I'm Fine: The White Lie of Eating Disorders
Like many young women, Elizabeth Sim felt awkward and self-conscious as a teenager.
"I was anxious and afraid of screwing things up a lot," she said.
"I felt shy, but my friends didn't think of me that way. They would say, 'What? You're not shy,'" she said. "I was good in school and very good at projecting a happy facade. Very good."
But unlike most teens, Elizabeth dealt with her anxieties by dieting and obsessively exercising. She became bulimic and continued her habits through college.
It was generally thought that eating disorders struck upper-class white teens and young women. But therapists and those who treat women with eating disorders have begun to notice that women of all races and socio-economic backgrounds are falling prey to the disease. Like Elizabeth, a Japanese-Chinese-American, these women feel out of place because they are bombarded with images of American culture that equate thinness with success and happiness. As a result, they are starving themselves to keep up.
"The eating disorder is often an extension of trying to be perfect, not just on the inside, but on the outside," said Pam Guthrie, the outreach director at the American Anorexia-Bulimia Association of Manhattan. "It's always about other things than food. It's about trying to be the perfect person. In Western culture, thinness is equated with success, beauty and love. They want to be that perfect person. They want to be successful in every aspect of their lives."
As Elizabeth recounts her battle with eating disorders, the pressures of being a perfect American girl become clear. She also suffered from self-doubts that plague many teenage girls and young women.
Elizabeth grew up in a predominantly white community called Orinda in the San Francisco Bay Area. But still, she never felt like she totally fit in with other Americans.
"One time I helped out a friend of mine, serving at a party because she couldn't make it," said Elizabeth, who at the time was a waitress.
"I showed up at the front door of this place and the woman opened up the door and just stared at me," she said. "The woman spiked the punch and got tipsy, and started bragging to her guests about a statue she had from the Orient. She came into the kitchen [and] came up to me and said, 'Oh, I told them that we also have a lovely Oriental girl in the kitchen, too.'"
As an adolescent, Elizabeth grew increasingly self-conscious. She began to doubt herself. More often than not, when she felt that she was a seriously flawed human being. But, even on the rare occasions when criticisms were tangible, Elizabeth did not get mad at the carper. Instead, she got mad at herself more.
"I didn't really care about my weight that much until I got teased," she said. "One time, I was in the seventh grade [we had dance class]. This boy had his hand on my waist and he said I was chubby. The next year, right when I got back to school, I overheard the boy talking to another boy about me. He said, 'Wow, Elizabeth really lost a lot of weight.'"
Guthrie of the American Anorexia-Bulimia Association called Elizabeth's experiences 'trigger events.'
"The comment completely undermines the person's self-esteem," she said. "These off-hand comments have a profound influence on the person."
Elizabeth reacted the same way when one her best friends in junior high school ditched her to be part of a more popular crowd.
"They left me for this white, good-looking, outgoing group," she said. "I felt like I should have more designer clothes to be accepted. I felt I wasn't good enough because I didn't feel accepted by the popular crowd I felt like a total loser."
When Elizabeth moved away to go to college at the University of California at Davis, she was still dating her first boyfriend from high school. He stayed behind in their hometown, several hours away.
"He would always tell me that I think too much, because I would bring up feelings that I had that he didn't want to talk about," Elizabeth said. "The communication gap widened. He became very distant with me. Then one day, he made a flippant comment about dating other women."
Elizabeth said she assumed the worst.
"I was so devastated," she said. "I thought he had discovered that I was unworthy. That's what triggered everything. Even though I knew in my mind that it wasn't right or logical, I thought if I could just lose weight, he would want me again."
It was downhill from there.
"So, I did that 500 calorie-a-day diet," she said. "On a typical day, I ate a package of Quaker oatmeal, Jello for lunch and an apple. For dinner, I had a salad with practically nothing on it. I was barely eating anything. I lost weight quickly and people reinforced that. I was a size zero. I was 5 feet tall and my weight was in the low 90s."
"Then I started bingeing because I was starving," she continued. "One day I took a jar of peanut butter and I ate half of it. Then I felt tremendous guilt and shame. I knew I was going to gain weight. That's the feeling I had: Intense fear of being fat.
