Reevaluating Recovery

by Maryka Gillis; image by Charlie Theobald

I was admittedly surprised to find myself kneeling onthe floor of an El Diente bathroom and actively reversing the contents of my stomach six years after I’d supposedly “recovered” from my teenage eating disorder. It was easy enough to justify the next day, though, when I told myself it was just because I was drunk. I didn’t want to be hungover, I had such little self-control when intoxicated and, after all, I had been feeling sick all day from the food I’d been eating. I told myself the same thing the next few times it happened. Even after some sober slip-ups, I thought it was just that—a few meager slip-ups. I’d slipped up before and it hadn’t been an issue, really. I didn’t see why this was any different.

It took restricting and compulsively logging calories for me to acknowledge that I was, perhaps, relapsing. But the strange thing was, I didn’t feel any different than I had before—the only change was reverting to my old habits. Emotionally and mentally, I felt the same. My relationship to my body and to food hadn’t worsened. I didn’t feel any emptier. The only thing that changed when I started restricting again was an increase in the heartburn I already had and a heightened sense of control.

That is, until this went on for long enough that my actions impacted my perception of food and my body. I realized that in the six or so yearsI had been “recovered,” the only thing I hadn’t restricted to (what I considered) an unhealthy degree since then, either. But relapsing and joining an on-campus eating disorder support group the following semester forced me to realize that my six years of “recovery” were still disordered. I didn’t spend hours each day counting calories and planning food intake for future weeks, but my distorted body image and relationship with food, fat and exercise still controlled integral aspects of my life. For years, I had to actively try not to binge, purge, restrict, over-exercise or count calories. I was basically successful, but I never went to the root of my urges to control caloric intake and output, and, what was worse, I never knew I should.

It was as though I had put a bandage on a wound that never healed. Neither I nor anyone close to me could tell I had an open wound. We assumed it had healed, but it was festering. And in some ways, I find that scarier than my active eating disorder, because it was imperceptible, not only to my friends and family, but to me, too. I was in less danger of the physical consequences of eating disorders: bone density loss and osteoporosis, tooth decay, esophageal degradation, menstrual irregularities, malnutrition and death, to name just a few of the most common side effects—but I now believe relapse was an inevitable step for me to actually begin recovery.

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A 2011 study in the Journal of American College Health found that 13.5 percent of undergraduate women and 3.6 percent of undergraduate men surveyed screened positive for the likelihood to have an eating disorder. The study also found that those students were more likely to feel that they need professional help with their mental or emotional health than were their peers with healthy eating habits. Of the students that were likely to have eating disorders, however, only 47 percent perceived a need for help. Also, only 10 percent of students likely to have an eating disorder had ever received a diagnosis and only 20 percent had received any mental health treatment in the year prior to the study. The same study found a positive correlation between screening positive for varying levels of depression, generalized anxiety disorder, suicidal thoughts and non-suicidal self-injury among both men and women likely to have eating disorders. This study shows that eating disorders are rampant on college campuses, and that individuals suffering from them are not actively seeking help. 

Eating disorders are pervasive in the U.S., with 0.5 to 1 percent of women suffering from anorexia nervosa, 1 to 2 percent of women suffering from bulimia nervosa and 3.5 percent of women and 2 percent of men suffering from binge eating disorder. They are even more prevalent on college campuses. It is estimated that 10 percent of Americans suffer from eating disorders—about 6.5 percent of women and 3.5 percent of men. That means that eating disorders are more than twice as common among undergraduate women as they are among women nationally.

On a physiological level, the three major eating disorders (anorexia nervosa, bulimia nervosa and binge eating disorder) are often seen in individuals with lower levels of serotonin, which often contribute to depression and anxiety disorders. This implies that the disorders can cause low levels of serotonin, or that individuals with lower than healthy serotonin levels are more likely to develop an eating disorder. Also, individuals suffering from anorexia nervosa often experience heightened dopamine receptor sensitivity, while those suffering from bulimia nervosa and binge eating disorder experience a decrease in dopamine receptor sensitivity. This directly impacts physiological responsiveness to food and eating. Counterintuitively, bulimia nervosa and binge eating disorder are associated with decreased reactionary strength to food and tastes when compared with healthy individuals, while anorexia nervosa is associated with increased reactionary strength. This means that people with anorexia have stronger reactions to food and taste than healthy individuals, who themselves react stronger than people with bulimia and binge eating disorder. Researchers postulate this is because of the addiction component of bulimia nervosa and binge eating disorder to food, as substance addictions are also associated with low levels of, and receptiveness to, dopamine.

