Being Perfect: A battle against myself, my eating disorder and society

By Maggie Stehr

Above my head, fresh air blowing through the window perfumes the room with lilacs, green grass and a hint of sprouting wheat.

I smell the breeze before I open my eyes. Through the darkness, shadows emerge across the spackled white ceiling.

My boyfriend snores lightly beside me. During the night, he flung his arm around my waist. I stroke the blond hairs along his wrist, the skin soft beneath my fingertips.

Then, something feels wrong.

My own breath is shallow and my heart … slow.

Innnnnhale. Exxxxxhale.

I fall deeper into the mattress, drowning in a down comforter, feathers filling my lungs, when I know: It finally happened.

I wasn’t surprised, really. For nearly five years, I’d been chasing it. Each skipped meal, each protruding rib, each dizzy spell, each blackout. I was getting closer and closer.

And now, I was there.

I wanted to be thin, and it took dying to get there.

***

More than half of all Americans know someone like me, someone with an eating disorder.

Today, studies show more than 10 million women nationwide suffer from the disease that confounds doctors, medical researchers and mental health experts. The epidemic, devoid of a single cause or cure, ignores barriers of race, gender, age and social status.

And as the number of eating disorder cases grows, particularly in the Midwest, few states offer adequate treatment programs and services. In a 2000 study of 3,006 women with serious eating disorders who were left untreated, 601 — or nearly 20 percent — eventually died, according to the U.S. National Institute of Mental Health. That makes anorexia among the deadliest of all mental health disorders.

Yet millions of women never receive life-saving treatment because of financial obstacles. National studies show individual health-care costs for eating disorders can exceed tens of thousands of dollars. Along the way, insurance companies often are reluctant to provide adequate coverage for the illness.

“(Insurance companies) are trying to make money and until they see how they can benefit from treatment that is mostly given to young women, a group not usually lobbied for in Congress or that has disposable income for care, they will not offer more coverage,” said Charlie Foster, an eating disorder specialist at the University of Nebraska-Lincoln who treated me for nearly two years.

“It unfortunately is that simple: Money drives the therapy process.“

On average, health insurers provide 10 to 15 in-patient days for individuals with eating disorders, although at least 40 might be needed, according to a 2002 report published by the American Psychological Association. Many policies also require women to reach dangerously low weights and mental instability before approving coverage, meaning those with potentially higher success rates might never receive help.

But even with treatment, nearly half of all those with eating disorders never recover, according to data compiled by the National Eating Disorder Association. Similar to alcoholism and other addictions, eating disorders often subject their victims to daily struggles against relapse.

For me — and many other women and young adults — the internal battle over weight and food begins in childhood. Often fueled by depression, perfectionism and media portrayals glorifying thinness, an eating disorder reveals itself slowly. Eventually, bouts of anorexia and bulimia consume nearly every waking moment.

For six years, eating disorders stole my life. Some days, my pulse raced so fast I wondered if I was having a heart attack. My nutrient-starved mind obsessed over calories and fat grams. The resulting paranoia revved my anxieties.

Slowly but surely, I was disappearing, nearly dead from the inside out.

***

The blue hospital gown feels rough against my skin.

I wrap the thin cloth tight around my hips.

It’s the third week of May 2006, and alone in the large bathroom, I study the closed door for a few seconds.

Eventually, I reach for its handle and almost immediately, a short round woman walks in, closing the door behind her. She smiles with her cheap mauve lips and we exchange “good mornings” and thoughts on the weather.

We begin walking, and I barely lift my eyes from the patterned tile, cold beneath my bare feet. Inside the bathroom, her sandals squeak and screech across the floor.

The noise subsides when we stop near the back wall. I ignore the anxiety and climb onto a rubber panel in front of me.

Instantly, its digital screen blinks twice before revealing the numbers controlling my life, my obsession.

Proudly, I step off the scale as the office assistant leaves, the door making a sharp click behind her.

I put my T-shirt and gym shorts back on, throw the hospital gown in a laundry basket and walk out to the dining area.

Inside the kitchen, the low din of clinking silverware and crinkling wrappers swirls above the laminate floor. In a binder beside the fridge, I check my calorie assignment and begin preparing precise measurements of juice and cereal.

