To avoid monotony, and provide a basic framework for my story, I’d like to get the basic facts out of the way. I developed anorexia nervosa at ten years old. The weight loss was quick and drastic, and when my parents’ friends began asking if I had a terminal disease, they got right on the phone to make an appointment with the nearest specialist. I was diagnosed at the beginning of my fifth grade year, and fought and cried and saw three treatment providers weekly. By the beginning of the next school year, however, I was better. I thrived in middle school, and even remember joking with friends about how “I couldn’t even be anorexic again if I tried.” False. At thirteen, a few months before middle school graduation, I relapsed. It was slow, and it was gradual, but my eating disorder came back with a force that I hadn’t even remotely felt when I was ten. On my first visit back to my old specialist, in early August, I was admitted directly to the hospital.
That year, my freshman year of high school, was marked with three more hospitalizations, bringing my total time spent in the hospital, and not spent in school, to seven months. I was discharged from my last hospitalization in late June, when all of my friends were finishing their final exams of freshman year. I continued to fight and struggle, probably even harder than I had in the hospital, to get healthy.
I want to share what it’s really like to live with an eating disorder – beginning to end, no glitz, no glamour, no vain teenage girl who wants to be skinny. Most people think eating disorders are sociocultural illnesses caused by the media. While our societal obsession with thinness can certainly exacerbate the illness, in reality, eating disorders have some of the strongest genetic and neurobiological underpinnings of any mental illness. For me, what started off as a simple diet quickly set off a very different reward and motivation system, and my behaviors became compulsive rather than logical. Further, when most people think of eating disorders, they think of white, young, rich, skinny girls. Unfortunately, this stereotype is wildly inaccurate. Rates of most eating disorders are equal across socioeconomic brackets, in white, latino, asian, and black communities, and rates of bulimia can actually be higher in black and latino communities. One in three sufferers are men. Roughly 30% of sufferers struggle with an eating disorder for their entire lives, so we’re not just talking about teens. And the majority of people with eating disorders are not underweight: you really can’t tell just by looking at someone. The one thing I am certain that all sufferers would all agree on is that there is absolutely no glamour in suffering. I hope I can provide concrete evidence of this.
My eating disorder was not a reaction to any traumatic experience, nor an attempt to fix any horrible flaw. I was born into a loving family, and had a happy childhood. I was also born into a family with an extensive history of OCD, anxiety issues, and depression. My eating disorder began at 10 when my babysitter went on a diet, and I decided to try it. My relapse at 13 started, rather innocuously, as a way to make myself “perfect.” I didn’t like the few pounds that puberty had caused me to gain, so I decided to lose them.
It was harmless at the beginning, and felt great. I don’t think it had very much to do with a number or how I looked (as a few pounds is pretty insignificant). I just loved that I had set a goal and achieved it so quickly. The important thing to point out is that at this point, my personality had been unaffected. I am, by nature, an extremely outgoing and vocal person. I’ve always been the “social-butterfly” type in and out of school, speaking my mind with very few worries or restraints. This is something I never intended to change. With the reemergence of the eating disorder, however, it completely did.
I never understood that losing weight – too much weight – not only had physical consequences, but psychological ones as well. I slowly started to become much more isolated and withdrawn and socially anxious. I didn’t have energy, and wasn’t fun anymore. When I talk about my anorexia, I liken it to OCD, and in fact, 41% of patients with eating disorders have an OCD diagnosis as well. The logical, or at least semi-logical, goal on which my actions were motivated was long past. Restricting had become my new answer for everything; starvation was my default mode. When my parents fought, for example, not eating lunch would take care of all the uncomfortable feelings I was having. Logically, I knew that losing weight was unhealthy, and would make me unattractive, and that I was pretty close to destroying my family if I kept this up. It didn’t matter, though, what I thought or knew or wanted, as the eating disorder had grown to a new level, the mental anguish of putting that food in my mouth was just too much. Kind of like a compulsive handwasher, you know it doesn’t make logical sense, but you can’t stop doing it. It was extremely gradual, which made it even harder to pinpoint, as there was no distinct change. Eventually, though, I lost all aspects of Kristina and became all consumed in darkness.
When I was engaged in anorexia, I was a completely different person. All of my time and energy went into protecting my disorder. I’ll give you a few illustrative examples. At the time, my parents were doing family based treatment, now the gold standard for adolescents with anorexia, where parents prepare, serve, and monitor everything you eat. I was required to have caloric beverages at every meal, which my parents would monitor. I would sneak out, walk to the grocery store a mile away, buy diet beverages, and when my parents were in another room, intricately switch the labels and dispose of the drinks that my parents had bought. Similarly, I was obsessed with scales, I used to weight myself multiple times a day and that number dictated everything. My parents threw away my scales, and three separate times, I lied about afterschool plans and took the bus to Macys to buy a new scale. Keep in mind, I’m a 13 year old, in the suburbs, without a car, before UBER. Perhaps the anecdote that best captures who anorexia turned me into is this one. It was a weekend, my mom was supervising me for lunch, and I was delaying because I knew she had a hair appointment, and just maybe I’d get out of eating. Should have thought that one through a little more, because she just made me come to the hairdresser with her to eat in front of her. It was a frigid January day, and I was wearing a down jacket. Every time my mom would turn to glance at her hair, I would frantically tear a chunk of my sandwich off and stuff it into my jacket. That’s who anorexia made me. I didn’t care about my neighbors looking at me strangely thinking “what in the world is this girl doing;” I was more scared that I’d have to eat the sandwich.
