Brain Over Binge (11 page)

15
: Was I Really Recovered?

B
ecause I recovered so quickly and easily, it's natural that some people will question the legitimacy of my recovery, so here I'll address the question of whether or not I truly recovered. I had to grapple with this question in the weeks and months after I stopped binge eating, because as I've mentioned, I'd thought that a full recovery would require a major personal transformation or resolution of certain issues. However, after I stopped binge eating, I felt basically the same—minus the binge eating, purging, and all the problems that went along with it. So was I still a bulimic at some level? True, I didn't binge and didn't purge anymore, and my urges to do so had completely disappeared, but was that enough to claim a full recovery?

WHAT IS RECOVERY, ANYWAY?

I've found that the answer to this question often depends on who you talk to, and through my years of disordered eating and recovery, I've encountered endless definitions. Here are a few of them:

• Recovery means resolving the root causes of the eating disorder.
  
• Recovery means coping with life's struggles in healthy ways.
  
• Recovery means maintaining a healthy weight and eating regular meals and snacks.
  
• Recovery means having skills to deal with feelings, emotions, and problems.
  
• Recovery means loving yourself.
  
• Recovery means being assertive in relationships.
  
• Recovery means finding spirituality.
  
• Recovery means forming an identity and having purpose in your life.
  
• Recovery means living happily.
  
• Recovery means something different for each person.
  

In therapy, I learned that recovery could be defined as one, all, or some combination of the above statements. The quotes below are typical of some things that I believed during my years of therapy:

Recovery means that, instead of using eating-disorder behaviors to cope with [negative] feelings, you will be able to use constructive techniques to make your way past them. When you have regained possession of your life and you can live happily without the eating disorder, you will have recovered.
30

You will understand the underlying emotional reasons for your eating disorder and learn to take care of yourself in ways other than overeating, undereating, or obsessing about food and weight. You will discover a new and loving relationship with your body, honoring it no matter what size, shape, or age. You will explore how to set boundaries, say no, and nurture yourself in ways that feed your soul. You will deepen your connection with your spiritual self and listen to your inner voice that can guide you to live in your own truth and create your own dreams.
31

The ultimate goal is to increase your self-esteem, change your belief system so that you no longer place such a high value on appearance, and find healthier ways of dealing with stress.
32

Recovery from disordered eating is about accepting the wholeness of your being. It is about accepting all of who you are, all of your emotions, thoughts, and desires, even those you may not like or those that bring discomfort. It involves recognizing that certain attributes you have viewed as liabilities are actually assets, realizing that your sensitive nature is part of your beauty, and understanding that your uniqueness does not have to lead to isolation, rejection, and loneliness.
33

The above definitions make recovery seem a rather daunting task. When recovery included such goals as connecting with my spiritual self, coping well with problems and feelings, living happily, accepting the wholeness of my being, or improving my self-esteem and body image, recovery became a difficult, complicated, and long-term process.

My lengthy therapy was not an exception; in fact, it is common for eating disorder therapy to last two to five years or even longer.
34
I believe this is due to overly broad definitions of recovery—such as the examples above—that are popular in traditional therapy today. But, as I learned for myself, recovery need not be so daunting. If defined in practical and commonsense terms, recovery can be simple, quick, and completely self-directed. In order to arrive at this new definition of recovery, I asked myself three important questions.

QUESTION 1: WHAT WAS I TRYING TO RECOVER FROM?

I was trying to recover from bulimia—which, over the years, I learned to be a complex psychological problem. However, the definition of bulimia is rather simple:

Bulimia Nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
35

Bulimia is defined by binge eating—eating an excessive amount of food in a discrete period of time and feeling a lack of control during the excessive eating. Without binge eating, bulimia cannot exist in an individual. The purging aspect of bulimia consists of compensatory behaviors to offset the binge eating; without the binge eating, purging becomes unnecessary. I'll talk about purging specifically in Chapter 36; for now, it's sufficient to know that, without binge eating, purging does not characterize bulimia.

The definition of BED is basically the same as bulimia, minus the purging:

Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.
36

Nowhere in the above definitions of bulimia and BED is there any mention of an inability of the patient to deal with emotions, cope with life, think positively, love herself, or build healthy relationships. Nowhere in the above definitions is there any mention of an inability to achieve happiness or live life to the fullest or even maintain a healthy weight and healthy diet. It simply does not follow that recovery is then defined to include such broad goals. The meaning of recovery should fit the definition of the disorder.

Sure, dealing with such other problems is a worthy goal, and it would have been fine for me to tackle them outside of the context of recovering from bulimia. But my recovery taught me something that had eluded me for many years: if I wanted to recover from bulimia, I absolutely had to stop binge eating. Which brings me to the next question I asked myself.

QUESTION 2: WHAT IS RECOVERY FROM BULIMIA OR BED?

