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Feb. 21, 2019 - Dr. Oz Podcast
39:46
The Hidden Epidemic of Eating Disorders

In this Interview, biologist and journalist Trisha Gura reveals what she believes is the root cause of eating disorders that millions of people suffer with every day. Trisha opens up about her own struggle with anorexa, and how she finally overcame the disease with what she calls her six step program. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

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An anthropologist went down there because on the entire island there had not been a case of an eating disorder ever.
Is that right?
Ever.
So she studied this small village for about 15 years and interviewed all the teenage girls.
In 1995, the chief introduced television into the village.
And within three years, 85% of the girls were on diets wanting to be thinner and 11% were bulimic.
Hey everyone, I'm Dr. Oz and this is the Dr. Oz Podcast.
We'll be right back.
When we were writing You on a Diet, I struggled a lot with how to address anorexia and bulimia.
Because unlike alcoholism, where you're taking a toxin that you don't have to have at all in your life, or drug addiction in a similar fashion that you don't have to ever have in your life, with bulimia and anorexia and binge disorders, you actually have to touch food at some level.
You can't just get rid of the problem.
You have to actually take what you're not supposed to take or take what you're too much of And make it part of your life.
And it's the mouth that becomes the big issue in how you deal with that material that you're putting in your body, which makes it, for me, a very different category, much more complicated to deal with than drug abuse and other addictions that are often easier for me to say, listen, do this to zero of it.
Don't smoke at all, and you'll be fine.
You can't say that to a bulimic.
So, in doing some homework on this, we ran into somebody who's well-known in the area, Trish Gura, who's visiting with us today in the studio.
Thanks for joining us.
Thanks for having me.
Her book, Lying in Wait, The Hidden Epidemic of Eating Disorders, does a very nice job laying out the foundation for how to think about these different problems and give us some action steps to address them.
So, I'm hoping today's show that you can help us understand a little bit better about how these things come about.
With your background, I think you'll be able to help us more than many could.
And then hopefully land up on some action steps that folks can think about if they think they've got a loved one who's suffering from one of these different eating disorders.
And I should say right off the bat that Trish is a PhD in molecular biology.
And so let me ask you, how did you go from a PhD in molecular biology to a journalist?
Because that's what you do now.
She's won numerous awards and different scholarships, and she's been involved in the public press in a variety of different ways.
But how do you go from being a PhD working in a lab to what you've done now?
Well, I've always loved science, but in the lab, I was knowing too much about one thing.
And I'm the kind of person who likes to know a little bit about a lot of things, as opposed to so much about one.
So I more or less jumped ship and went to work at the Chicago Tribune and started covering anything even remotely related to science.
It could be head injuries in sports or OJ in DNA and got hooked on journalism.
And there's a real need to translate technical information to something we all can understand.
And that's something that I do well.
And why journalism?
Just because it gives you the ability to jump around and see a lot of different things?
Words are one way to explain things.
So are pictures and visuals.
And at the time, it's an opportunity that opened up to me.
But now with the web and the internet, there's a lot more you can do with visual and audio as well.
So let's talk about eating disorders.
What's the difference between an eating disorder and disordered eating?
Eating disorders fall into a spectrum, more or less.
And at the one end, we have something I might call food issues.
Okay, so this is someone who counts out 24 shredded wheats in their cereal bowl every morning, no more, no less.
Has to run 60 minutes every day.
That's not an eating disorder.
But then at the other end of the spectrum, we have hospitalization and death.
So in between there is all the things that we do, you on an unhealthy diet with food.
And what seems to happen is, starting with real little kids, like three, four, five years old, you start picking up the unhealthy behaviors and doing more and more of them in sort of episodes, and they start to coalesce, and at some point, you cross the line.
And when you cross the line, you get a clinical definition of an eating disorder, anorexia, bulimia, or binge eating disorder.
Draw that line a little more clearly for me.
So, take a binge eating disorder.
How do you know that's what you have?
Well, binge eating disorder is eating a lot of food.
For some people, it's up to 10,000 calories in a sitting.
But the second part is you feel helpless to stop.
So binge eating disorder is not Thanksgiving, where we all overeat and unbutton our pants.
Binge eating disorder is I can't stop.
