How did my eating disorder start?
I have a picture on a bulletin board next to my bed. It shows a brown-eyed girl with blond curls tumbling away from her round face in a halo. She looks to be only five or six years old but her gaze strikes me as intuitively wise, confidently determined, and full of questioning wonder. She is jean jacketed, ready to change the world, and unassumingly sure of herself.
I have another photo hidden between the pages of a book. This one is of another girl. She too has curls but these brown ringlets are pinned up and fall stylishly around a face painted with new make-up and a fake smile. With a toothpick skinny arm propped on a bony hip she poses delicately. In her hazel eyes I see a constant striving, an insatiable hunger to be better, and a cold inside of her that she barely keeps from breaking through. She is pretending she can face the world but she has no idea who she is.
Both photos depict me. Myself. Zoe. I. Zoe Vlastos. However, a wide gap lies between these two girls. They are separated by a question that seeks to explain the difference in their eyes and smiles: how did my eating disorder begin?
How did that defiantly confident girl who was opposed to conforming to social norms become obsessed with appearance, body weight, and eating? How did she go from a happy little girl to an anorexic young woman? How did the eating disorder develop?
That’s the million-dollar question, isn’t it?
It’s the question that haunts my parents. It’s the question mental health practitioners wish they could answer and researchers spend thousands of dollars of grant money trying to understand. It’s the question I’ve asked myself for the past six years of recovery.
How? How? How?
And, also, Why? Why? Why?
I wish I could point to one moment during my adolescence and say, “There! Right there! That is where the eating disorder started.” Maybe it could have been when I realized my skirt fit a bit tighter than it had a couple months earlier. Maybe it could have been when we talked about calories in health class. Maybe when I started running more. Or maybe that party when I felt unbearably awkward. Unfortunately, I cannot point to just one moment when my eating disorder started because it was so many. My eating disorder, like all eating disorders, developed from a complex compilation of biological, psychological, and sociological factors.
As Guido Frank, a psychiatrist and researcher at the University of Colorado Denver, says, “It’s a perfect storm.”1 Through his behavioral and neurobiological research Dr. Frank has developed a theory that an eating disorder develops distinctly in each individual depending on that person’s personality, upbringing, genetics, socialization, and life experiences. Psychology, biology and neuroscience, and society all play important roles. When the perfect combination of these factors for that particular individual occurs—their perfect storm—an eating disorder can develop.
My story can be used as an example: Since my mother had an eating disorder I had a higher genetic risk of developing one myself. Being type-A, a perfectionist, a planner, driven, self-directed, and female all added to the building clouds of probability in my own perfect storm. Living in a society where the ideal of physical beauty is largely unattainable and pop-culture shoves diets and guilt in our faces constantly, the pressure of a thunderstorm built. Feeling shy, unsure, awkward, unconfident, and as if I did not fit in with my peers brought on the raindrops. Then the uncertainty of looming college decision, unintentionally losing weight while on vacation, and learning about healthy eating and exercise broke the clouds open with thunder and lightning. Without knowing it, I was in the middle of my own perfect storm: Anorexia Nervosa.
This was my ‘perfect storm.’ However, in the world of eating disorders not all ‘perfect storms’ are created equal. Although, some of the psychological, biological, and sociocultural factors are similar across cases of eating disorders, no two cases are identical. Each eating disorder and its causes are unique. This, of course, makes it very hard to understand the development of eating disorders and explore how to treat them.
Furthermore, because eating disorders are inside a person’s head it is sometimes hard to distinguish between healthy and disordered behavior. During my eating disorder I had everyone—including myself—convinced that I was just trying to be ‘more healthy’. I justified my eating disorder behaviors (such as attempting to deal with self-loathing and uncertainty by not eating) by telling myself I just wanted to be “fit” or “healthy.” However, once the disorder took over, my definitions of “fit” and “healthy” were constantly changing to accommodate lower weights and increasing fragility. My desire to be healthy suddenly was very unhealthy.
So, when did I cross the line? When did the storm begin?
It is probably obvious by now that there is not a clear answer to these questions. However, I do believe that in some cases of eating disorders there is a switch…a threshold when the building clouds let loose with a boom and the storm begins. This phenomenon is explained by the diathesis-stress theory as having a certain predisposition that is then activated by a particular circumstance. If you have the predisposition but you have never been put in the ‘trigger’ situation, you will be fine. If you do not have the predisposition but do get put in that situation you will also be fine. However, if you have both the predisposition and the trigger, the storm commences. I obviously had the predisposition for anorexia and I experienced a trigger situation. My “switch” was living in Spain for a month the summer I was 17 years old. I ate differently, walked everywhere, and unintentionally lost weight. I remember a moment looking in a bathroom mirror when I realized I could control the shape of my body with what I ate. I felt powerful. For me, that is when I stepped over the line. I could have stepped back over to the other side but from that time forward it was going to be a lot harder. Instead, I stepped forward and into a yearlong denial of downward spiraling.
In the end, how do I explain the difference between those two photos…those two beautiful girls?
The short answer is, I cannot. The longer answer is the story of my life. Maybe in the future psychological and neuroscience research will give us clearer answers to these questions. For now, they remain elusive. Nonetheless, we can educate ourselves to be more knowledgeable and aware of the different factors that contribute to eating disorders in order to help individuals avoid building their unique ‘perfect storm.’
I share my story in the hope that others will at least know that eating disorders exist even if we cannot yet explain exactly how or why. I also share my story in order to give hope to those who are struggling.
I am in recovery, I survived my eating disorder, and that powerful vivacious little girl lives on in me.
- Frank, G. W. (2016). The Perfect Storm – A Bio-Psycho-Social Risk Model for Developing and Maintaining Eating Disorders, Frontiers In Behavioral Neuroscience, 1044. doi;10.3389/fnbeh.2016.0004 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785136/