Three-fourths cups orange juice, 80 calories. A container of yogurt, 125. Granola for 250.

Among the six or seven women milling about, I move mechanically, thinking and feeling nothing. The on-duty therapist supervises this routine, her beady eyes never missing when a patient tries to skimp on her allotted calories.

Eventually, everyone finds seats around the dining room’s long wooden table. We sit in silence, studying our breakfasts.

The glass of thick, pulpy orange juice towers before me. The fake-red yogurt looks lumpy in my bowl.

Never have I hated anything more.

Out the corner of my eye, I watch the other girls maneuver their spoons toward their lips, treasuring the last seconds before the creamy blobs fall on their tongues.

For them, and me, those were our moments of control. For whatever reasons — deep-seated childhood trauma, need for attention, low self-worth — at some point, each of us decided we didn’t want to eat like everybody else.

But that morning, I eat breakfast, just like the other girls, until only a creamy pink film stains my glass bowl.

Slowly, I lean back in the wooden chair, wincing slightly when my spine encounters the unforgiving rungs. I rub my painful bloated stomach as the therapist congratulates us on a successful breakfast.

Some mornings, I want to kill her almost more than I want to kill myself.

***

For three months, the days at Omni Behavioral Health — an eating disorder treatment center in Omaha — faded into one another. A blur of scheduled feedings, group therapy and workbooks on positive coping skills and hunger signals.

For most of the past five years, I had ridden a roller coaster of anorexia, bulimia, starvation, binges, purges, blacking out, and finally, losing hope.

And I as tired of it.

So that summer, I returned to treatment for the second time in three years to regain my strength, and, I hoped, conquer my eating disorder.

But most of all, I came to save my self.

I was 17 when my therapist first diagnosed me with anorexia nervosa. For nearly a year, I severely restricted my diet, sometimes plunging more than 30 pounds below a healthy weight.

Before re-entering Omni’s program, which I frequented for nearly two years in high school, I scoured the Internet for other treatment options. Only a handful of in-patient and residential centers existed in the Midwest, with just two covered by my family’s insurance.

When I called the other programs, mostly residential-living and hospital settings, admissions staff offered only waiting lists, saying I should expect a few weeks before a bed would open. Some required non-refundable deposits of nearly $1,000 just to be added to the list.

Every week, Lora Sladovnik, my primary therapist at Omni, and others on the treatment team reviewed my progress with insurance specialists. After a few minutes on the phone, strangers who knew me only as a weight and price tag determined my treatment recommendation without ever asking my opinion.

But without insurance, my family couldn’t afford the daily cost for Omni. Monthly expenses for in-patient treatment can exceed $30,000, and lifetime care costs — including medical monitoring and outpatient therapy — can surpass $100,000, according to the National Association of Anorexia Nervosa and Associated Disorders.

After seven weeks of partial in-patient treatment — consisting of nine-hour, Monday through Friday therapy stints — a reviewer cut back my treatment at Omni to three days a week.

On paper, I had met my weight restoration goal. But emotionally, my eating disorder still suffocated my recovery.

***

The metallic taste of blood trickles down my throat.

I wince as my nails scratch along the roof of my mouth. Inside, the pain swells as I kneel on the bathroom floor, resting my arm along the stained toilet rim.

Silently, I curse myself for having scarfed down the bag of potato chips, the cheese pizza, the box of chocolate chip cookies and a loaf of bread slathered in butter that afternoon.

I steal a look in the mirror, disgusted by the lumpy white globs covering my lips and cheeks.

But I have to get it all out.

Bending over the toilet again, I shove two fingers down my throat. Pushing them deeper and deeper, saliva running down my hand, I gag as chunks of half-digested food plop into the toilet, splashing water onto my face and throwing my body forward.

A few more times, and I finally reach for the flusher. I steady myself and try to stand, but the blood rushing to my head blurs my vision.

Without washing my face, I walk into the hallway. Leaning against the wall, I slide down onto the floor, a sharp pain gnawing behind my eyes.

Just a couple of more feet and I can crawl into bed.

