Transcript from Online Conference with: Stacy Evrard on Her "Experiences with Anorexia"
and Dr. Harry Brandt on "Getting on the Road to Recovery"

Bob M is the moderator.

Ed. Note: This interview with Stacy Edvard was conducted in 1999. On April 15, 2000, Stacy died from medical complications stemming from her eating disorder, anorexia nervosa.

Her sister, Cheryl Wildes, chronicled Stacy's long battle with anorexia on her website. She writes:

"Stacy fought a long, hard battle against this devastating disease. For all of you that have known her in person or through my website, I thought you should know: Eating Disorders do kill. Even the toughest people die from them. Please let her story help in warning others of the danger. Get help and get it early. Stacy was on her way to a 6-month treatment program when an infection set in and ended any chance of recovery. Don't allow your chance, or the chance of a loved one, come too late."

BEGINNING

Stacy: Hi Bob. Good evening everyone. Thanks for inviting me.

Bob M: How long have you been dealing with anorexia and how did it get started?

Stacy: I have been dealing with anorexia since I was 16. I have had it for 20 years. It got started when I was 16. My mother used to weigh my younger sister and I every Sunday morning. I think that's when my obsession started.

Bob M: Can you tell us how the anorexia has affected you mentally, and then physically, over the years?

Stacy: I have short-term memory loss and tend be be depressed alot. Physically, I had kidney and liver failure, 3 heart attacks and have been hospitalized over 100 times. Now I cannot exercise, or bike, or even rollerblade unless I take it very slow. My heart tends to beat very fast. I also have to be in the hospital 2 days a week to be hydrated and get potassium infusions.

Bob M: When the anorexia started, at the age of 16, were you in denial, or did you not recognize it as "being a problem"?

Stacy: Back then, nobody had ever been trained to deal with eating disorders. I didn't even know what anorexia was.

Bob M: Why do you think it got so out of hand - to the point where you are today?

Stacy: Well, I went to a summer camp when I was sixteen, and I just stopped eating because I wanted to lose weight. Years of abuse take their toll on a body. I was raped when I was 17 two times, and started to really feel that I was not worth much. This time around, I got really sick after an operation and I couldn't keep anything down for a month. It threw me right back into my disease.

Bob M: Now you know, there are people in the audience saying, you are unique. They may be saying "this can't happen to me. I WON'T LET the eating disorder get the best of me". What do you say to them Stacy?

Stacy: IT WILL HAPPEN IF YOU DON'T GET HELP!

Bob: We are speaking with Stacy Evrard. She is 36 years old and has been dealing with anorexia for 20 YEARS. During that time, she has had 100 hospitalizations, 3 heart attacks, kidney and liver failure and literally been at death's door. A little later, Dr. Harry Brandt, medical director of the St. Joseph's Center for Eating Disorders will be joining us to discuss "getting on the road to recovery". Stacy, here are a few questions from the audience:

want2bthin: Stacy, how much have you recovered?

Stacy: I feel like I am stable right now. I am not as depressed at before, and I try to be a little bit more social. College has really helped me to build up my self-esteem. I haven't lost any weight in the past 2 years. But I am not any better physically. Actually, I am worse.

Heatsara: It seems you have had to acknowledge the need for help and support. Can you talk about how you came to that realization and what you went through when you "admitted" you needed help?

Stacy: I watched a program about anorexia and realized that I was not the only one with anorexia. I went to a treatment center, but they kicked me out because I was not compliant. When I was sent to the state hospital and lost 16 pounds in 3 weeks, I realized that there was something wrong in my head.

Jenna: What role did your friends and family play in your recovery? How did you reach out for help?

Stacy: My family was too far away to give me any help. Although they were very concerned about me. I have a 16 year old daughter and I want to live to see her grow and have kids. Some of my friends left me because they couldn't watch me die. Everybody thought that I was going to die when I weighted 84 pounds.

Donnna: Stacy, what really made you decide enough was enough? I've been both anorexic and bulimic for 26 years and am totally sick of it.

Stacy: When I didn't know who my daughter was when she came to visit me at the hospital, my brain finally got the message. Because of my daughter, I have a reason to live. Before, I just wanted to go to sleep and never wake up.

Bob M: Since you've been dealing with this for 20 years, why has it been so tough to get through recovery?

Stacy: I am not recovered, but I am stable. I have a treatment team, they help me out a lot, but I just can't convince myself that I am terribly underweight. I will get better. SOMEDAY I WILL.

Bob M: You also mentioned that your family lives far away from you. I imagine it must be difficult to get through recovery without the support of family, without them actually being there to help you. Is that true or not?

Stacy: Sorta, I visited a few times last year. I was fearful that they would reject me because they thought that I looked so bad. I try to just give them a: "I am doing fine". I don't want pity from them either.

Kathryn: Stacey, is your memory loss permanent or can it be reversed? My doctor knows a lot about Magnesium, which is what causes the problems in memory and sometimes I have to get infusions. I also know a girl who is on daily infusions of Magnesium.

Stacy: I cannot remember alot of things. My doctor told me that maybe I don't need to remember. Apparently I was extreemly bad off. I get potassium when my levels are not too low. That helps me remember a little better. I went to college to relearn and to help me store my memories so that I can retrieve them when needed. Chronic malnutrition also has effects on memory.

JYG: I'm 19 and I have battled through this for about 7 years. Even though I have been in recovery for about a year, every once in a while I still find myself throwing up. Stacy, I believe that you can get through this. But I wonder, does it ever really all go away?