So I come home, I have a stressful day, I open up the refrigerator, I just start eating mindlessly, and suddenly I can't stop until my stomach is so full it's uncomfortable.
But that comes after years and years and years of doing these binges.
Right.
And so crossing the line is more or less doing the habits to a certain point where it sort of clicks.
No one understands what that click is, but we know that stress is a big part of it.
Major stresses and transitions.
Adolescence is the one we know best, but it's also marriage, pregnancy, parenting, mid and late life.
All those kinds of major stresses can click a person over.
I, like many, think of these eating disorders as being something that happened during adolescence.
What percentage of the time are they doing adolescence, and how often are they in one of these other stressful moments in your life?
No one knows the exact percentage because eating disorders in older women and in younger kids aren't real well measured.
They're underreported and a lot of people are hiding them.
But in general, eating disorders is the biggest blip on the radar because there's so much happening at the adolescence period.
But it's not the only time.
And so there are women getting sick for the first time in their 30s, 40s.
The oldest woman in the book is 92. You're kidding me.
I'm the oldest woman I talked to who got anorexia for the first time at the age of 68. That's not a young girl who wants to look like a fashion model.
You're a scientist, so help me understand, at the level of the brain chemistry, what we think is happening.
Take anorexia as an example.
What's going on there?
Seems like the gateway to all of these is a diet.
Okay, so an unhealthy diet.
So what ends up happening is a person starves.
They think, well, I'm going to diet by, I'm going to skip five meals or whatever it is.
There is a whole series of biochemicals in your body that make you want to eat because dieting to a caveman is a death sentence.
So those start to ratchet up and ratchet up.
In the case of anorexia, you ignore them.
And you ignore them and you ignore them enough and you break your sensations of hunger and fullness.
And so what ends up happening in the case of bulimia is you go and you binge.
You put the one piece of cake in front of you.
And so what you're doing is you're altering your biochemistry permanently, all the sorts of molecules that you talked about in your book.
And then a person can't tell when they're hungry or when they're full anymore.
And that's when you start to get the eating disorder.
As you try to help folks who have these problems, is there sort of a cadence that you create with them?
How do you first get them to understand that they're having a problem?
Or do they usually have that insight?
Often not.
Huge level of denial.
So if you were to sit down a person who has anorexia and say, I think you're sick, you're going to hear a no, I'm not.
So the way to approach this, if you know someone, is more I statements.
Like, I'm observing that you do these behaviors.
I'm concerned that you're doing these behaviors.
I think that you should go to this such and such a person to do help.
So if you're talking to someone, you should do your homework first.
And then don't make any threats like I'm going to leave you if you don't get better or something like that.
And if you are a partner or close to someone who is ill, you might want to get some help yourself because these are long-term illnesses and it's very hard to be in a situation with someone who's not doing well.
Well, you make the point in the book, actually, that in the media, we create this image that it's a curable process.
You know, someone goes in, I think you used Mary-Kate Olson as the example, you know, public reported to go on to get help for an eating disorder, and then the press covers her as coming out and being cured from the problem.
And oftentimes, folks have the feeling that they actually are seeing a completely healed person, when frequently with their natural history is not that simple.
Back to your alcoholism analogy.
You can be a dry drunk.
You not drink a thing, but you still got alcoholism.
And again, to your analogy, we would never tell a person who has alcoholism, go into a bar, have a beer, just one beer, three times a day.
No more, no less.
So when you're dealing with eating disorders, we almost expect relapse.
It's very, very hard because you have to make your peace with food.
You have to find moderation and middle ground.
And that's a lot trickier than abstinence.
And so a lot of the programs are about learning how to live with food, learning how to eat enough food, and learning how to pay attention to your body's signs of hunger and fullness once again.
So let's be very concrete about the telltale signs that you have an eating disorder.
And then we'll go to the treatment side.
If you've got someone that you care about and you're trying to figure out, is this really normal or not normal?
For example, I would have thought that counting out 24 little pieces of cereal was an eating disorder.
And maybe that's just a retentive compulsive personality and isn't a problem if they're getting their calories.
If you have a normal weight, you probably wouldn't consider the person anorexic or bulimic no matter what they're doing.
Is that true or false?
That is true.
There's a lot of people with bulimia who are normal weight.
Anorexia, by definition, you wouldn't be normal weight.
