Rebuild the relationship

I came back to Taiwan three weeks ago. Inside my house, I can hear TV anchors broadcasting the news on the COVID-19 pandemic every day; outside my window, I can see the view of serenity from the 12th floor of my 23-story apartment.

Just like the coronavirus, which is invisible but destructive and affects people worldwide, eating disorders, also have global impacts and cause the highest mortality rate of any psychiatric illness.

I feel relieved that I already walked away from the darkness, but I’m also aware that millions of people in the world are still combatting this mental illness. To show the global reach of eating disorders, I sought out people from around the world to tell about their experiences.

I talked with five people of different backgrounds: Julissa Minaya, a high school student living in Dallas, who once engaged in purging and was diagnosed with depression, anxiety and OSFED; Courtney Smith, a junior at the University of Texas at Austin, who almost died from anorexia and orthorexia; Jolene Lee, a recent graduate living in Hong Kong, whose binge eating disorder co-occurred with anxiety; Chiao Chen, a Taiwanese pursuing her bachelor’s degree in French, who has been struggling with the cycle of restricting and binging since she was 14; and Matt Shepherd, a YouTuber based in L.A., who got into recovery over 13 years from binge eating disorder.

Minaya was an actress when she was a child. She clearly remembered the day after getting callbacks from agents, her acting coach praised her but added that if she “lost a bit of weight,” agents would have liked her more.

That was the day when Minaya went on her official first diet.

“I've never been super confident in how my body looks because I was a bit heavier than all the little girls around me,” Minaya recalled.

“I knew I was talented in some realms. I was a good dancer. I was a good figure skater. I was a good actress. But it was like this one thing that's not good about me,” Minaya said. “I'm a huge perfectionist.”

Just like Minaya, many people with eating disorders describe themselves as perfectionists. They believe weight loss is the way to cure all of the discomfort with their bodies. “They conceptualize that the problem is that their body is incorrect and that if they seek diet behaviors, they will be able to fix their self-esteem and they will be able to accept themselves and be accepted by other people,” said dietitian Aleana Naylor.

She added, “What they're not making the connection with is the mental harm that disordered eating and chronic dieting is having on them.”

Two years ago, Lee started her journey of “eating clean and healthy” while pursuing her master’s degree in the U.K. She worked out a lot and focused on “the number” on the scale. She was restrictive to herself in terms of what she could eat.

“I wanted to lose weight simply because I wanted to look better,” said Lee.

However, when Lee forced herself to follow the strict diet for a while and holidays came, she would start binge eating. “I ate until I was uncomfortably full, and I didn't sleep well as well because I felt so bloated all the time,” said Lee.

The feelings of guilt often arose from Lee’s binge eating behaviors and she would try to do more exercise or starve herself the next day to compensate for it. Lee found herself was stuck in the vicious cycle of repeatedly restricting and binge eating.

Smith’s connection with food had also deteriorated since she was 16. She could not feel the joy of having food with family on holidays or even her birthday. “I just felt like I had messed up all my progress and I was never going to get it back and I was going to gain 30 pounds. And I was a failure, just kind of like a spiral of guilt and shame.”

According to the Multi-Service Eating Disorders Association, many people begin a diet in hopes of controlling their weight or shape, and often times, they’re physically and mentally depleted. This could lead to obsessive thoughts about food or feelings of extreme hunger, and eventually causes eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder and orthorexia.

“I care so much about what people think of me. I know I didn’t meet Asian beauty standards so I tried so hard to make my body shape look better,” said Chen. She has been on a diet since an early age, but it finally evolved into binge eating disorder. She would restrict herself on weekdays and binge on weekends.

For others who have binge eating disorder, they may use food to deal with stress. Shepherd went on the recovery road 13 years ago. “I grew up around a lot of alcoholism and drug addiction. So even from a young age, I was finding ways to cope with all the craziness that was going on around me that way.”

In addition, many people tend to use calories tracking apps to help themselves stick to a healthy diet. However, the research shows that calories tracking is associated with eating disorder pathology, and the app is perceived as contributing to eating disorder symptoms.

“When I got a Fitbit, a fitness tracker, it went downhill from there,” Smith had been addicted to calorie counting and that was when her eating disorders began. She counted calories and tracked carbs intake. Her daily calories goal eventually got to only 600 calories per day.

“It spiraled out of control very quickly.” Smith lost 30 pounds in only a few months.

