself through college and graduate school at MIT, valued education above all else. He expected straight A's, and my grades just weren't quite good enough. He died of lung cancer when I was 12. I knew he had no choice about leaving. But having a daughter like me, I thought, maybe secretly he didn't mind. To make up for disappointing him, I believed the only thing I could do was be perfect from then on. That way, no one else would leave me like that.

Fear of Failure

In college, I quickly realized that achieving a 4.0 grade average was unlikely. But during my sophomore year, I stumbled on a new pathway to perfection: achieving an ideal body. I had gained the freshman 15, so during winter vacation, I tried a drastic diet I'd invented based on severely restricting calories -- and lost it all. When I got back to school, my dorm mates actually gave me an impromptu award recognizing my "dramatic diminution." The praise and admiration were almost unbearable.

I loved being successful, but I didn't love that others were keeping tabs on my weight. It meant that regaining was not an option. I didn't dare eat anything "fattening" in front of my friends. However, like many people with an eating disorder, I would sneak into the kitchen after everyone else had gone to bed and wolf down everything I had denied myself.

The Bingeing Cycle

To a bulimic, avoiding food all day means "being good." But a starving body will eventually revolt, inducing an out-of-control binge. The shame that follows makes a disordered eater promise to "do better" the next day, starting the whole cycle over again. Clearly, I thought, I couldn't be trusted around food, so I vowed to be even more careful at meals. Still, my weight began to creep up -- more "proof" that I needed to double my efforts. Desperate for a way to drop the pounds, I registered for Nutrition 101 -- and aced it. Every A paper justified my obsession with food; after all, the more I studied about eating and calories and dieting, the better my grades were.

Obsessive-Compulsive Behavior

Around this time, a friend from another school came for a visit. A bunch of us took her out for dinner before a party, and, having eaten nothing all day in order to save room for beer, I inhaled my food. I was complaining about how full I felt, so my friend told me how easy it was to make yourself throw up. She took me into the bathroom at the restaurant and showed me how to trigger my gag reflex. After vomiting, I felt so much better. For once I felt in control of my body, and a lightbulb went on. I thought I had finally found a solution to my bingeing problem.

Things became worse when, soon after, I got a summer job at a fitness center, where I could work out as much as I wanted -- all day long, and after hours, too. I was logging about 50 hours of exercise a week at that point. Extreme physical activity often goes hand in hand with bulimia; studies show that starvation induces not only the urge to overeat but also the urge to move (probably in order to go get food or to stay warm, but we misinterpret it as an urge to burn off more calories). A host of other obsessive-compulsive behaviors can accompany the excessive exercise: One of mine was compiling recipes from cooking magazines. The thing is, I rarely made anything to eat; but I pored endlessly over cookbooks, reading them like romance novels to lull me to sleep.

I also obsessively logged my progress in composition books. Each page read like the one before: a roundup of calories eaten and burned, plus a pep talk to "do better tomorrow." I weighed a reasonable 135 pounds (on a five-foot-two-inch frame), but still, every few pages, I would chart how much I expected to lose that week.

The Breaking Point

My friends, who were unaware of my late-night bingeing and purging, continually praised me for all this hard work. But as the months and years went by, throwing up felt less and less like an easy (albeit shameful) solution. Now it just felt gross, emotionally agonizing -- like an obligation. I knew it was bizarre and abnormal; I knew the sensible way to lose weight would be simply to eat less in the first place. Still, I just couldn't stop.

Based on what I now know about the disorder, it makes sense: Some experts suspect that dysfunctional eating behaviors actually "help" a stressed-out brain relax. Bingeing, starving, exercising, vomiting -- they all affect brain chemistry as powerfully as drugs. As with an addict who promises to quit, when the next stressor hits, the behavior returns. Instead of quitting, I just worked harder and harder to keep my habit hidden. Secrecy was crucial.

Confrontation: A Reality Check

One day during the summer after I graduated from college, my mother confronted me. We had gone out to eat at a Chinese buffet; starved after a day of fasting, I had gorged myself, then run to the bathroom to vomit. When I returned to the table-hair disheveled, eyes watery-my mother asked, "Did you make yourself throw up?" I lied and said, "How could you even think that?" She dropped it, but the conversation jolted me into reality. Keeping food out of my stomach felt good; Mom noticing felt bad. (I found out later that she herself had frequently purged as a child, after her mother force-fed her a full breakfast before rushing her off to the school bus. Maybe that's how she recognized the signs.)

When people ask me whether it's smart to confront someone with a suspected eating disorder, I tell them to handle it the same way they would if they thought their friend was drinking and driving. Regardless of how she acts in the moment -- with denial, anger or a promise to change -- the most important thing is that she now knows you care and will stick by her. And that might be what saves her life.

Starting Over

Several months later, the week before I began graduate school, I finally hit bottom that fateful night in my mother's bathroom. It dawned on me that I was about to embark on a career where others would listen to my advice about food. Out loud I said, "I don't want to live like this anymore."

The hard part was actually following through -- eating a meal and resisting the urge to regurgitate it, even if I had slipped and eaten too much. After purging for four years, I quit cold turkey, on my own, through a combination of willpower and faith. Sometimes I had to drive around the block instead of going home, because I knew where I would go as soon as I walked in the door. It took years to learn how to eat the right amount, which helped lessen the temptation to vomit.

I was shocked, however, to realize that sometimes I wanted to vomit even when I ate nothing at all. Throwing up seemed to be a way of expressing bad feelings and trying to make them go away. Only six years after quitting, when I was 28, did I start seeing a therapist. My cousin had just died, and the temptation to vomit was the strongest it had been in a long time. This process helped me understand that bulimia isn't just about food; often, it's a dysfunctional defense mechanism against life's difficulties.

I now understand why I needed my eating disorder, and also what I needed to let it go. I'm grateful that it led me to my calling: counseling others who are fighting the same battle. Originally, I thought that becoming a dietitian would give me the answers to my food and weight problems, but it turns out that overcoming my food and weight problems made me a better dietitian.

Living Through an Eating Disorder

Even now, at age 33, when I feel overwhelmed, I still eat too much or too little. Sometimes I think about weight loss, even though my weight is absolutely fine. With psychotherapy, I've learned to identify the emotion behind these thoughts: I'm not good enough, so I have to be better. And better means thinner in our culture. That's why emaciated girls sit in my office, desperate to lose even more weight. Thin people always feel good, they believe; since they're not happy, they must be fat. Telling their friends they feel unlovable would be pathetic and burdensome. So they say "I feel fat" instead, which is much more acceptable. The danger is that they eventually start to believe it.

It's been 11 years now since I bottomed out. In my practice, I use my experience to help women struggling with body-image issues to think more deeply about what's truly bothering them. Together, we experiment with different ways of eating -- varying meal schedules and nutrient balances and portion sizes -- to keep their bodies nourished. (Antidepressant medication and behavioral therapy are also effective treatments for some eating disorders.)

I do much the same for all my clients, whether they need to lose weight or just improve their health. And as I help them find their own perfectly imperfect eating plans, I continue to work on accepting my own. We all want a flawless body, but sacrificing ourselves to get there just isn't worth it.

Originally published in Fitness magazine, March 2006.