So some of the signs that you might look for is skipping meals.
Oh, I already ate.
I'm not hungry.
I'm not hungry.
Eating in secret.
You know, anything like...
People have talked about signs in the bathroom.
An example of how easy it is to hide an eating disorder.
There was a couple that was married for 35 years.
The woman had bulimia.
Normal weight.
Husband never knew.
And he's a detective.
35 years.
Don't your teeth start rotting?
A lot of people get very good at brushing their teeth.
Yes, dentists are one of your first-line people who can spot these sorts of things.
But often they go unnoticed because the women are very good at hiding them.
But a total preoccupation with weight.
I'm fat, I'm fat, I'm fat.
A total preoccupation with food.
That's most women in the country, I think.
There's...
Degrees of it.
The one, constantly.
If you're in a profession where appearance is very important, anything with TV or models or the media, that's also a risk factor for getting sick.
Anorexia is kind of easy to spot.
Right.
Anorexia, the people who...
Bulimia is a lot harder, but often what she'll see is people sitting down with you and eating lots of food, going out to dinner.
There was a husband and a wife situation where all the friends kept coming up to the husband saying, she has got a problem.
We go out to dinner with her and she's ordering entree after entree and then she's off to the bathroom after dinner.
And also remember that purging doesn't have to be vomiting.
Purging can be overexercising.
So this is the person who's at the gym four hours every day going bonkers with it.
That's not healthy exercise.
So these kinds of things are what you can look for.
And the person's usually not very happy.
Yeah, and they're not happy because this is an ego dystonic movement.
They're just not doing what they know their body wants them to do?
They're obsessed with food.
They can't think about anything else.
And there's a reason for that.
The food is a distraction from other bigger things in their life that they're not dealing with.
A bad marriage, a pregnancy, kids who are kind of having trouble.
It's a distraction.
You also mentioned that in adolescence when you have eating disorders, it actually stuns psychological growth.
Yes.
And why is that?
Because you're fixated so much on food or because it doesn't allow you to mature because you're preoccupied with it?
Both.
So there's all kinds of components of development in adolescence.
So there's like a sexual self, there's a physical self, there's a social self.
And if you were to study Erickson, you'd say all these parts have to kind of develop on their own.
And then you develop a whole person.
An eating disorder can insert itself in any one of those and stop development because you're thinking about food all the time.
You don't have to go out and make friends or figure out a situation or solve a problem because you're doing it with food.
So that part, you never learn those behaviors.
You get older, you still haven't learned those behaviors.
And so now you're a mother who can't make friends or now you're a mother who's got these other issues with sexuality or social problems and you still haven't figured it out.
More questions after the break.
We're talking with Trish Gouraud, a Ph.D. and a writer living in Massachusetts, Brookline, actually, an area that I spent a fair amount of time in when I was in actually, an area that I spent a fair amount of time in What got you to write about anorexia, bulimia, and eating disorders?
How did you wander into that particular topic?
Writing a book takes a lot of time.
Well, there's two reasons.
As a scientist, I wrote a lot about obesity for Science Magazine, all the molecules about it.
But also, it was a chance conversation I had with another journalist friend who had bulimia as a teenager, relapsed after her pregnancy.
She asked me what happens when they grow up.
And I said, well, I assume they're fine.
I have anorexia.
I'm fine.
And then we started talking more about it.
And it's a no, no, no, no, no, no, no.
I'm not fine.
There's there's a remnant that stays.
And it stays pretty much through life.
It's just whether you choose to act on the behaviors or not.
And we're looking around at boys.
And they're finding that boys in professions like wrestling or jockeys, like horse jockeys, where weight's an issue, are getting it.
It's a little bit different because men don't have one ideal, one body type ideal.
So you can have something called bigorexia.
Okay, and this is the guy with the 19-inch bicep.
He looks in the mirror and he thinks, I'm small.
Okay, I got to work out more.
I got to eat more.
The protein shakes and on and on and on it goes.
There's also maybe a more lean ideal.
And so there's a lot of men who are working out in the gym to try to hit that one.
And often with men, it's a little bit more about performance than it is about how you look.
I want to hit this workout and then I want to go up one to this workout and so on and so on.
And that part becomes addictive.
There's more of an exercise component.
And there's some work coming out with male models are now talking about having bulimia.