“If I could minimize my calories with certain behaviors, I would engage in those behaviors without a doubt,” Minaya said she would overexercise, hide food and force herself to purge. Hence, besides losing weight, overly restricting calories took a huge toll on her body.

Naylor emphasized that calorie tracking apps can add a lot of stress on people who are struggling with eating disorders because it’s not adjusted to the specific person. “It's kind of making food seem very black and white.”

The path to recovery

“I loved to be called skinny queen, and I was almost dead. It’s just not worth it,” said Smith. During the time when she was struggling with eating disorders, her body was crying for help. Smith’s hair was falling out and her fingernails turned blue; she couldn’t sleep well because she had trouble breathing and her heart rate was low; her eyesight was temporarily damaged, and her memory was severely damaged.

From the initial intention of managing food intake to stay healthy to the results of harming her body, Smith was finally aware of how serious the situation was and decided to seek help from experts.

She had seen a psychiatrist, a doctor, and was eventually sent to a residential facility, staying for 52 days. “There were reasonably hard days like an angry day and just a boring day, but I was so tired that I knew I needed to be there. I was so sick.”

Minaya has also been through a tough time when she had no energy and was always in an irritable mood. She lost her period, and her face became pale; her throat and esophagus were damaged; and she was close to having osteopenia, which happens when the inside of bones become brittle from a loss of calcium.

She began working with a therapist, a dietitian and a doctor two years ago. “I have to get on a meal plan. I have to take supplements. I take vitamins. And I have doctor’s appointments every four weeks with also meeting with my dietitian and therapist once a week.”

The road to recovery takes time and requires support from professionals, family and friends. It’s common to feel uncertain or frustrated about the progress, and unexpected factors can also exacerbate an already difficult situation. The COVID-19 pandemic, for instance, has set up roadblocks on many people’s recovery roads.

“It was very hard for me to stick to my plan when I was staying home, working from home,” said Lee. She thinks it’s more challenging for her to fully recover from eating disorders during the pandemic.

Lauren Muhlheim, the director of Eating Disorder Therapy LA, said “the pandemic has been really hard on people with eating disorders.” She and many other eating disorder professionals are “swamped with referrals” and are recording higher numbers of cases.

She said the lack of normal regular activities and routine and all the stress have caused some people to switch their focus on controlling their diet and exercise, and setting fitness goals.

Living in the time with uncertainties while recovering from eating disorders, Muhlheim encouraged people to reach out to professionals and get free resources from supporting organizations.

She emphasized that having family and friends’ help is “hugely beneficial,” especially during the mealtime, because it’s really helpful to have people to eat with. “Eating is one of the things that has to happen. It’s part of the recovery. And eating regularly is kind of the core of recovery.”

Reconnecting with bodies and foods

Despite there is no single cause for eating disorders, research shows that body dissatisfaction plays a role in developing anorexia nervosa and bulimia nervosa. A negative body image can lead to depression, isolation, low self-esteem, and eating disorders.

“We live in a culture with a very strong ‘thin bias’,” said Muhlheim. She has worked with clients of diverse backgrounds and pointed out that “pressure to be thin” is now in almost all cultures.

Since negative body image is one of the eating disorder symptoms many have experienced, shifting from body rejection to body acceptance is critical in the process of recovery.

In addition, even though the diet frenzy is widely welcomed, experts suggest people embrace intuitive eating, an eating style that promotes a positive and healthy attitude toward food and body image.

Naylor explained when people with eating disorders are connecting so much with the fear and guilt in those diet thoughts, they're disconnecting from how their body is feeling. Intuitive eating leads to food freedom and can help people reconnect with their body as well as get out of the diet thoughts which are controlling their relationship with food.

Eating disorders are way more serious than what the media have portrayed. “People with eating disorders die about two to five times more than their age matched peers who don't have eating disorders. So, it is very significant. A lot of people also die from suicide due to their eating disorders and the struggles,” said Muhlheim.

The path to recovery and the process of reconnecting with bodies and foods can be time consuming and frustrating, especially when there is still a lot of misinformation around this mental illness. However, only when those struggling with it embrace who they are and restore the broken relationship with food can they thrive in the recovery journey and regain control of their life.

“I'm a big picture person and thinking about how my entire life could be taken like that from a mental illness and how there's no guarantee I could survive this if I don't start recovering -- that is really scary for me and is something that I don’t want to happen,” said Minaya.

“I don't want this to be the rest of my life. I want to have a happy life and I can't do that with an eating disorder.”