Today, I’m happy to present an interview with Therese Borchard, who contributes regularly to Psych Central and has her own popular blog, Beyond Blue. There, she writes candidly and thoughtfully about her struggles with depression and anxiety. Her memoir “Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes” will be released in January 2010.
Below, Therese talks about her eating disorder, recovery and what families can do to help a loved one.
1. How and when did your eating disorder start? What do you think contributed to it?
My eating disorder started in the sixth or seventh grade, once I began to dance (ballet) seriously and get pressured by my dance instructors to maintain a willowy figure. By the time I was in eighth grade, I wanted to pursue becoming a professional ballerina, and to do so (at that time … I hear the pressure on young dancers is less now) pretty much required watching absolutely everything you put in your mouth. By the time I was in ninth grade, I was no longer menstruating and weighed 103 pounds (at 5”8’).
Even if I hadn’t pursued dance, however, I was extremely susceptible to an eating disorder at that time. My parents separated when I was in fifth grade, and our home life was a bit of a mess in the years that followed. As so many adolescents do, I manipulated my relationship with food because it was one thing that I could control … the only thing at that time, and so it gave me a false sense of power, which was very seductive.
2. Many women with eating disorders are reluctant to seek treatment. Some describe their eating disorder as a friend and, as a result, tend to be very protective and secretive about it. What motivated you to seek treatment?
I didn’t really seek treatment. Treatment sought me. What I mean was that it wasn’t until my freshman year at college that I really admitted to having an eating problem and started to ask myself the hard questions about what might be lurking behind it. Throughout high school, I simply transferred my eating problems to alcohol abuse. It was only when I gave up drinking, right before I graduated from high school, that I could begin to heal.
So when I asked a counselor at school early my freshman year where I could find a support group for my drinking, she invited me to come back, suspecting there was more to my story than the need to stay away from booze. She is the one who confronted me with my eating problem, and also my depression and OCD.
3. Eating disorders are tremendously treatable but the key is to find the right treatment. How did you go about seeking services?
I was tremendously blessed to treat my eating disorder while attending Saint Mary’s College in Notre Dame. Since it is an all women’s college, the school provided excellent resources. For example, one semester I logged in everything I ate into a nutrition software program. That way, with the help of my counselor, it could guide my diet, and let me know if I was eating enough calories, the right kinds of foods, etc.
My counselor helped me to begin eating three meals a day. I entered a contract whereby I would have to tell her if I started to skip meals. In many ways, that first year of recovery—my freshman year at college—was like starting to learn healthy living from scratch. It didn’t feel right, because my life had been so unmanageable from the beginning.
4. What were the toughest parts of your recovery and how did you get through them?
For me the three meals a day was the hardest. Throughout high school, I would fast for days, trying to get down to a certain weight. I’d get there, go on a binge drinking spree and then lose all self-control with the eating. So my weight was up and down, my diet a total yoyo. Once I promised my counselor Nancy that I would eat three meals a day, I had no recourse on those days I overate—where I would skip the next meal in high school—I had to eat the next meal anyway. That took a long time to get used to. In fact, I still struggle with that. If I binge on brownies, my first response is to skip the next meal. But I now I know that route is too dangerous.
5. Do you still struggle with eating disordered thoughts and behaviors? If so, how do you overcome them?
Yes, as I mentioned in the last point. When I overeat, it is extremely hard for me to not want to skip the next meal, or take a laxative, or to over-exercise to compensate for it. I have to simply forgive myself and move on, as weight loss blogger Janice Taylor says. I also struggle with the fat voice: “You’re getting fat. You look fat. You are so fat,” and it’s not helped by statements like the one my lovely spouse said last night, “That sweater puts about 15 pounds on you.” So I have to treat those thoughts just like I do the ones of depression: as an uninvited houseguest with an opinion for everything. Sometimes I employ the cognitive behavioral tips of Dr. David Burns, where I “examine the evidence,” like seeing that the majority of my clothes still fit me, so I’m not obese yet. Or, if I have gained five pounds, that the world is still going around in the same way it did before I gained the five pounds. Or, if I can, I just try to put a name and face to the voice (Ed, standing for eating disorder), and tell him to go to hell.
I have a few rules that I live by: I eat three meals a day, I weigh myself once – no more – a day, and I don’t exercise more than once a day. There are exceptions to the third, but you get the idea. I still have to operate under a structure of sorts.
6. What can family members do to help a loved one with an eating disorder?
That’s by far the hardest question. I know that a person isn’t going to recover until she wants to recover. She’s got to get there on her own. But I also know if my counselor hadn’t been there at the right time, I might still be skipping meals, and who knows if I would have been healthy enough to get pregnant, carry a baby, and give birth. Twice. So I first recommend having a candid talk. Especially if there is “proof” of a disorder—times you’ve noticed a family member throw a meal into her napkin instead of eating it, or if you’ve caught her in a lie, or overheard her throwing up, or found a laxative box in the trashcan.
By far the best thing a family member can do is to become educated on eating disorders and why they happen. It would be helpful if you had some resources on hand in case the family member is open to seeking help, or at least to inform her about for the time when she is willing to pursue treatment.