And so it's coming out in men as much as women.
Differently, men don't talk about it as much, particularly with binge eating disorder.
It's a little more acceptable in our society for men to be heavy than women.
That's just the common thinking.
If you're not suffering a physical abnormality from your disorder, for example, this bigemia, is that the right term?
Bigorexia.
Bigorexia, sorry.
Is it really a problem?
In medical school, I remember learning about personality disorders.
And personality disorders are normal behaviors gone awry.
Things that we would typically do that aren't so bad for us that we just do too much.
Washing our hands.
Washing your hands after you touch something dirty is appropriate.
Washing it continually because you think that you have germs on your hands, which you always do, and it's driving you crazy, is also acceptable and not diagnosed as a problem until the washing of the hands causes a problem itself.
Your hands become all chaffed.
You can't function in your job because you're always washing your hands.
Those kinds of insights, for me, were very valuable because I began to think, okay, I can't diagnose all the weird things we do as humans as being a disease.
And I was reminded, when you look at a jade stone, if it looks really pure and green with no blemishes in it, it's boring.
What makes the jade stone so beautiful is the little vines in there, the little colors, the little cracks.
It makes it unique.
And we're all like that.
We all have our own abnormalities that make us unique.
When the crack gets too large, the stone falls apart, which is, I think, what we're talking about with eating disorders.
But it must be a very subtle differentiation between someone who's really trying to get to the ideal weight so they can wrestle in the match on Saturday or win the horse race.
Or win the Mr. Olympia contest and a personality disorder that inhibits their ability to do other things in life.
I don't see how we can differentiate that so readily.
I think the answer in this case is genetics.
At least that's where a lot of people are going with this.
So the kind of person who's going to cross the line and actually have the raw hands that are bloody is someone who's got a certain type of personality.
They're just born that way.
And so the way we can describe it is over-anxious, Very intelligent, takes everything in, super-duper sensitive, has a hard time dealing with stress.
And you take this person and you put them in today's society, and you put them around weight sort of issues, and this is the person who uses the food and it clicks for them because it's distracting them from this overwhelming amount of stress.
So washing the hands, I'm focusing on my hands.
Not on the stress.
And it's a way to cope.
So that's often what crosses the line.
And researchers are trying very hard to get at what those genes are.
They're looking around the serotonin pathways.
They're looking around the dopamine pathways to see what genetic culprits there might be.
That's just one component.
Although it is interesting to me, Tricia, you've mentioned several times that it often will occur in men when they're competing in an environment where losing weight is in their best professional interest.
And women often are thinking about that because they think it's more attractive to their spouses.
They don't have a sense of self-worth unless they're thin, as the women in front of the magazines are.
And models certainly have a big issue with anorexia.
In fact, if they get so skinny, they end up falling off the runway, but also causing themselves long-term and sometimes irreparable damage.
So there is something environmental about this process that's turning on, clicking on certain genes.
Eating disorders are caused by a mix of, I would say, three things.
Genetics, psychology, and culture.
Now back to your culture issue.
To show you how strong the culture is, there was a study that was done in Fiji.
An anthropologist went down there because on the entire island there had not been a case of an eating disorder ever.
Is that right?
Ever.
So she studied this small village for, oh, about 15 years, and interviewed all the teenage girls.
In 1995, the chief introduced television into the village.
And within three years, 85% of the girls were on diets wanting to be thinner, and 11% were bulimic.
In just three years of television, watching the Power Red.
That's how strong culture is.
But the biology is equally strong because there's studies in rats.
Okay?
So what they've done with rats is they've dieted them.
They let the rats regain their weight, which is like a blown diet.
And then they shock the foot of the rat, which is a stressor.
You put those three things together, diet, blowing diet, stress.
After three times, the rats will binge.
And they will binge on Oreo cookies.
And they will ignore their food chow that's sitting next to them to go across a whole alley of foot chucks to get the Oreo cookies.
And you can see that the parts of the brain that are responsible for reward and punishment are altered.
And you can do this with drugs, and you can tell food becomes an addiction by dieting, blowing your diet, and stress.
Have you done this foot shock experiment with humans yet?
I think in the real world, we all know stress, we all know diets, we all know blown diets, so it probably could.