Since bulimia and BED do not exist without binge eating, the following definition of recovery is the only one that makes sense:

Recovery from bulimia is the termination of all binge eating.

I've defined recovery from bulimia as a termination of
all
binge eating, even though to be formally diagnosed with bulimia, a woman has to binge/purge two times per week for three months.
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Technically, if a woman reduced her behaviors so that she binged/purged less than that, she would not be formally diagnosable as bulimic. However, it would be nonsensical for a woman to claim full recovery if she reduced her binge eating just enough to fall out of the clinical diagnosis; and furthermore, the twice-a-week criterion is likely to be dropped from the next version of the
DSM.
38
The defining characteristic of bulimia is binge eating and the compensatory behaviors that accompany it, regardless of how frequently it occurs. This is why I consider recovery to be a termination of
all
binge eating, not merely a reduction in binge eating.

I only wish I would have learned this simple definition of recovery as soon as I entered therapy, because it would have allowed me to target my problem directly. It is true that the termination of all binge eating was a goal of my therapy, but it was not the driving force of treatment. To the contrary, my binge eating was supposed to stop only as I reached other therapy goals. A termination of binge eating was certainly expected ... eventually; but it was to be an afterthought, a pleasant side effect of the recovery process. Yet the termination of my binge eating was not an afterthought—it was the only thing that brought me true recovery. It was not a side effect of other therapy goals—it was the only goal I needed to accomplish all along.

Now I turn to the last and most important question I asked myself to define my recovery.

QUESTION 3: WHAT DID I NEED TO DO TO ACHIEVE RECOVERY?

In light of my new definition of recovery, the answer to this question was:

Stop binge eating.

Done. I am recovered.

I truly believe I could have recovered at any point during my years of bulimia if I had only had the right information. I didn't know it was entirely in my power to stop binge eating at any time I chose. Stopping binge eating was the only clear-cut and practical solution to my bulimia. Now that I am recovered, I still have many other problems—like everyone else in the world—but I do not binge eat. That's the only true proof of recovery from bulimia.

Stopping my binge eating was not simply treating the "symptom" of a deeper problem or disease. Binge eating was the problem. Some may say that if I stopped binge eating without resolving the underlying issues, I will inevitably relapse or I will turn to other unhealthy means of coping—like drugs, alcohol, or other self-harming behaviors. Some may say stopping behaviors is only one aspect of recovery from an eating disorder, and by just doing that and calling myself recovered, I am selling myself short. I hope to put these criticisms to rest in the remainder of this book.

I used to believe these common criticisms as well. While I was in therapy, I used to think:
Stopping my binge eating will only be the beginning of my recovery. I need to conquer my self-esteem issues to have a full recovery. I need to be a healthy weight and eat a healthy diet to achieve a full recovery. I need to cope with the pain from my past and learn to manage the problems in my daily life to achieve a full recovery. A full recovery won't be possible until I can be happy.

Because of what I learned in therapy, I often confused what was recovery from bulimia with what was just life. Therein is one of the major pitfalls of my therapy: it simply required too much. It was too complicated and unnecessary, especially considering my age at the time. Recovery should have been as simple as possible.

So I've learned to replace the word
recovery
with the word
life
in my thoughts:
Stopping my binge eating will only be the beginning of my
life.
I need to conquer my self-esteem issues to have a full
life.
I need to be a healthy weight and maintain a good diet to achieve a full
life.
I need to cope with the pain from my past and learn to manage daily problems to achieve a full
life.
A full
life
won't be possible until I can be happy.

Wouldn't it have made more sense for my therapists to help me quickly and easily end my binge eating, so that I could get on with the business of living? That, after all, is why I decided to try therapy in the first place.

During my years of therapy, I resented any friend or family member who suggested that I simply quit binge eating. Once I was vested in therapy concepts, I viewed anyone who thought I could stop bingeing anytime I chose as unenlightened. They didn't understand eating disorders, I thought. Now I'm here saying they were right. I guess now I'm officially unenlightened—because I believe that, if I can do it, any bulimic can stop binge eating anytime she chooses.

ANOTHER DIAGNOSTIC CRITERION

Besides the binge eating and compensatory behaviors (purging), the
DSM-IV-TR
includes another criterion for the diagnosis of bulimia: weight and body shape are extremely important for self-evaluation. This means that a bulimic places excessive value on her body image. However, as I will discuss more fully in Chapter 32, this criterion is not exclusive to bulimia. No one can be bulimic or have BED without binge eating, regardless of how that person feels about his or her body. This is why, in my definition of recovery, I do not include "improve self-image" or "learn to place less emphasis on body weight." These are obviously worthy goals, but they are not necessary for recovery.

WHAT IF THE
DSM
DEFINES EATING DISORDERS INCORRECTLY?