The Cloudy Days - Bulimia Thoughts, Treatment, and Recovery

TRIGGER WARNING: If you are currently struggling with eating disorder thoughts or behaviors, please be advised that this article deals with subjects of ED behaviors, body measuring, ED treatment, and self-harm.

“You were really sick”, said my therapist a year and a half out of residential treatment, and it was the first time I believed it.

 I started to see how bulimia affected my life once I got a glimpse of living without it. As if I peeked under the storm cloud that surrounded me head to toe. I did not feel “sick enough” to be in treatment, even during the two weeks of hospitalization. “Sick enough” felt like a finish line in the distance, when, in reality, it was already behind me. 

In October 2021, I looked for a therapist who had experience with eating disorders because I was getting scared. At this point, I was restricting food intake (even though I didn’t acknowledge it at the time), binge eating (uncontrollably eating to the point of pain), and purging (throwing up forcedly) multiple times a day. Regardless, I wasn’t sure if this was considered an eating disorder. I could not see the entirety of what I was experiencing. My eating disorder’s goal was to be small enough to fit my index finger and thumb around the side of my waist and I saw binge eating as a barrier to this goal. My determination to stop binge eating motivated me to reach out for help. Eventually, I found a wonderful therapist, who later referred me to a nutritionist for extra support. We had a lot to talk about and I was especially concerned with how my behaviors affected my performance in school. They helped me start to see the entirety of my eating disorder and later recommended that I may need more intensive treatment. In the following months, I was on a call for an inpatient intake that ended with a strong recommendation for residential treatment (a live-in healthcare facility). 

That summer, I planned to stay at my college apartment to do a dance intensive at Garth Fagan in Rochester and start an internship with the sustainability office. Everything fell nicely into place -- my roommate was already going to be driving to Rochester every day, and our landlord let us stay over the summer for free since we were coming back to the apartment in the fall. I was excited for the summer because it felt like a new chapter and a big step towards adulthood. When treatment came into the picture I had to reimagine my summer. I tried to look at all my different options - maybe I could wait until next summer to start treatment - but my nutritionist encouraged me to start treatment sooner rather than later, which is ultimately what I decided to do. I was on the residential program waiting list for a few months. When my semester ended I went home to wait for a spot to be available. On a summer day in Brooklyn, I got a call that a spot was opened and I needed to be there the following day. 

My parents drove me to the residential home. It wasn’t until we got to the driveway that it hit me. This was where I would be sleeping for a while and I had little idea of what I was getting into. I forced myself to focus on moving my feet and walking in the right direction. The house was big and beautiful, with a lush green lawn, tall windows, and a white fence. A woman greeted us at the door, we brought in my bags and I took a moment to say goodbye to my parents. I put on a face mask - still required in medical facilities at the time -  and followed her to a room for more intakes and forms. I remember using the bathroom before the intake, and little did I know, this would be the last time I could fully close the bathroom door without supervision for a while. 

The woman brought me outside where the other residents were spread around a pretty green lawn with a recovery coach (someone who supervised and provided emotional support)  sitting on the landing. I sat on the steps alone for a minute until a girl came up and talked to me. I was so grateful for her. She told me she just got there a few days earlier and understood how it felt. Soon I was introduced to more people who greeted me and engaged in pleasant small talk. After a few minutes, another girl came to introduce herself. She told her friends that she was surprisingly excited about Snack. They hugged her with excitement and gave encouraging responses. I clearly remember this moment because it took me aback. This was all new for me. 

When Snack came around everyone sat at the table in their designated spots. In front of me was a place mat, a blank paper name card, my ear plugs, and a small white plate with a lemon Luna bar. I was at the end closest to one of the recovery coaches, listening to the chatter of the people around me. At this point, I hadn’t eaten at a table with people for at least a few months. I was terrified. I forced my brain to move my hands to the Luna bar, break off a corner, put it in my mouth, and repeat. Everyone around the table started introducing themselves with their name and a fun fact, and then we moved on to a table game, something about saying a word based on the word that was said before you. When it was my turn, I had to ask for the instructions again because I hadn’t fully processed them the first time, and I still barely processed them the second time, but I managed to provide an answer. I noticed the people who seemed to guide the conversation, they spoke with ease and wondered if I would be like that one day. Over the next few weeks, I eventually got used to the table games and enjoyed the engaging distraction. And I finished the Luna bar. 