We're speaking with Tisha Gura, her book, Lying Your Weight, The Hidden Epidemic of Eating Disorders.
Teach me a little bit about binge eating disorder.
So the part about binge eating disorder is definitely there's the emotional component.
Okay, so binge eating disorder is eating a large amount of food in a short period of time.
And a person does this.
And they do it also feeling worthless about themselves.
I don't feel very good or I'm very, very stressed out.
And you put those things together and they do it.
Binge eating disorder tends to show up later in life.
Okay, so we don't see it around the teenage years as often.
We see it more in people in their 30s and 40s.
And it's not clear why.
Maybe it just takes time to develop that binging.
Maybe people don't quite have the cognitive ability to do that as a teenager.
But then it gets to be a big problem, no pun intended.
And so these people are 200 and 300 pounds.
And the question in this case is, well, do you try to get them to lose the weight?
Because if you put them back on a diet, you're going right back through the binge cycle again.
Or do you just try to stop the binging?
And right now the consensus is stop the binging, even if it means they're going to lose only about five pounds or something like that, because the binging actually is more detrimental to their health than the obesity.
Right.
And then do people who are binge eaters complain, like to me, a lot?
You're talking about me.
Actually, people with binge eating disorder are the most secretive.
They were the hardest to find to interview.
These are people who are horrified.
It's a double whammy.
Not only do they have an eating disorder, they're heavy, and society still is allowed to discriminate against people who are very heavy.
And they feel terrible about it because people think it's about willpower.
Yeah.
As you know.
Yeah.
And it's not about willpower.
It's a disease.
They can't stop.
I mean, they have altered their chemistry.
You know, I was going to say there's a recent study actually looked at the psychological component of dieting.
And they took a bunch of people who were heavy, put them on a diet, and of course they began to crave food because they're on a diet.
And then they took a bunch of thin people and they put them on a diet.
Although the set point was different, they also began to crave food the exact same way.
They start to see it in their dreams.
They start to want it in everything they do.
It dominates all their thought processes.
They fixate on it.
They embellish it.
They have fantasies about food.
The difference between the people who are thin and heavy may only be the set point.
When that starts to happen.
And I'm curious in eating disorders if there's something wrong with that functionality, that little hook-ins.
It's not just a matter of feeling hunger, it's the fantasy checkpoint where it becomes the dominant thing in your life, your relationship with food.
It's quite possible.
There's a very famous study that was done on men in Minnesota during the war.
These were conscientious objectors.
And they wanted to study what fasting did to prisoners.
So these guys basically, they kind of had to volunteer.
Either that or go to war.
And so they had them eat...
I can't remember the exact percentage, but they lost a lot of weight.
And these men were basically lying on the ground skeletal.
And then they allowed the men to eat again.
And these, of course, these men, like, binged.
Okay, so they'd go and they'd sit down and they'd be cramming food in their face.
They still would be hungry.
And they regained the weight.
But that's when it started to get real interesting.
These men, who were in their 20s, started complaining that their thighs were fat.
They started having all their weight.
Bizarre fantasies about food.
One of them cut off three fingers.
Why would a man in his 20s, in the 1940s, start complaining about excess weight on his hips and thighs?
The whole aspect of going way down below your set point by force and then trying to readjust back up to it does something psychologically.
So it's not just about where the weight is.
It's how you went there, how quickly, and what happens to your brain when it can't catch up.
Have you ever gone on a diet?
Oh yeah.
Oh yeah, I had anorexia.
I've gone on a diet.
No, no, now, recently.
No, no.
Diets are not for me.
That's a place that I wouldn't go.
So, as you say in the book, there are probably temptations in your life that would sort of maybe pull you back into the anorexic camp.
How do you resist those?
I think the biggest...
Compelling for us right now is my daughter.
I have an 11-year-old.
So sometimes what you can't do for yourself, you can do for your kid in the moment, and then you can go back and do it for yourself.
She came home one day saying that Granny told me I'm fat and I have to go on a diet, and she was 8. Is Granny your mother?
My mother-in-law.
My former mother-in-law.
My ex-mother-in-law.
Who met well.
She's a diabetic.
And so she thought by telling my daughter that she was fat and that she would need to go.
This would be a good thing.
And I knew what to do.
I took my daughter in front of the mirror and I said, you are a soccer player.
