Altering body image: an interview with a medical doctor who suffered from an eating disorder, and found a cure
By Catherine H. Knott, Ph.D.
Dr.Sarah Pratt (not her real name) looks, according to one friend, like a woman in a Botticelli painting, tall, with rippling golden hair, and a beautiful figure. But she has not always seen herself that way. Now in her forties, a successful doctor and mother, she treats patients with a wide rand of conditions. She treats those with eating disorders with a special understanding, because she once had an eating disorder, too. She shares a unique solution with those patients, one that she discovered for herself years ago.
Interviewing her now about the eating disorder she suffered in her teens and twenties is easy. She feels fully healed now, at a deep level. She shares the story of her eating disorder freely, and laughs ruefully at some parts, although she knows that eating disorders are no laughing matter. Some are deadly.
“I remember in high school, when it started, I was on the track and cross country teams. I ran a lot, and I ate a lot, compulsively at times, tons of ice cream, or fruit, or lots of cookies and sweets. I tried to make myself throw up once afterwards, but couldn’t because I have too strong a gag reflex.” Instead, feeling guilty, she exercised constantly, running competitively for both track and cross-country teams in high school and college, even adding other sports in winter. By doing so much vigorous exercise, she managed to keep her weight in check, despite binging at times.
The causes of her eating disorder, a not-quite-fully developed bulimia, came from typical sources. Her family was full of high achievers and perfectionists, and she herself fit the mold, an all A student, and by senior year of high school, captain of the track and cross-country teams. She applied and was accepted to an Ivy League school. Her family, not very open emotionally, stressed achievements, and had a low comfort level for expressing emotions or anything else that might slow the pace of achievement. She describes her family as emphasizing head over heart, cognition over emotion. Sarah herself was not comfortable with certain emotions such as feeling sadness or disappointment, or even anger. Bingeing was “a method of numbing out”.
In track and cross-country, the focus on achieving an ideal weight intensified in college. In high school, when eating disordered behaviors, including “sneaking down the back stairs to the kitchen” to eat large amounts of food, first started, Sarah was unaware that she had an eating disorder. But by sophomore year in college, it grew more serious. She and her roommates drew last in the room draw, and had to live in an annex far from the rest of their classmates. Feeling socially isolated, and eating in a large dining hall with incoming freshmen rather than her own class, she began to overeat on a more regular basis.
She ran for both the women’s track and cross-country teams, which intensified her focus on food and weight issues. The male coach for these teams was unfamiliar with women’s health issues, and did not recognize the signs of unhealthy eating-disordered behavior in several team members, including Sarah. Meanwhile, the young women on the team knew that, at least up to a certain point, the less they weighed, the faster they would be able to run. Team members would order salads – skip the dressing please – instead of foods rich in carbohydrates and proteins. They would run up to thirteen miles a day (a half-marathon), trimming the fat levels down to the point where some team members stopped having their periods altogether, or dropped below 100 pounds. Being around other people who were not eating in healthy patterns, in a high intensity sport that emphasized thinness, did not help matters for Sarah.
Part of the problem at college, she said, was that by comparison, high school had been “a relatively happy and easy time” for her. It had been easier to attain the high goals she set for herself, and easier to seem nearly perfect. In the more competitive Ivy League setting, this ease disappeared. She had trouble handling feelings of disappointment and sadness when she did not do as well as she wanted, perhaps in part due to less emotional openness in her family of origin.
Sarah noted with some sadness in her voice that when she needed time to just “be” and perhaps take a year off from college, the older adults in her life were not prepared to listen to her feelings. Instead, they offered advice and solutions designed to “fix it quick” and keep her in college. The pressure, and her increasing sense of disconnectedness from her feelings and her body fueled the eating disorder.
She describes college as a perfect environment for eating disorders to fester and worsen. “There was always so much food around” in the dining halls, she says. They were open almost all day, and on the meal plan students could eat as much as they wanted at any meal. Far away from home and family, often eating alone or with strangers, students lose a sense of proportion and community around food. With an inexperienced coach, and no older adult to intervene, Sarah feels she fell through the cracks. While not blaming anyone else for her disorder, in retrospect she things that it would be better if colleges enabled mentors, coaches, counselors, and other adults who deal with students’ daily lives to be better educated about eating disorders.
Sarah never gained more than twenty-five pounds above her ideal weight, but she experienced many classic bulimic behaviors – secretiveness about finding ways to eat large quantities of food at one time, then overwhelming shame and guilt the next day, and patterns of over-exercise to get rid of possible weight gain. “There is a line you cross between healthy teen eating behaviors and unhealthy eating-disordered behaviors,” she says. “We need to ask: when does it start to affect personal life? Interpersonal dynamics? Does eating start to dominate the person’s thoughts, and turn into a need to control many aspects of life?” Unfortunately, many people suffering from bulimia can be very good at keeping the outward face under control. For those whose actual weight gain is minimal, the suffering and depression can go unnoticed for years.