When the time for snack was up, I was allowed to leave the table. One of the recovery coaches brought me to my bedroom and I unpacked as she took inventory of all my belongings and checked what I could keep. She had a little box where she put my wallet, insurance cards, phone, face wash that had alcohol in the first five ingredients, my glass perfume bottle, razor, bag of beads, and bracelet strings, along with a few other things. This box would be locked away and labeled with my name for safekeeping. Dinner came around and it was different from Snack. The weight of the day caught up to me and I sat in front of a larger plate with multiple food components. This time it was much harder to move my hand to the plate. It was practically impossible. I felt a lump in my throat and could barely hear the conversation at the table. I was in over my head. The recovery coach checked in with me, he explained the rules for when you couldn't finish the meal. He asked what I was feeling at that moment. I have no idea what I told him. Tears threatened to sneak down my flushed cheeks. I could not process or even hear my thoughts and I got flooded with anxiety. I did not complete dinner that night. 

The next couple of weeks are mostly a blur. I decorated my table spot, went to groups, did my individual nutrition and therapy sessions, took medicine, sat outside, saw bunnies munching on dandelions in the yard, took naps, and got to know the other residents. I started to enjoy the presence of the people around me and grew more comfortable in the house. Sometimes, during downtime, we would play games and talk. We could laugh about the way life has become. Other times, I would sleep to take a break from the world. I learned that my (confusing, distressing) thoughts were typical for someone with an eating disorder and that most of the other residents had them too. This felt validating; it grounded the thoughts that floated around in my mind. I learned that I wasn’t the only one who didn’t feel “sick enough” and got tips on what I could expect during treatment.

 When people go through the process of healing from an eating disorder it could feel like a virus that is fighting to stay. The more the virus is targeted, the more it holds on and multiplies, doing everything to stay comfortable in its host, before it eventually lets go. I remember a sense of loss and confusion. The rose-stem nest I intricately built was getting picked away, and I felt like a bird being forced to leave the comfort of home. I got mad that the treatment contradicted my goal of having a smaller body. The idea that my appearance was not tied to my worth felt like a lie. I could fill a book with examples that proved I had to be thin and pretty before I could be happy (I dismissed all the examples that disproved this). Making my face pretty felt less possible so I figured controlling my body was the least I could do. It was my mission to hold on to my body goals and keep my rose stem nest intact. I was subconsciously holding onto bulimia without entertaining the thought of consequences. But the thing about bulimia is that it provides anything but control over your body. 

One afternoon, I was called up to the clinical director’s office. They told me that they were worried about my progress and would need to move me up to hospitalization if they didn’t see any improvements. I had developed a habit of scratching my skin when I got nervous. The first time I did this I didn’t even notice until someone asked me why my chest was so red, and this was another reason they wanted to move me up in care. The idea of being hospitalized scared me enough to leave the office with the intention of improvement. That intention lasted around 45 minutes.

  I was called back into their office a few days later when they had not seen the improvements they were looking for. I needed to move up in care and transfer to a hospital program. A few days later, my parents picked me up and drove me to the hospital. During the intake process here, a security guard looked through my belongings and he cut the drawstring out of all my pants that had one, including the ones I was already wearing. I couldn't keep my toothbrush and was told that I would be provided with one. I waited around for the different intakes; a medical check-up, getting a wristband with my information, and a psychological interview where the woman told me that some people may get restrained to their bed if they are a danger and that she understood because she was trying to lose weight too.

I got brought up to the eating disorder ward and went through a large locked door and then another locked door. The floor was a long hallway with bedrooms along the side, with a nurse’s station at the end. There was a bathroom with showers and stalls with blue mats instead of doors, a small room with a washer and dryer, an eating area, and a lounge that stretched along one big hallway. A nurse took my vitals and brought me into a private room to undress so they could log any scratches or scars. 

In my first bedroom, I was alone. All new patients were required to quarantine for the first four days. The room had an open dresser with shelves and a slanted top, a desk, a radiator, and a bed with a pillow, white sheets, and a thin towel-like blanket. The sheets had a hole in them and the blanket had a faint stain on it that matched the one on the wall. I had a window. It had three layers of glass and bars. It looked out over the parking lot and a small grassy area with a tree. Each day I was there, I looked at the grass with a growing thirst and fantasized about climbing the tree. I used to not like the feeling of lying in grass, but now it was what I wanted most. I see why they put all those layers on the windows because I would have jumped out if I could. I would have jumped out, hugged the tree, and ran as fast as I could into the forest on the other side of the highway and figured out the rest later. I would close my eyes and dream of the trees. It was better to sleep than to be awake. ( Months later, the image of this room would haunt me as I tried to go to sleep in my bed at home) 

 During the 4-day quarantine period, all my meals were brought to me and I was only allowed to leave my room to shower in the morning and use the bathroom. Every 15 minutes a nurse would pop their head in as part of their routine and twice a day they came into my room to take vitals and give medication. When I wasn’t sleeping, I was watching TV on the iPad that they gave me or re-reading “Into The Wild''. I liked keeping the room super cold because it made me feel clean and distracted me from the stains on the sheets. Those four days felt like a week.