"So that day in the dorm, I went downstairs to the single, lockable bathroom. I locked the door and I tried to make myself throw up and I couldn't do it," she said. "I knew it wasn't right or normal, but I felt like I had to get that food out of me. I thought I was a failure before, and now I couldn't even throw up."
Instead, Elizabeth said she used exercise and dieting as methods of purging the food from her body. Those purging methods and her bingeing episodes qualified her diagnosis as bulimia, rather than anorexia, even though no throwing up was involved.
"I moved home over the summer and I lost control," she said. "I would tell myself, 'I'm not going to binge,' and then I would eat ice cream. I think I could easily eat a quarter of a gallon of ice cream or a package of cookies or brownies and then hide the evidence.
"It was desperation," she said. "I would have to find time to be alone and eat. When I was alone, I would cry a lot. I couldn't control my behavior or my feelings."
Elizabeth's symptoms continued through college. Three years later in 1991, she was still bingeing.
After therapy, Elizabeth eventually realized that her dieting and purging actually was a disorder, and a method for coping with her feelings.
"I learned how to bring feelings up to the person [I was communicating with.] And it became important that people could bring things up to me also, so that we could communicate in a much deeper way than I had ever done before," she said.
"There was never any resolution of conflict in my family. There would be a huge blow up and then we would pretend that it never happened," she said. "You're raised as a woman in a Japanese American family to anticipate other people's needs and be empathetic."
One of the best ways to treat women like Elizabeth is to challenge their thoughts, said Beth Pritz, a therapist at Renfrew Center, a national eating disorder clinic in Florida.
"You have to challenge the black-and-white thinking which means she thinks she's got to weigh 90 pounds or she'll have no job, boyfriend, friends," she said. "You have to challenge what they're afraid of."
Elizabeth said part of her recovery took becoming aware of herself as being Asian American.
"Becoming aware that other people had stereotypes of me was a big help because before that I thought if people treated me weird, it was a result of my true personality," she said. "All the time, people hold themselves back from patting me on the head," she added. "Here I am, 31-years-old and yet people treat me like a kid, especially in new situations. I get condescended to, which is probably typical. They assume I'm a quiet, Asian woman. I learned that I didn't create this myself."
Elizabeth also doesn't obsess about food anymore.
"I think that what's happened is that the issues around food are no longer in the picture, except when I'm anxious or not dealing with feelings," she said. "But even then, I don't binge. I write, jog or talk to friends. In the past [food] was a big issue. It was sucking the life out of how I was feeling. But now, if I'm hungry, I eat."
But that's not to say that Elizabeth doesn't worry about gaining weight.
"Turning 30, my metabolism slowed down," she said. "I sometimes find myself feeling fat, uncomfortable. I tell myself that it's okay to feel that way because, God, we're bombarded about how we're supposed to look. I tell myself that I am so lucky to have a body that's healthy."
When all else fails, Elizabeth said she tells herself to lower her standards.
"It's the times that I'm hardest on myself or feeling the worst about myself, those are the times I need to be most nurturing to myself," she said.
However, eating disorders cannot be turned on and off like a light switch, experts say.
So, simply telling someone who is anorexic to just start eating more or telling a bulimic to stop throwing up is ineffective. An eating disorder is a mental illness, not a physical one. It never strikes a person suddenly. It develops over time and invades all aspects of a person's life. And, old habits are hard to break.
An estimated 1,000 women die each year from complications associated with eating disorders including low potassium, suicide, heart attack, and starvation, according to the National Eating Disorder Screening Program. It is the highest death rate among all psychiatric disorders.
Asking someone to relinquish an eating disorder is like asking that person to completely change life as she (or he, as the case may be) knows it. Instead, people with eating disordersregardless of raceneed to be reassured that each and every thing they do or don't do or choose to eat or not to eat is not going to have a serious and visible consequence.
"Eating disorders are a symptom of not taking care of your soul or listening to your feelings," Elizabeth said. "I had to learn to do that before my symptoms went away."
Michelle May is a 2000 graduate of Columbia University's Journalism School. This article originally appeared on Shewire, Chickclick's news channel.