by Harvey Widroe, M.D.
American Reporter Correspondent
May 30, 2007
Part I: EAT OR DIE: WHEN THIN ISN'T BEAUTIFUL
ORINDA, Calif. -- Editor's note: Psychiatrist Harvey Widroe authored a classic textbook on psychiatry and many journal articles. This is his first commentary for The American Reporter as a regular Wednesday columnist on mental health topics..
Debbie looked lost in the chair at the side of my desk. She huddled there, 17 years old, a bit bewildered, not knowing what to expect. While she had seen many doctors in the past six months, she hadn't been to a psychiatrist's office before. She saw no reason to see a psychiatrist.
After all, she wasn't crazy. The only reason, she said, was that she had been half commanded and half dragged by her "freaked-out" parents. "They should be here instead of me."
Over the course of the past year Debbie's mother and father had become increasingly worried about their daughter's extreme weight loss. She now weighed 93 pounds, down from 125 pounds a year earlier. Her family doctor, searching for some medical cause, had run batteries of lab tests, some standard and others more esoteric.
But no result, at least initially, came up with even a questionable abnormality. He advised Debbie and her parents that she needed food supplements to supply extra protein, and also regular multivitamins with minerals. Sending Debbie to a dietician, he thought, might help her develop better eating habits.
The mystery of progressive weight loss went unsolved for months.
Then, one night after dinner, Debbie's mother heard retching sounds from the bathroom. Confronted by both parents, Debbie at first insisted she was ill from something she had eaten. But more intense questioning brought forth a confession.
Debbie regularly stuffed herself until she felt more than full, then deliberately vomited. She did it at home, and at school. She often repeated the stuffing and vomiting cycle in clusters of three or four, with clusters as often as three times a day.
Debbie explained her motive. She wanted to be thin and beautiful, and at 120, 115, 105, and even at 100 pounds, she felt that she looked like a whale. When she looked in the mirror, she literally saw a fat blob. If she could just lose another 10 or 15 pounds, she insisted, she might look good - even beautiful just like a friend of hers, or like Paris Hilton, or her favorite screen star, or any number of professional models.
Then it dawned on Debbie's parents that her increasing passion for exercise, with two-hour workouts almost daily, was more than a healthy routine for increasing cardiovascular tone or developing more muscle in exchange for fat. Debbie admitted that she was working out to the extreme in order to burn off calories and achieve more weight loss.
Her mother wondered if Debbie was taking diet pills, but didn't have to wonder for long. Debbie admitted that she regularly bought over-the-counter diet pills to try to kill her appetite or to burn up more calories. She knew this gave her more energy, but the effect on her appetite was only brief, and the pills did make her more irritable.
Her mother ran to the medicine cabinet in Debbie's bathroom to confiscate whatever diet pills she might find. A secondary discovery was a package of laxatives. Debbie admitted she used laxatives whenever she felt bloated or thought she had swollen up from eating too much.
Debbie's parents felt confused, frightened, and angry. A fundamental trust within the family had been broken, and her parents felt betrayed. It had became clear that in their relationship as a family, Debbie had been living a lie. This was not the lovely daughter they thought they knew so well. But far more important, Debbie's parents had read that anorexia or bulimia was unhealthy at best, and possibly fatal at worst.
Debbie's case gives rise to many serious questions we can productively examine:
Debbie said she felt fine. She didn't see anything dangerous in her behavior, and she was sure she could handle another 10-pound weight loss without any problem. Hadn't the family doctor said that all of the lab tests were normal?
Her mother began to cry, and her father started shouting. To them it seemed as though their daughter were committing suicide before their eyes.
They insisted Debbie pledge that all these behaviors would stop, a pledge she gladly made at the moment to stop her parent's hysteria. But it was a pledge she knew she wouldn't keep.
What she hadn't told her parents was that she thought about eating and her fear of being fat almost all of the time.
Dieting had become a preoccupation from early morning, through her classes, and after school into the evenings. It was her favorite topic in talking to friends.
No wonder her grades had dropped. She couldn't concentrate on homework assignments. After the big scene with her parents, she erased dozens of emails to friends about weight, dieting, exercise, diet pills, even her bulimic behaviors - like a criminal trying to hide incriminating evidence.
Given her parents' pressure, she did modify her behavior. Diet pills and laxatives were no longer in her bathroom or purse, but she kept a secret cache for occasional use. Cutting back on her exercise program made her anxious that she was ballooning up because she couldn't burn calories as fast as she was taking them in. But she had the ultimate control through eating behavior: she could easily stuff herself and then vomit at school.
Then, as she was coming out of the restroom one day, she fainted. Despite her protests, the paramedics were called. Debbie would make the first of many ambulance trips to the emergency room. This time her lab results, not at all normal, revealed that she was dehydrated, anemic, and had a potassium deficiency; her cardiogram was borderline abnormal. She was scared, but more worried about her parent's reaction than about her physical condition.
After an hour of intravenous fluids, Debbie felt okay again. While the doctor and her parents emphasized that her condition was the result of her anorexia and her vomiting, Debbie couldn't and wouldn't make the connection. In her mind, it had something to do with her period or some other hormonal variation. Anyone could faint from time to time, she reasoned.
By now Debbie's parents knew that their daughter had a severe eating disorder, an illness that could be life-threatening. That was the beginning of our relationship.
Harvey Widroe, a longtime practicing psychiatrist, is the author of the recently published,"The Smart Dieter's Guide to Cheating: Eat and Watch Pounds Melt Away," with Ron Kenner (Outskirts Press).