 My parents were allowed to visit every day and they did. They brought me books and I would ask what was happening in the family. I would usually go to sleep when they left. When I wanted to purge or scratch my arm I would pace my room and try to distract myself until the urge passed (a skill called “urge surfing”). I knew that the absence of these behaviors was my only way out. 

When the quarantine was over I now had to eat in the eating area with the other patients and I could go into the hallway. There was more medical care and a lot less emotional care in the hospital. However, I did value the educational aspect of the group therapy sessions. Eventually, I was approved to go outside into the yard and do mild movement a few times a week. There was grass and a tree, a walkway, a labyrinth maze, lawn chairs, and some plant beds with flowers. We were allowed to walk the labyrinth, in and out, or the walkway once, before we had to sit down. I became friends with the girl in the room next to me who had arrived on the same day as me. Later I got moved into her room. She was friendly and we got along well. We found out that we were from the same area and we would do the New York Times Monday crosswords together from the book that she had. One day, I asked one of the social workers why I had bulimia and not one of the other eating disorders and she said that people gravitate towards the behavior that fills their needs the most. This made a lot of sense to me. 

Around my 12th day there I started getting more comfortable and on my 13th day, I was discharged from the hospital. I felt guilty leaving my friend, the girl I had gotten closest to. It felt like I was leaving her behind. I was released back to residential treatment at the same location as before. My parents drove me and we stopped at the pharmacy so I could buy shampoo. It felt strange (like a fuzzy out-of-body experience) being out in the world, without rules, just for two hours. As a psychology major, I struggled with the idea of hospitalization. On the one hand, I dread knowing what someone may experience, and on the other hand, I understand why a clinical practitioner may recommend hospitalization when a client’s immediate health is at risk. In such a situation, the emotional distress of hospitalization is safer than if the dangerous behaviors continue. 

I remember looking forward to the cleanliness of the residential house. The clean bathrooms, clean walls, clean sheets, fresh air. When I got there I was greeted by familiar faces and some new faces too. This time around had different challenges than my time here before. I grew more desperate to have my own autonomy and became generally fatigued. One thing I struggled with was affirmations. I didn’t like them. They felt superficial and dishonest to vocalize something I did not believe. One afternoon, we did an exercise where we had to pick a random affirmation card and say it out loud. Mine was “I am a warrior”, which just made me mad because I did not feel like a warrior. I asked why affirmations were a part of treatment, but I didn't get an answer until I stepped down in care and was with a different program. They told me that saying positive affirmations primed neuropathways to start believing them and staying positive statements about your body would counteract your judgments and eventually push them out.

 I spent around a month and a half back in the residential program before getting discharged in mid September. Ideally, you leave residential with a partial hospitalization program (PHP; the next step down - a day program) already in place, but I didn’t find a program until three months later. During this time, I was on medical leave from college. This was my first fall without classes to attend. My 20-year-old world that was measured in grades was suddenly wide open and a little empty. My identity had been tied to classes and clubs, and without them, I didn’t know what my interests were. I was scared that a break from school would make me slow down and lose momentum. I was used to always thinking about the future and now I was forced to focus on one day at a time. Slowing down helped me to acknowledge that I was running in quicksand before and this break gave me the time to stop running and get out of the sand. 

After a long three months, my outpatient team helped me find a PHP that worked for me. This was a new program that was completely virtual and very individualized. I liked their structure and started feeling positive about recovery. Treatment changed when I was the one pursuing it. The long space between residential treatment and outpatient treatment helped me find internal motivation and reduced some treatment fatigue. For the first time, I didn't feel like I was treading water, but the lack of that feeling was almost as unsettling as the feeling itself. Over time, I felt like I was coming back into myself. 

I consider myself to be in recovery now, which means I have a bad day every once in a while (instead of every day); my body image takes up 5-20% of my thoughts rather than a consistent 99%; I can catch negative thoughts and use coping strategies when I couldn't before. I am in a spring of my life, with windy rain showers, instead of a dark cloudy winter. 

When I need to remind myself of how much has changed, I think back to my junior year at Geneseo, when I was taking an abnormal psychology course. I sat in the second row from the front, on the right side of the room, closest to the doors. I was late that day because I kept changing my clothes. I remember my professor standing in front of the projector, speaking, and yet I could not hear her. Overwhelmed by my own internal monologue, I didn’t have room to process her words. All I thought about was how big my body felt, as if I filled the entire room, and if the people behind me were thinking the same, and I needed to figure out an acceptable meal for later that day, and should I walk on the uphill road and would that make enough of a difference, and how much happier I would be if I looked the way I wanted.

Now, I sit in a different abnormal psychology course and I can hear the professor, every word.