Soccer players don't go on diets.
Eight-year-olds don't go on diets.
You need food to be able to play soccer.
Right.
You are beautiful just the way you are and so on.
But for me, the bulbs were flashing.
It's not just what I tell her, it's what I do.
It's what she sees me eat.
So if she sees that mom doesn't eat breakfast or mom doesn't eat lunch or mom doesn't eat both breakfast and lunch...
Well, what moms don't eat, she's going to understand that something's wrong.
So she's going to understand if I'm walking around the house talking about how fat my thighs are.
So she's a big influence.
But another big thing to resist the temptation is to have a voice.
I mean, writing the book was a cathartic experience for me.
Every woman that I talked to was who I could become.
And if they were doing poorly, I could become that.
If they were doing well, I could become that.
And there's something to be said about a community that Not a pro-anorexia or pro-bulimia community like you find on the web, but a good one.
That's the support that helps you to get past a lot of your issues.
You mentioned that the pro-anorexia community is on the web.
They're really trying to take them down off the web, but there's creeds.
There's the thin commandments and thou shalt not eat this or thou shalt not put this between your lips and so forth.
There's a lot of good things on the internet as well.
There's a lot of people who've found communities and support groups through the web.
There's a lot of good information on the web.
I have a website, trishagura.com, where I'm trying to filter a lot of this information about eating disorders, make it understandable for people.
I'm blogging regularly.
So what's chewing and spitting?
That's kind of the latest.
Chewing and spitting out food, you know, and so forth.
And so the internet can be a good thing, and it can also be a bad thing.
When folks are creating communities around things that are unhealthy, obviously it belies a certain lack of insight about themselves.
The people who are attracted to these kinds of things feel very poorly about themselves.
And so if you're going to affiliate with this cult-like group, it gives you your identity when you can't find it on your own.
There's lots more when we come back.
Let's talk about pregnancy for a second.
Because it's a place where women gain a lot of weight.
A lot of things happen to their bodies.
And they've got, you know, eating two for one and coming to grip with the hormonal shifts that occur.
And yet it tends to be another one of those stressful times you mentioned where eating disorders rears its head.
What happens?
Well, you would think that during pregnancy, you know, a person who's going to freak out about two or three or four or five pounds would really have a hard time with 20, 30 or 40 pounds.
But actually, the majority of women who've had histories of eating disorders, when they get pregnant, do better.
They stop or cut way back on their symptoms.
And it's kind of like two reasons.
One is what I can't do for myself, I can do for this baby.
And two, first time I have permission to be fat.
And so it's almost a very liberating experience.
But the problem comes after the baby's born.
Postpartum is a really, really horrible time.
The rates of depression are three to ten times the norm.
Mm-hmm.
And so what's going on is once the baby's born, there's not the excuse to be heavy anymore.
You're faced with this new identity as a mom and all the responsibilities of it.
And now you're really in stress.
You can't go back to all your eating disorder and behaviors because you can't go to the gym because you've got to take care of your baby.
You can't leave the cupboards bare because you've got to have food there for the baby and you're breastfeeding.
And so all those things in postpartum is a difficult time.
So researchers say that if a woman has a history of an eating disorder and she gets pregnant, quote, she should be in therapy, unquote.
Is that right?
That's how strong.
So did you go into therapy when you were pregnant?
I did.
I did.
So what do they do in therapy?
I know how difficult it is because I've had friends enter into therapy, but it's almost a black box from outside because the kinds of things that you need to hear when you have an eating disorder aren't the kinds of things that I never think about telling anybody.
It depends on the therapy, too, because eating disorders aren't one size fits all.
So different kinds of therapies are going to work for different kinds of people.
For me, I had a Jungian psychologist who gave me images of huge Botticelli women and fertility goddesses and helped me deconstruct a lot of the different pictures that I had seen.
And we were talking about motherhood and so forth and what that meant.
And that was extraordinarily helpful to me.
There are moms groups.
So like women with eating disorders who have babies come together and they'll bring their babies and they'll talk to each other.
And that's also helpful.
And so there's many, many different things you can do in therapy.
But often it's cognitive behavioral therapy where we're working on the behaviors.
Or it's another kind of psychotherapy where we're talking about your past or we're talking about what's in your head and what your images are and trying to deconstruct them.