Often, anorexia nervosa and bulimia nervosa are lumped together, while binge eating disorder is considered its own category. In my experience, bulimia shares just as much, if not more, with binge eating disorder than it does with anorexia. Researchers consider both anorexia and bulimia addictions to dieting in the form of fasting, restricting, purging, over-exercising or some combination of these behaviors. Both bulimia and binge eating disorder indicate an addiction to food and the associated bingeing impulse. Additionally, there is gray area in each disorder and overlap in all three. Many individuals suffering from anorexia have bingeing episodes, and bulimia often includes fasting and restricting, while binge eating tends to prompt controlled food intake after a binge. And each of these disorders has a specific list of necessary symptoms to be diagnosed. If unfulfilled in any way, the disorder is considered an “Eating Disorder Not Otherwise Specified” (EDNOS). Up to 70 percent of people with eating disorders fall under the category of EDNOS—their symptoms are somewhere on the spectrum of one or more of the three major disorders but don’t fulfill all of the criteria of any. Many people diagnosed with an EDNOS feel invalidated because their eating disorder is not as widely recognized and often falsely considered less serious. However, EDNOS has a mortality rate of 5.2 percent. This compares to at least a 4.0 percent mortality rate for anorexia nervosa and a 3.9 percent mortality rate for bulimia nervosa.

Chemical factors do not necessarily indicate a person is more likely to develop an eating disorder. Rather, physiological factors are one component of many that can cause people to develop negative body image and poor coping mechanisms. Psychological, emotional and social factors all contribute to the development of eating disorders. Because there is so much at work, and because every affected person has a unique experience with the illness, it is challenging to generalize any of the disorders. But eating disorders can be particularly challenging addictions to deal with because, unlike substance abuse or self-harm, the cause of the addiction cannot be avoided: if the individual stops eating completely, they will not survive. Food is an essential part of life, and it must be approached every single day. Though substance addictions are sometimes overcome without completely avoiding the substance, many addicts ultimately recover by achieving sobriety. But those struggling with eating and body image disorders can’t avoid food or their bodies to overcome the disease.

For disordered relationships with food, it is difficult to define what a cessation of unhealthy habits actually is, because it is nearly impossible to gauge what is too much control over one’s food intake and how much exercise or restriction is considered unhealthy. I’ve often wondered about ultra-healthy peers’ diets—is eating exclusively healthy food actually healthy, or a more disguised way of controlling intake? Eating disorders and unhealthy habits occur on a case-to-case basis, and it is often impossible to tell when an individual has an unhealthy relationship to food and dieting because self-perception and habits are so personal. I discussed eating disorders and body image recently with a friend who said he had no idea how to tell if friends were experiencing disordered behavior or relationships to food and dieting. He said he could tell when friends had unhealthy relationships to substances based on when they were using and how much, but he pointed out that it is much more challenging to place numbers and values on individual relationships with food, even for oneself. Which is ultimately the challenge I experienced. I’d put off real recovery because I didn’t know what it meant.

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Now that I am at the healthiest I’ve been in my years of recovery, I can speak candidly about my struggle with an eating disorder without the permeating shame I used to experience. But this point in my recovery only came by being legitimately ready to deal with my eating disorder and relinquish the sense of control it gave me. My eating disorder served a vital role in giving me a sense of power over and privacy in my life and circumstances when I felt otherwise. Though I didn’t realize how it served me at the time, in recovery I am able to see both the ways in which it helped me and the destruction it waged. Before I had the coping mechanisms to survive without it, my recovery was forced and only surface-deep. It appeased my family and my own conviction that recovery was immediately necessary. But I still needed that outlet, and I never really let go of it, until I accidentally fell back into the hole of bad habits and self-destructive coping that my eating disorder has always been. 

Colorado College has resources for students struggling with eating disorders and their loved ones. The Colorado College Counseling Center offers students six free sessions per year, and some counselors specialize in eating disorders. Additionally, the eating disorder and body image support group offered by the Counseling Center is free for students and meets weekly. Contact counselor Alexis Wilbert (, 719-389-6905) to inquire about the group or for other questions or concerns. The on-call counselor can be reached 24/7 through Campus Safety at 719-389-6707.