7. Anything else you’d like readers to know about eating disorders?
Just that they are very real and can be fatal. I still remember the time when I was in high school and my sisters and I learned about a woman who had graduated the year before. All of us looked up to her because she excelled at everything she did. However, she was bulimic, and didn’t address it. Ultimately her heart had weakened to a point where she had a heart attack and died.
It’s not uncommon for persons who struggle with eating disorders to be perfectionists. It is somewhat part of the illness. And that makes it extremely difficult to detect, because the person still functions at an incredibly high level. But you must look beyond the homework and extracurricular activities. You have to look straight into their eyes, and ask yourself if there is a sadness there. If so, be honest, and tell your family member that you’re worried. Think about how you’d feel if you didn’t say anything, and her heart stopped beating.
Thanks so much, Therese, for your honesty and insight!
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Thanks for this Q&A. There’s good information here. My mother and sister (and many of my friends) have various eating disorders and it is so challenging to express concern in a way that doesn’t make the situation worse. And the common sense of eating three healthy meals a day–how true. Though I sometimes feel like one of the few woman in America who dares to do so. Fasting is an unhealthy and sad way of life for so many. Thanks again!
You’re welcome Joy! Thank you for your comment. I hope to feature more Q&As like this.
It’s tough to approach someone with an eating disorder, because oftentimes you don’t know what to say. You don’t want to upset the person or risk your relationship. You can’t stop someone from engaging in destructive behavior (like fasting, throwing up, binging, exercising excessively), but you can help them find help through therapy or a treatment center. As Therese points out, approaching that person can save their life.
The National Eating Disorders Association has a nice page for family and friends on talking to a loved one along with information on eating disorders:
http://www.nationaleatingdisorders.org/information-resources/family-and-friends.php
So you find that many people don’t eat three meals a day? Personally, in addition to three meals, I also eat snacks between my meals, because I get hungry 
Thank you for the interview and for putting a little information out there that goes beyond the ‘distressed teenage girl’ trope that I, now a grown woman, have become somewhat tired of. Eating, maintaining relationships and daily structure, accepting oneself, these are things that are good for all of us and applicable to every age.
Most of all, however, I heart the last paragraph: “But you must look beyond the homework and extracurricular activities. You have to look straight into their eyes, and ask yourself if there is a sadness there.” I wish someone had done that for me; instead, far too often when I tried to hint at my problems (I mean, it’s not as if you didn’t know that what you’re doing is, on some level, insane) I got the very opposite: “But you’re doing great. You accomplish so much. And you’re losing weight!” As if that last point was the ultimate clue of how awesome you are.
So thanks. I hope lots are going to read this.
Thank you, Hannah, for your comment! There are many misconceptions about eating disorders (and body image), one of which is that eating disorders automatically disappear after your teenage years or early 20s. However, many women continue to struggle in their 30s, 40s, 50s and 60s.
Weight loss gets associated with so many positive things, even if you’ve lost weight after having the flu, it’s still viewed as a nice bonus.
I’m sorry that someone didn’t recognize that you were hurting. Many times, we’re so focused on appearances (i.e., if you’re losing weight, clearly you’re doing well) and being agreeable, that we neglect to look beyond. I loved the last paragraph, too. I’m thrilled that Therese was able to do the interview! Hearing others’ stories is important.
I consider myself to have an eating disorder without the typical binging and purging; fasting, etc. Mine is just basic compulsive over-eating — because I’m lonely, or bored, or whatever. To me comfort = ice cream. Period. I’ve “comforted” myself to the tune of being 60 pounds overweight.
The most obvious result of this is that I skip events because I think I don’t look good enough.
I have declined/cancelled about 5 important events in the past month, including my college homecoming – the cancelled trip will cost me $100 penalty. Why didn’t I go? Here’s what my brain has to say about that: “What will they/he/she THINK when they see what a COW I am?!?! Just LOOK at that saggy fat on your arms, LOOK at your double chin!!!!” It just goes on and on. That’s my internal dialogue. Sucks. I’ve taken matters into my own hand and have started eating smaller portions and exercising 4 days a week. I want instant results. However, I’m determined to un-hide myself and become proud of my choice to be more disciplined — resulting in a fit, toned body and clothes that I wear and feel confident in.
Deb, thank you for sharing your story. It’s important to feel confident, and it’s good you’re taking strides to do that. But I think the key is leading a healthy lifestyle, not going after quick results (though I know it’s tempting to reach for quick-fixes). And to love and respect yourself unconditionally, regardless of your size or shape, which I know is also easier said than done (but so important to work toward).
Also important is addressing your overeating. For instance, it may help to see a therapist and/or check out some resources on overcoming overeating. This website has some excellent books: http://www.overcomingovereating.com/
Thanks so much for this. There just isn’t enough knowledge out there about eating disorders and the willingness of the media (and insurance companies) to recognize them as valid medical conditions continues to exacerbate the issue.
Thank you. Thank you. Thank you.
Although this made me cry with empathy and appreciation it contained a lot of valuable information.
I wonder, for your next Q&A how you would advise someone who has no access to professional help anymore… self-help, in a way.
Jodie, I’m so glad this resonated with you. Thank you for your comment!
And thank you for bringing up such an important question! In an ideal world, seeing a therapist would be my best recommendation. But, when that’s not feasible, turning to reputable self-help resources may be helpful.
But I’d like to ask an expert about that, and get back to you. This way, I can provide you with some specifics. Stay tuned
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