Recovering from Bulimia in Micro-Moments

“I’ve done everything you wanted me to do to stop the bulimia. I’ve stopped spending compulsively. I’m taking medication. I come to therapy every week. I’ve talked about my childhood. I know my triggers. I even know what to do INSTEAD of binge and purge…But I am STILL doing it every single night! Maybe I need to stop therapy and see if this thing clears up on its own.”

Cate’s story is a tale of the insidiousness of an eating disorder. Her problems began in high school when, as an overweight teen, she decided to join the swim team to lose weight. Swimming and starving, she dropped pounds rapidly. After feeling invisible for years, the attention she received for her svelte body was a high she had never encountered and as addictive as heroin. When she started binge eating (a common occurrence after a spell of starvation) she learned to rid her body of the calories through purging. She would never be “fat” again, no matter the price.

At that time, she could not know nor foresee the price she would pay. A daily and seemingly endless cycle of starving, over-exercising, binge eating, and throwing up lasted throughout her teens and twenties. By the time she arrived in my office at 29, her eating disorder was a firmly entrenched part of her daily routine.

Fed the media stereotypes of what a person with an eating disorder “looks like” (young, emaciated, sickly, depressed, isolated) Cate is the last person anyone would suspect. Over 16 years she has thrown up over 5,000 times, although miraculously there are no outward signs. She appears to be the picture of health. A stunning beauty with a body that other women would envy, she has perfect white teeth and thick flowing hair. She is bright and successful at her job, and she is kind, compassionate, funny and popular. From all outward appearances, she has the perfect life. After successfully hiding her bulimia from the world for half of her life, those her know her would never suspect the secret daily hell she endures.

So how is Cate going to get better?

There are a number of stages on the road to recovery. Over three years in therapy, despite her frustration with herself, Cate has made progress. She’s been creating the conditions that will support a healthy life. She now takes medication to treat the underlying depression and anxiety that have fueled the bulimia. She’s curtailed a too-active social life that left little time for exercise or alone-time. She started volunteering with a charity that helps her feel like she matters. She joined a therapy group where she learned that people who knew her whole story could love her.

So now it’s time to put it all together.

A purge is the grand finale of a series of micro-decisions made in micro-moments, most of which take place just below the surface of awareness. Fatigue, hunger, boredom, stress or just the time on the clock – any of these common daily occurrences –can set the destructive routine in motion.

Cate will need to be mindful and aware of how each of these tiny moments can lead to seemingly innocuous decisions that then lead inexorably to the next problematic decision, until the point where turning the thing around is like stopping a locomotive.

First, knowing herself well and collecting years of data, she’ll need to anticipate each possible trigger and prepare for it in advance. This means having tasty, satisfying healthy foods on hand when the voice tells her to grab some candy. She’ll need to carry an inspirational book when her brain says, “Bored? Head to Starbucks for a cookie.” She may need to knit when she feels like procrastinating, text a friend when she feels lonely, walk her dog when the voice calls her lazy, and remind herself that even if she gains a few pounds that being addiction-free will make her more beautiful.

It’s about being ready every time that seductive little bugger says,

"Honey, I can make that icky feeling go away. You deserve it. Screw recovery! You can be good tomorrow.”

The final and most challenging step is to re-commit to recovery during those key moments. It’s easy after throwing up to promise to be good tomorrow. It’s easy sitting on the therapist’s couch to vow to do the right thing.

But in the moment….?

The turnaround comes when you realize it’s not going to be any easier to get your act together tomorrow. The pay-off may not be instant, but you’ll feel proud of yourself an hour from now if you defeat the monster. That good feeling is BETTER than the high of the food, and it’s just a few minutes away. And tonight you will sleep sounder having had a binge-free/purge-free day.

And even if no one else knows – no one shames you when you binge or applauds you when you don’t – even if only YOU know that you did the hard thing in that moment, that is enough. If you can get through one day, then you can get through another day. Just as that first purge morphed into 5,000, the healthy moments will turn into days, then weeks. The micro-moments will add up and a new normal will be established. Then you are Free.

Today matters. This micro-moment matters. You matter. Adopting this belief is where addiction ends, and real living begins.

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com and www.mindfullivingnetwork.com. You can visit her on the web atdinazeckhausen.com and MyEdin.org.