Something else weird happened to me when I was in my disorder, too: I didn’t want to get better. Anorexia and the treatment world became my identity, they were safe, and they were comfortable. I looked up to the 40 and 50 year olds in my treatment centers who had been in and out of hospitals upwards of 30 times. When doctors told me they thought I was going to be a chronic case like them, I thought it was cool. This is actually pretty common. Anasognosia, which means “lack of insight into illness” is a term that we typically associate with schizophrenia and bipolar disorder, but it happens commonly in eating disorders too. People with eating disorders often don’t think they’re sick, don’t think they need help, and don’t think recovery is possible.
Clearly, and thankfully, I got better. There was no click. I also didn’t have any wonderfully compelling reason. It was more of a “what do I have to lose”. (No pun intended.) I decided that real life was at least worth giving a shot; if it didn’t work the eating disorder would be waiting for me with open arms. The recovery process, though, was hell. People always told me to latch on to the things in my life and parts of myself that were unrelated to the eating disorder. That made sense, except for the fact that nothing, not even one small fraction of my life, was “unrelated to my eating disorder.” Everything I could think of inevitably led back to mirrors, or food, or weight, or perfection, or calories, or body image, or measuring cups, or The Best Little Girl in the World. No, I was unable to dissect and revive any “normal” pieces of myself. Essentially, I had to wipe my slate clean and restart.
When I returned to school in September of my sophomore year, I felt, socially, like a five year old. To make matters worse, my insight and self-awareness were far beyond age appropriate, so I was painfully cognizant of my awkwardness. My self-consciousness extended far beyond body image – (though, thinking that you look 200 pounds while still idealizing 60 pound girls on feeding tubes is a pretty torturous mental state to be in.) I vaguely remembered the bold, happy girl that I used to be, and longed to be her again. But there was such a disconnect between me and her; I had no idea how she had gotten so confident, and even less of an idea about how shy, strange, me could even come close. The simplicity and convenience of anorexia was so tempting. But my parents were breathing down my neck, and my body was tired, and I logically knew that no matter how many times I went into the hospital, I would eventually have to come out, and face all of this. Comparatively, facing it in the present would probably be my least painful option.
Recovery required me to step way out of my comfort zone for about two years. Or, rather, forever. That comfort zone was keeping me sick, and so I had to eventually create a new comfort zone. Eating wise, I had to butcher all my “sick” rules. No more measuring cups, fat intake limits, or “I don’t eat after 8pm.” If we had a surprise pizza party in school, I ate pizza. It killed me to forgo my turkey and lettuce on whole wheat bread for a fresh baked cheesy slice, but that’s what normal teenagers do. I wanted to be a normal teenager. I got rid of my scale. Best decision ever. I had tried to convince myself for years that I could have a healthy relationship with my scale, as it was my biggest security blanket, but our relationship had never been anything but unhealthy and I knew it was hindering my recovery. I resisted my crazy impulses to “body check” by seeing exactly how my clothes fit and where they hung and scrunched. Sometimes I felt like I was crawling out of my skin, but I wouldn’t let myself do the checking.
Socially was probably the hardest. As previously mentioned, I had horrible anxiety around social situations. Or really, around people in general. At first, I challenged myself in little ways, though at the time they seemed enormous. I began to call friends to get coffee with me, or get our nails done. Once I had built up enough confidence in myself and realized I could hold a conversation and be fun for an hour or two, I stepped up. When my friends would call and invite me to parties, instead of saying I’m sick or tired or have homework, I would say yes. For a few solid months, I was miserable. I kept putting myself out there, though, in hopes that I would eventually begin to actually enjoy spending my time as normal teenagers do. Today I do.
After a solid while of doing well, I hit a minor plateau. For a while, I thought that this was “as good as it was going to get.” This is where the self-insight work came in handy. Slowly, I began to realize that, frankly, I will always be a perfectionist. That’s okay, and that doesn’t mean that I will always have eating disordered thoughts and be unhappy with my body. For me, it wasn’t about trying to rid myself of my perfectionist tendencies, but rather, redefining my image of perfection and who I wanted to be. I stopped idealizing waif bodies; healthy Kristina was beautiful and had a real woman’s body. She exercised to feel healthy and strong, and not in a panic about eating too much at lunch. She ate ice cream with her friends, and was able to laugh at herself. She got excited about books, and current events, and making a difference in the world. She radiated an inner confidence that made people gravitate towards her. She was happy.
I never believed I’d be one of those girls who ate whatever they wanted and embraced their healthy bodies. I also never tried. There was no click, no “magical pill” to cure me. I made a conscious decision to change my life, and worked at it. Now I’m a real person. I have hopes and dreams. I have real relationships. I go out and socialize. I care about important things instead of how many calories I ate for lunch or how much I weigh. People don’t pity me anymore, they want to be friends with me. None of this would be possible if I hadn’t gotten rid of my eating disorder. So, as a dear friend of mine once told me: You have a choice. Miserable sick little girl who misses out on everything. Or real girl who LIVES. Try it.
Kristina Saffran graduated from Harvard College with a bachelor's degree in psychology in May of 2014. She is currently serving as the executive director of Project HEAL. Kristina was named a 2017 Forbes 30 under 30 social entrepreneur, and has been profiled in The New York Times, Fast Company and People Magazine. She’s spoken across the country –Stanford Medical School, Harvard College, The International Conference of Eating Disorders, and more – on eating disorders, recovery, and launching a successful social entrepreneurship as a teen.