Estimated read time: 8-9 minutes
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Like a child with a coloring book, Pat huddled over the figure of a gingerbread person she had drawn on a large white piece of paper.
It was the first assignment on the second day of a six-week group therapy program for eating disorders.
Therapist Ann Kreindler-Siegel asked each of the women in the group to draw a "gingerbread person," to let that outline represent their own bodies and to "color any part of your body that you don't like, in colors that feel like those parts that you don't like."
With crayons in hand, they focused on body parts.
One woman who struggled with overeating smothered everything but hands, ears, hair and eyes in brown, then covered it again in black.
Even the thinnest of the women, who either ate very little or binged and purged, covered hips and thighs in colors that signified hatred or unhappiness.
Pat colored the figure's face black, but left white dots for eyes.
When it was her turn to explain, she said she thought her face looked drawn, thin and old. But her eyes were important and useful.
"I see all kinds of things, and I have thoughts about all kinds of things, but I don't express them," she said.
What she didn't tell the group was that she felt she could never say what she really thought. People at work often told her how much they liked her because she was so "pleasant." But they didn't really know her, she thought. They didn't know she wanted to scream at them sometimes. But she never allowed herself to show anger or even to say "No." She always smiled and said, "Yes."
Instead of expressing anger to others, she showed her defiance with food and exercise. She would not eat what everyone else expected her to. She exercised more than most. It made her feel safe and in control. She stayed thin, and that made her feel special.
Ann and Joyce Hennessy, the group's co-leader, encouraged the women to think differently about their body parts, to think of them in terms of the important tasks they perform. For example, without thighs and knees, you couldn't sit or stand or be independent, they said. Without arms, you couldn't hug the ones you love.
Sometimes the unrealistic perceptions that women have of their bodies come from messages they've heard in childhood, the therapists said. And sometimes those beliefs stick with us even though we know they're not true and long after they're useful.
"You're adults now," Ann said. "You can parent yourself. You do know what's best even though no one's told you that."
Instead of overeating, refusing to eat or bingeing and vomiting, Ann suggested the women try other ways to get rid of anger. Take "mad walks," stomp as hard as you can, write "unsent letters" to the people you're angry at, throw ice in the back yard.
"It's OK to just be angry, rather than turning it against your body," she said.
The women left with instructions to nurture a part of their bodies.
Pat said she would use some scented lotion on her face.
During the second week of therapy, Pat felt more at home. It was two hours in the day when she felt safe. But then came the third week, and she was nervous again.
That was when the women would begin to share their personal stories.
"For most people it's the most healing week," Ann said, anticipating their anxiety. "You, of course, are welcome to share as much or as little as you want. But other women who've been through the group tell us that the more they're able to share, the more recovery they're able to get."
Ann and Joyce said people sometimes develop eating disorders to help cope with traumatic events from childhood.
Trauma might mean death or divorce, or it could be subtler, such as teasing. It is "any emotionally overwhelming event," Joyce said, and you may have tried to cope with it by stuffing down the emotion instead of acknowledging it. You may have looked at food as the only thing you could control, as a way to cope.
"This has been your way of being resilient," Ann said.
By confronting that trauma as an adult, you can see it for what it is, and get in touch with the emotions that you've been avoiding, they said.
"Once you develop the awareness, and push through the denial, you don't go back," Joyce said.
The woman who had covered her gingerbread person in brown and black volunteered to speak first. She said her mother had been ill from the time she was born. "She wasn't able to hold me for maybe the first year."
As she spoke, the woman's eyes glazed with tears.
Someone passed a box of tissues.
Ann wiped her eyes too. She had been seeing this woman in one-on-one therapy for five years and had never seen her cry.
The woman also said that a man who worked for her father had once exposed his genitals to her. She told her mother, but she said her mother didn't believe it.
One of the other women said she'd had a similar experience. A third said she had too.
The story moved Pat to speak.
"You told (someone) who was supposed to be the authority, and they didn't do anything about it," she said. "That makes me sad."
The group felt warmer and more nurturing. For the rest of that session and through the next, the stories spilled out, and the women offered words of support.
When Pat's turn came, she tried to hurry. Compared to the others, she didn't think anything significant had happened in her life, nothing that justified her eating disorder behavior.
She said she was born into a family of successful people. Her grandparents, parents and brother were all perfect, she said.
"It was understood that you were going to behave. I was always afraid I was going to disappoint someone."
Her hands moved nervously, but her face showed no emotion.
When she was 8, Pat said, her grandfather was killed in an accident, and she became afraid of being left alone. "I'm not sure I ever learned how to deal with that fear," she said. "I was afraid to go to school, to be left alone with the babysitter."
Then, when she was a teenager, she suffered a series of tragedies - a basketball teammate committed suicide, a friend was diagnosed with a brain tumor and a beloved teacher was shot and killed by her husband.
Pat told the group that, after many years of therapy, she knew that fear had kept her from going to sleepovers with other girls and doing other fun things as a child. In the same way she had "restricted" her social life, she said, she would later restrict her eating as a way of gaining some control.
When she graduated from high school, she forced herself to go away to college, and then she graduated with honors and joined a large national accounting firm. But after two years, her job was cut. She took it as another sign that she wasn't good enough: "Just me as myself, I'm not on a par with other people. I need to do more."
Not wanting to take too much time, she left out a lot of her past.
She didn't tell the group about the day her eating disorder began.
She was between junior and senior years in high school, when she stepped on the scales and decided to go on a diet. She weighed 122 pounds, an acceptable weight for her height, 5 feet 5 inches. But she thought she should weigh 115.
She doesn't remember why weight became so important that day. She had watched her mother diet continuously for years. And she had always been self-conscious about her "long-waisted" figure. For dance class, she always had to buy a bigger size leotard than normal so it would fit her long torso.
At the time, dieting didn't seem like a big deal. She thought it was something she and her mom could do together.
Pat already got plenty of exercise, with basketball and dance class, so by cutting back on meals, she quickly lost weight.
About three months later, she had lost so much weight that her menstrual periods stopped. Her parents worried. During second semester of her senior year, when she came home at noon, either her mother or father arranged to be there to make sure she ate lunch. When she went out with friends to Burger King, they'd get hamburgers, but she'd order salad. She felt powerful knowing she could resist foods she liked.
"There were so many things that weren't under my control," she would recall years later. "This is something I have power over. I can control what goes into my mouth. It was one thing I knew that went totally against what my parents wanted."
She told the group that she is still afraid of appearing less than perfect.
"If I have to admit that I need help, then I've admitted failure."
When Pat paused, Joyce assured her that she'd been very resilient by finding ways to cope with her fear.
"But why is it still baggage?" Pat asked. "It was so long ago."
The events might be old, Joyce said, but the feelings remain unless they are confronted, examined and rejected. If you change what you think about what happened, you can change the way you feel about it, Joyce said. And when the emotion changes, the behavior - in this case, refusing to eat - will change too.
"You ARE good enough," Joyce said.
Pat thanked them for listening.
But she didn't feel comforted.
She thought they were only trying to make her feel better.
When she was gone, she knew they would say she was just being silly.
(c) 2003, The Charlotte Observer (Charlotte, N.C.). Distributed by Knight Ridder/Tribune News Service.