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Faces of eating disorders: irene’s case FACES OF EATING DISORDERS: IRENE’S CASE
Twenty-six-year-old Irene worked as an executive at a major cosmetics firm. Part of her job was to entertain clients, which she did two or three times a week. Usually the entertainment took the form of elaborate buffet dinners at fancy restaurants. For Irene, these meals were a form of delicious torture.
During her teen years, Irene became concerned about her weight. She tried restricting her eating, skipping meals and nibbling on salads for dinner, and managed to lose a few pounds.
She couldn't keep it up for long, though. Feelings of hunger would overwhelm her, and she would rampage through the house, eating anything in sight. After the binge, she felt such revulsion and self-loathing because of her lack of control that she induced vomiting. This cycle-attempted self-starvation leading to bingeing and purging-recurred once or twice a year for several years.
Eventually Irene gave up attempting to lose weight. The bingeing continued, however. She eventually developed a routine in which, every night, she would come home after work and drink an entire bottle of wine. One effect of the alcohol was to lower her inhibitions so that, at some point, the urge to binge would take over. She would then gorge herself on sweet foods, such as cookies and ice cream.
Often, too, she stocked her refrigerator with leftovers brought home after her business-related dinners. Although she exercised restraint during dinner, she always asked to take food home "for her dog." Of course, there was no dog, and her refrigerator was thus always filled with a supply of binge food.
Shortly after eating she would flee to the bathroom, where she vomited into the toilet. With a perverse sense of pride, she told me that she had become so adept at inducing vomiting that all she had to do was think about it, bend over, contract her stomach muscles, and-boom.
If you were to meet Irene, you wouldn't think she had a weight problem at all: At five foot six, she -registers 135 pounds. Yet she is convinced that unless she vomits virtually everything she eats, she will turn into a "fat sack of lard."
I listed Irene's diagnosis as bulimia nervosa. Certainly she fit the DSM-III-R criteria to a tee.
On the surface it would seem that in order to diagnose anorexia there must be low weight, whereas the essence of a diagnosis of bulimia is bingeing and purging. If both of these symptoms are present, then we can diagnose both anorexia and bulimia.
In reality, however, things are not so simple. Many patients with what we call "normal-weight bulimia" have lost as much weight as, or even more than, an anorexic they just started at a higher weight to begin with. The body senses that its weight is too low and starts sending out powerful "feed me" messages. Often the person responds by bingeing.
This raises a logical, but complicated, question: What is normal weight? It's easy enough to establish what the average weight is for a given population. But the average weight for a group of people is not the same as the normal weight for a particular individual.
Research has confirmed that there is a tremendous range in people's natural weights. We know, too, that a person's weight, determined largely by heredity, tends to be remarkably stable over time. In other words, if your body's weight-regulating mechanism is set at a certain point, say, 120 to 125 pounds, then you will probably remain at that weight for years unless such factors as exercise or diet are significantly changed.
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