Do you remember a click point in your life where you saw a magazine article and thought, I want to look like that?
What was it that made your ideal body look different from what this Jungian psychologist was trying to get you to see later in your life?
So back when I was a teenager, what sort of did it for me?
Were you anorexic when you were 10?
No.
It came about when I was 15 years old or so.
And I can't tell you anything more than I just thought my thighs were fat.
And it really wasn't about the I think I'm fat.
It was a time in my life where there was a lot of stress going on in my family.
And I was reaching, you know, there's puberty issues.
And I remember it just felt so bad.
And one weekend, I just said, I wonder what would happen if I don't eat.
And it was like a calculus problem.
Can I do it?
I was an overachiever in school.
I was a straight-A student.
And so there's a flip side to anorexia.
The kind of person who's going to starve themselves is the kind of person who's very driven.
Right.
So the kind of person who's going to achieve a lot is the kind of person who gets it.
So it's sort of like you talked about the jade stone, okay?
Everybody has their flaws.
And I'm not going to promote anorexia in any way, shape, or form.
It's a horrible disease.
But the silver lining to it, it's a drive that can do wonderful things if it's channeled in a healthy direction, like writing a book.
But if it's channeled on, I'm on the scale and I want to see if I can get lower and lower and lower, it's very destructive.
So there's a yin-yang quality to it.
Let's talk about the healing elements that you mentioned in the last chapter of the book, including some of the spiritual issues.
You give a six-step program, identify the problem, which is always the most difficult step because that's the one you never know you have to do.
Very hard.
Then you reach out for help.
Again, I don't know how anorexics and bulimics reach out for help.
Do they say, hey, I think I'm too thin?
Doesn't someone usually say, hey, I think you're too thin?
No.
It's more like, I am so miserable.
I want to die.
I can't stand this anymore.
And so it's just a pain.
It's a cry.
It's gotten so out of control, I can't control this anymore.
It's affected my life and I'm unhappy.
That would be coming from the anorexia.
But often it's people around the person who has the eating disorder who have to step in and do some sort of intervention.
Because particularly when you drop to a very low weight, your thinking gets very distorted.
And you will rationalize all kinds of things.
So you do need someone to step in and help you.
And then it's about either going for inpatient treatment if you're really having trouble or trying to go for outpatient therapy.
And for older women outpatient is an option because often there's kids at home.
And then there's different kinds of psychotherapy.
The biggie is cognitive behavioral therapy, which focuses on the behaviors and the thoughts behind them, not digging into your past.
There's interpersonal therapy, there's group therapy, but there's also a lot of alternatives that are helping women.
Things like yoga.
Yeah.
Mindfulness, where you're focusing again on your body and its signals.
Pilates, biofeedback.
What I found a commonality with all the women who seemed to be doing the best was this, I'll call it religious or spiritual or creative sort of endeavor.
So, one person got very involved in a religion and she was reading the Torah at the synagogue.
Another person had this mystical experience standing on the street corner and felt like she was loved by the whole world and joined a unity church.
Other people are writing poetry.
They're putting up all kinds of websites.
Some are becoming advocates for women's issues.
It's all about finding your voice again because the eating disorder is secrets.
It's hiding.
So when you can take it and put it out there and you have a voice, then the power is out, not in.
And that's when real healing takes place.
How about for you in the early stages?
What was the...
The time in your life that you remember thinking, I'm miserable.
This is not right.
Did someone say something to you that clicked that?
Freshman, you're in college.
I came home on break.
I was about 89 pounds.
I'm 5'4".
How much do you weigh now?
Oh, gosh.
I don't know.
I don't look at scales anymore.
But I'm going to guess somewhere around 110, 115. Because you look pretty good now.
Yeah.
But I can't see you 20 pounds thinner.
Yeah, scale's dangerous for me.
If I go looking at it, I'll want to go down.
So that's something I just don't go around.
If you were 112 pounds, would you panic now?
Probably.
I'll be honest.
Bring the scale in, please.
But it's also something I would live with.
You know, it's like then I would go through the talk in my head, now why do you think that?
You know, it's more about how you feel.
You want to be a mom to your daughter.
What are the things that you've accomplished in your life?
What can you do?
Get off the scale.
Don't worry about that anymore.