Finally, the summer after her first year of medical school, when she had a grant to stay and work in the city where she attended medical school, Sarah had a breakthrough. “I remember the moment exactly,” she says. “I was riding my bike one day, and I remember thinking, ‘I have a problem. I have an eating disorder.’” It may have helped more than she realized at the time that she was rooming with a friend who was good at listening and empathizing, and who emphasized the emotional side of life.
The solution appeared soon afterwards. Somewhere in town, she remembers, she saw a flyer advertising a creative movement therapy group, which practiced something called “authentic movement.” She had no idea what authentic movement was, but Sarah started with a six-week workshop, she remembers. The group began by closing their eyes while lying on the floor, and imagined outlining their bodies as if they were using a piece of string – going around each finger, each limb. The instructor asked the students to note where they could not easily outline a part of their bodies, helping them to realize that they had body issues or body image problems in those areas.
In another exercise, the group sat in a circle, and those who chose to could move into the center of the circle, where, with closed eyes, they began moving, expressing their feelings through the motion. Those who remained on the outer edge of the circle kept their eyes open, and acted as witnesses. Afterwards, they used colored pencils or crayons to record their emotional experiences in artwork. Finally, they would talk about their experiences.
“It was very powerful, releasing emotions through the body,” says Sarah. She eventually joined a regular group with this teacher, and stayed in it for three years, successfully emerging from the eating disorder. “But that was just the beginning. It really helped me deal with a lot of deeper emotional issues as well.” Sarah stops speaking for a moment, remembering. Her experience was so powerful and healing that eighteen years later she is still in contact with the teacher, and much happier about herself and her ability to express emotions and to listen to others.
The teacher, a gifted, and now nationally known body movement therapist, helped group members by encouraging them to move their bodies creatively and to think about the problems they faced psychologically, using archetypes and stories. This special teacher was “the ultimate witness”, Sarah says. “Through watching someone move, she could deduce whether a person had abuse or other issues, and even the age at which these occurred,” and could tell what types of psychological and emotional healing needed to take place.
In her professional life, Sarah occasionally sees patients, both young and old, with eating disorders. She tries to connect them with body work and therapy, because, she says, “Eating disorders are not rational – they are definitely about the body, and body image.” People suffering from eating disorders need to connect to the underlying suppressed emotions through the body, Sarah emphasizes, in order to heal permanently.
Equally important for Sarah, healing the eating disorder through body work allowed her to learn a new way to share emotions with others – through listening. The “let’s fix it” approach she had learned as a child was replaced with a listening approach that allows and encourages patients to explore their deeper emotions. They are able to open up to her, and when she focuses on just being with them, paradoxically, they open up the most, sharing their feelings and fears about their illnesses. Being in touch with her emotions not only helped Sarah to heal from her eating disorder, but also helps her to be a better doctor.
Suggestions for Parents
Sarah offered the following suggestions for parents of teens with eating disorders or those concerned that their teenagers may be at risk for eating disorders. First, make sure to bring up the issue privately with the family physician, at regular check-ups. Second, make sure that the teenager is comfortable talking either alone with the physician, or with a parent present, about the possibility of an eating disorder. It may help parents to understand that Sarah sees two main types of patients with eating disorders in her practice:
- Patients who are high-powered athletes, and other over-achievers and become either bulimic or anorexic;
- Patients who have been abused (not necessarily by family) in some way who compensate by overeating, or under-eating, compulsively.
She notes that there is a strong connection between childhood family dynamics and teen and adult eating disorders. She emphasizes the need for doctors, and parents, to build trusting relationships with teens and young adults to diagnose, monitor, and treat food disorders effectively. She also routinely asks all teenage girl patients, the population with the highest percentage of food disorders, “How do you feel about your body?” and suggests that parents can do the same.
Third, because of the seriousness of possible health consequences from eating disorders that go untreated, including heart rhythm abnormalities, diabetes, damage to teeth from stomach acid, and even death, Sarah recommends that parents educate themselves about eating disorders, and keep their eyes open for any unusual scenarios around eating, particularly with teenage girls. These abnormalities include eating a lot and leaving the table suddenly, secretiveness, or any blatant restrictive eating or weight loss. She also advises watching for the classic signs of teen depression, which goes hand in hand with eating disorders.
As we close the interview, Sarah emphasizes again, this time for patients and others who suffer from eating disorders, “It’s a body image and emotional problem. It is non-rational. So it is important to treat it through the body and with the body. That approach leads to deeper healing.” Her own experience has given her wisdom.
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