QUESTION: I am in the process of recovering from anorexia, but lately I have been struggling with binging and then restricting. Since my weight is normal, no one suspects that I am struggling. What should I do?

ANSWER: What do you think you should do? Before you read further for my answer, stop and journal an answer for yourself. You have more wisdom and insight about what is going on in your life than anyone else ever could or will, even someone else like me who has stood in similar shoes. What would you tell yourself, if our roles were reversed and I was the one who had just asked you the question above?

Now, for my answer – I think ‘what you should do’ and ‘what you will do’ are not the same thing, and this is because ultimately all personal choice boils down to self-worth. For instance, are you waiting for someone else to notice and say, ‘Hey, you have a problem you need to address!’ before you can validate for yourself the path you are walking down, and willingly accept the consequences of your choices?

Have you found your ‘key to life’ (the one thing that matters to you MORE than your ED – that will turn you from a victim into a fighter) yet, and do you consciously understand that you CANNOT have both the ED and the rest of your life? Do you know what you are fighting for – do you know why you want to live, and why you want your life back from the ED?

Do you know what purpose the ED behaviors (whether binging, purging, restricting, or other forms, it really boils down to the same issue) serve in your life? If you don’t, start journaling out some ideas about that too. When did they start? When and why did your behaviors shift? What happens immediately before and after you act out on any particular behavior? Can you in this way begin to see ‘patterns in the chaos’ – a repetitive theme or set of themes that can predict when ED is likely to rear its ugly head in your life?

Create for yourself a list of alternative coping mechanisms for dealing with these patterns. Even if you are under stress and cannot yet automatically override the ED urges and turn to these mechanisms instead, you will have planted the seed idea in your mind that you have other options available to you. Then work to strengthen your mental connections between stressful situations and alternate means of coping with them, so the ED doesn’t feel like the only source you have for ‘relief’.

By the way, it is not uncommon for recovery from anorexia to include periodic, sometimes sustained, descents into bulimic behaviors. This happened to me in my own recovery journey. I thought I was trying to heal, and deal with the stress of learning to eat again, by promising myself that if I got too overwhelmed I could just throw up what I ate. 30% or more anorexics eventually turn bulimic. So it is VERY important not to beat yourself up for what has happened. Just recognize that you are trying out different paths to health (if that is in fact what you are doing – it certainly was when I went through it) and say to yourself, ‘Well, that isn’t it – now I can cross bulimia off the list!’

You should also see a doctor, and have him or her check your electrolyte levels and overall functioning. Bulimia can be very hard on your heart and electrolyte imbalances from purging can lead to heart attack and death. Your question is not to be taken lightly. Your answer really is a matter of life and death – that is not to scare you, but just to let you know that I take this matter you have before you very, very seriously – and you should too.

Much love,

Shannon

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