So it's almost like I feel it's better to be healthy than on a scale.
So you come back from spring break in college.
Yeah, my parents saw me.
My father shook his head, went up the stairs, and my mother started to cry.
They didn't say anything?
My mom, yes.
There was problems going on since I was 15. People knew, but my parents didn't know what anorexia was.
And so it was just something to keep quiet.
I lived in a suburb in the Midwest, and it was something to keep quiet.
But I came home, and it must have been pretty bad.
Were you thinner when you came home than when you had lived on?
And I must have looked terrible.
I must have sounded terrible.
I was very hyperactive.
And so my parents called somebody up at the Cleveland Clinic.
The next day I was in a car sitting in this therapist's office and they said to my parents, she has anorexia nervosa.
If she doesn't get help, she's going to be in the hospital.
And she can't do it by herself.
And I was at an age where I was still willing to, whatever anybody told me to do, I would do.
You know, I wasn't in a rebellious sort of phase.
And I was so miserable, I would have done anything anybody told me.
So they set me up with an outpatient therapist near where I was going to school.
They wanted me to stay in school.
And I went, I rode my bike for four years, back and forth to Hyde Park.
I was in Cincinnati at Xavier.
And talked to this therapist, and that was the beginning.
I thought it was the end.
You know, when I left therapy, oh, I'm fine.
But actually, it was the beginning.
There was a lot more that came after that.
And he's the one who used the technique of showing you the...
It was a she.
A she.
She showed you the technique of...
No, she was...
That was someone else who came later.
So after...
When I got pregnant, I got very nervous about, I don't want to hurt this child.
And I'm scared about gaining weight.
I'm really scared about being a new mom.
I think I need some help here.
And so I found somebody and went to see him.
And he was wonderful and has helped me enormously.
So I would encourage it for anybody who's thinking of getting pregnant or getting pregnant or any other time in life where you know that you're hitting, if you're going to move, if you lost your job, if you're in a divorce, get some help.
When you were in college, did you know you had anorexia?
Did you know what it was?
At that point, yeah, I did.
So when you came home, I might get them asking this because the two cases that I've been involved in, the parents had the exact same response your parents had.
The father goes upstairs, shakes his head, and then the mother starts to cry.
There's not a conversation because the words have all been said.
And the child usually had insight.
But you describe it very beautifully.
You say, you know, I was miserable.
If you're miserable and you knew you had the diagnosis, why would it take that catalyst?
I wouldn't know the word anorexia.
Oh, you wouldn't?
So all I knew was that I would look at the scale and I would see 90. Oh, if I could just crack 90. If I could just crack 90. It was all about, like, it was like a mindset that was driven toward a number.
And that way, I didn't have to worry about being homesick.
I didn't have to worry about socially fitting in in college.
I didn't have to worry about my grades.
You know, it was, I could just, the scale.
And if I just took care of the scale, then all the rest of my life, that's all I knew.
But I just felt terrible.
You physically felt terrible?
Yes.
I mean, I felt hungry.
I felt driven.
I felt like my life was not my own.
I felt like there was a demon inside me.
A voice in my head that said, what you do is never going to be enough.
So even when you crack nine, you get to 89 pounds.
It wasn't enough.
I would have kept going.
You would have?
Oh yeah.
What were you eating?
What was a typical day for you?
A lot of salad.
A lot of salad.
It varied over the years, but it was a lot of skipping meals and a lot of just sort of salad or drinking things.
A lot of tricks, a lot of exercise.
What's the heaviest you've ever been?
Well, when I was pregnant.
And I don't remember how high I was.
When you weren't pregnant?
When I wasn't pregnant, probably about now, or maybe a little more.
About 112, 115. Yeah.
And it's when I was happiest, too.
Is that right?
Yeah.
So now I feel really, really like I've come so far.
I'm probably one of the happiest periods of my life.
And I also am...
One of the heaviest.
It's interesting.
My weight's sort of a barometer for how I feel.
Maybe that's true of people who are also dealing with obesity issues.
Sure.
Trish Gurra, thank you very much for joining us.
It was a very insightful book.
I also think that it's a wonderful experience to have that cathartic experience of writing about a project, a problem that you face personally, and shedding so much light on it.
Congratulations.
Thank you.
And I wanted to say one last thing.
It's never too late to heal.
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