I have been working on a chapter for my memoir that deals with the time in my life when I was bulimic. It’s hard to write about. For years, I blamed my eating disorder on my parent’s divorce. They had hurt me, and by throwing up my food, I was hurting myself, wanting them to see what their divorce was doing to me.
There was a girl at my school who taught me how to throw up in the bathroom of the art building (after pizza, chinese food and ice cream) with a toothbrush. Kate had long, thick, dark hair and a mole above her lip. She was a rich girl from New York City who smoked and had the first mountain bike on campus. Watching her grab her hair in her fist and lean over the toilet, I was fascinated and horrified at the same time. I hated to throw up. I had diabetes. My stomach was full of the pizza, noodles and ice cream and I’d been cheated. I wanted to follow her footsteps, but I was scared.
“Eating disorders and their subthreshold variants are approximately twice as common in adolescent females with type 1 diabetes as in their peers without diabetes.” Jones JM, Lawson ML, Daneman D, Olmstead MP, Rodin G: Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ 1320:1563-1566, 2000. Here is another interesting finding; “Eating disorders are associated with poor metabolic control (higher A1C levels) and earlier-than-expected onset of diabetes related complications, particularly retinopathy.” Steel JM, Young RJ, Lloyd GG, Clark BF: Clinically apparent eating disorders in young diabetic women: associations with painful neuropathy and other complications. BMJ 294:859-862, 1987 Young women with type 1 diabetes are more likely to have an eating disorder because of several factors: disordered eating may be a way to attempt for control, body dissatisfaction, dietary restrictions and the availability of the powerful and dangerous method of weight loss (insulin omission, “Diabulimia”).
When I came across these findings, I was stunned. No one ever told me I might be more at risk of an eating disorder because of diabetes. Writing my chapter, I thought of the way I felt standing alone after dinner in a bathroom, in the countless bathrooms, holding a toothbrush. I felt lonely and sad. I threw up my food for over a year, writing in my journal that I was, “fat, a cellulite goddess.” “I don’t know what’s wrong with me,” I wrote pages later, “I wish someone would notice and make me stop.” My sister also struggled with an eating disorder when she was a teenager. I called her immediately to talk with her about these findings and she too, was stunned. I wonder if anything would have been different for us if we had known about this risk. Family plays an important role in a young woman’s self-esteem , but I suddenly saw my experience in a new light. My parent’s divorce wasn’t the only reason for my eating disorder. The constant focus on food, what I could eat and what I couldn’t eat while my friends ate whatever they wanted, or skipped meals altogether, the need for balance and structure in my life when all I wanted to do was follow my friends toward our next unexpected adventure, and the responsibility of diabetes, these were the causes of my bulimia.
There are few studies on treating diabetic women with eating disorders. Here are some suggestions for treatment:
*Education about short and long term complications as well as education about the realities of weight gain and improved blood sugar control. (Initial weight gain as body adjusts to controlled care and then the young woman’s weight levels off!)
*Individualized, intensive intervention
*steps toward self-acceptance
How I wish I could have done things different. How I would like to take back that year of my head in the toilet. How I wish I could pick that girl up and dust her off, and point her in a different direction. I can’t do that for myself, I’m older, wiser now, hopefully different. A few months ago, I listened to Woody Winfree speak at the College of Charleston who wrote a book called, I Am Beautiful. She spoke for almost an hour, and toward the end, she walked across the front of the room and unsnapped her long, black dress, and pulled it off in a big swoop of her hands! She stood there, a woman in her 50’s, in her bathing suit, in front of male and female college students, grown women and me. She walked across the front of the room with her head held high and told us we were beautiful. I don’t know that I believe her just yet, but I’m trying to be kinder to my body, to myself.