I awake on the wiry carpet a few hours later. Wiping some crusted chipcookiecheese off my mouth, I stumble toward the kitchen, where an open pizza box and hardened bread slices litter the counters.

About half an hour later, the hacking and retching echoes once again through the dark apartment.

***

By 19, I suffered from bulimia nervosa, eating large amounts of food in short amounts of time — then purging by vomiting and laxative abuse.

At my worst, I lost a week at a time to bingeing up to three times a day. In college, the lure of dorm cafeterias collided with a barrage of celebrity and fashion magazines, leaving an ugly mess of bulimia.

As a freshman, I saw many of my dorm mates gush over fitness and celebrity gossip magazines and TV shows. While trying to fit in, I found myself among the drool fests over spring runway designs.

The waifish models and young celebutantes splashed across glossy pages and big screens glowed with airbrushed and unnaturally thin bodies.

Across the world, these American-bred ideals of female beauty — often equating success with thinness — contribute to the prevalence of eating disorders, said Foster, the UNL eating disorder specialist.

Along with such skewed messages, she said, recent news coverage of rising child and adult obesity rates has overshadowed the growing prevalence of eating disorders.

“This early push to try and fight the obesity crisis may backfire in some really bad ways,” Foster said. “I mean in the sense that they are giving impressionable youth the message that they are fat, and by virtue of that, bad.”

Among females who regularly watch TV three or more nights a week, 50 percent are more likely to consider themselves “too big” or “too fat,” according to a landmark 1999 Harvard Medical School study on the media’s unhealthy effect on self-esteem and body awareness.

About two-thirds of the TV-watching female teens dieted in the month preceding the survey, while 15 percent admitted vomiting to control their weight.

One of the first comprehensive studies of the media’s effect on body image, the Harvard survey exposed how eating habits changed among teenage girls on Fiji after the introduction of TV in 1995.

Before television became available on the Pacific island, inhabitants described the ideal body as round, plump and soft. Then, after 38 months of TV shows like “Melrose Place” and “Beverly Hills 90210,” Fijian girls showed serious signs of eating disorders, according to the study.

Behind the statistics, eating disorders destroy the lives of millions of women, also claiming families, friends, boyfriends and husbands as silent victims.

For more than six years, anorexia and bulimia built a wall between my family and me.

Each time I made the trip home to Omaha, my clothes looked baggier, my face more sunken. Almost every meal ended in screaming or crying.

Nothing my parents could offer made me want to eat. They begged and pleaded at the dinner table, attended family therapy sessions, filled a shelf with books and articles on recovery.

When that didn’t work, their frustrations and fears often left them lying awake in bed, unable to sleep knowing I was wasting away just down the hall.

Much of the tension stemmed from misunderstanding. They didn’t know why I couldn’t just eat; I didn’t know why they wouldn’t just leave me alone.

“They can’t know how conflicted you are on a week to week, day to day or second by second basis,” Foster said about my parents during one of our weekly therapy session. “They don’t know how scary and frustrating it feels to hate what you see in the mirror.”

By sunset, the brisk April breeze slices through my thin T-shirt. I wrap the blanket tighter around my shoulders, hugging both knees against my chest.

It’s been eight months since I left the treatment center and from my second-floor balcony, the whir of a distant lawnmower occasionally interrupts the silence.

I don’t mind the distraction, though. For weeks, I’ve been ignoring it, afraid of what might happen. But one night I know I’ll have to confront my fears.

I reach into a side pocket on my folding chair. My fingers rub against the crumpled photo buried deep inside.

I rest the picture on my knees, the image barely visible through its tattered corners and scratches.

But it doesn’t matter. I’ve long memorized the protruding collarbones, the sagging extra-small shirt.

Countless times, I’ve ripped the photo into tiny pieces, only to later dig it out of the trash, re-taping the torn edges.

Because of the darkness, I move the portrait just inches from my face, squinting to trace the curves of the young woman’s ribcage. I both hate and crave her.

She had control.

No, I was losing control.

She never felt sad.

So I have healthier ways to cope.

She was so thin.

Yes, but I was dying.

Every second, she’s with me.

Some days I ignore her, others I can’t.

One day, I hope she disappears forever.