Stacy: You know, I guess that those who have recovered would have to tell you that. I think that it sorta hides sometimes only to come out of hiding when we don't expect it.

Bob M: I want to add here JYG, that when Dr. Barton Blinder, an eating disorders expert, was here a month or so ago, he mentioned that research has shown that those with eating disorders, for the most part, suffer relapses at one point or another. Depending on your dedication to treatment the relapses can happen within 5 years of what you might call "recovery". The most important thing is to recognize the relapses and continue to seek treatment...so you don't slip all the way back. He also said that research has shown that the most effective way to treat an eating disorder is first with hospitalization, then medications and intensive therapy, followed by continued therapy.

tiggs2: What's the hardest part of your recovery?

Stacy: I am not recovered, although I wish I was.

Ranma: How have you managed to explain to other family members and friends what it is like to live every day with an eating disorder?

Stacy: My family has known about this for so long. They have accepted the fact that if they put a big plate of food in front of me, that I won't eat it. I live, I survive, and I try to not think about it alot. I do presentations at the college so that they can understand what people with eating disorders live with.

Bob M: What are the two most important things you have learned from your experiences?

Stacy: One, never just quit eating to lose weight. Get help as soon as you can. I may not be recovered, but I live with it. I know that I will get better someday. Don't wish an eating disorder on anybody.

Bob M: Here are some more audience questions:

Ranma2: Stacy, I am a 19 year old anorexic. Most of the time I starve myself and take diet pills. But sometimes I do eat like other people, so I always feel that I am not really anorexic at all. Could this be true?

Stacy: I don't think so. Do you feel wierd after you do eat?

Bob M: And let me add, anorexia is not just about weight or being able to eat an occasional meal, it's also about how you see yourself, body-image, self-esteem, and how you deal with eating issues. So, Ranma2, being able to eat "normally" on occasions, does NOT mean that you are not anorexic. I think a licensed doctor would have to help make that determination.

Sel: What sort of therapy/treatment have you had over the years? What if anything are you in now?

Stacy: I see my therapist twice a week, see my medical doctor once a week, and I spend two days a week in the hospital for hydration and potassium. Each member of my treatment team knows what the others are doing.

Kelli: Is it possible, do you think, to talk your family and friends into not worrying about you and constantly expressing their concerns about you having "a possible eating disorder"? In other words, I want them to lay off. How do I accomplish that?

Stacy: I try to. I do not let new friends know that I am sick. I only tell them after we have gotten to know about each other better. Therefore they meet me, not my eating disorder.

Bob: How do they react, once they know? And, if they are surprised or upset, how do you deal with it for yourself?

Stacy: Most of the time they offer me some of there weight :). Once they know, they don't bother me about eating. For myself, I try not to think about it if I can.

UCLOBO: Stacy, I am a 17 year old bulimarexic and have suffered for 4 years n ow. Do you think its possible to recover without professional help?

Stacy: NO!!!!!!!

Bob M: I want to post a few audience comments....

Marissa: I have had anorexia since age 10. I am now 38 and just found out 4 months ago that I have it.

Laurie: It's kind of hard Stacy, for fear and threats to health to scare one engaged in self-starvation into changing.

Ellie: College usually makes it worse because of the stress.

Donnna: I too have a daughter who is 4 yrs. of age. I want to be here for her. I'm ready to end this battle myself. It seems though that every time I hit an issue in my recovery, I fall back to the behavior

Taime2: I've struggled with this eating disorder for so long, I wonder if there is any hope.

Zonnie: Stacy, do you ever want to go back all the way to how you were before? I'm doing better, but I miss it, however weird that is.

Ranma2: I feel extremely guilty after I eat. Like I have done something shameful Stacy.

Irishgal: I have restricted my calorie intake to 200 calories every other day which I guess turns out to be 100 a day. I am trying to get back to my goal weight of 88 where I was a year ago, but its destroying me now. I passed out and got a bloody nose at swim practice today. I don't know what to do!!!

Julia: I know that my family and friends are worried about me all the time. If I go out for a walk, if I go out for dinner, if I am not feeling well, etc. They seem to make a mountain out of a molehill.

Bob M: Here's a follow-up question to the telling family or friends comment Stacy:

UCLOBO: How, would I go about telling them? See, they would COMPLETELY freak out on me and take me out of b-ball and that is my college tution. I'm very scared to tell them.

Stacy: They may understand, you cannot just push it at them. Let them know that you are in treatment.

Bob M: You can't force it on them. Let them know you are having difficulties...but that you are, or want to do something about it. UCLOBO, one of the most important keys to recovery is getting the help and support you need. Many people are afraid that if they tell their family or friends, they will be rejected. You are not alone with those feelings. But most family members care about each other and want to help. However, don't expect them not to react to the news. And remember to give them time to digest it. And, if your parents are not the supportive type, then you have to seek treatment on your own. Hopefully, you have a friend or two who can be there for you.

Bob M: Stacy, I want to thank you for coming here tonight and sharing your story with us.

Stacy: You are welcome Bob.

Bob M: The audience has been very receptive to your comments. Our next guest is Dr. Harry Brandt. Dr. Brandt is the medical director at St. Joseph's Center for Eating Disorders near Baltimore, Maryland. It is one of the top treatment facilities in the country for eating disorders. Prior to that, he was head of the eating disorders unit at the National Institutes of Health (NIH) in Washington, D.C. I will mention right now that if you are serious about getting help for your eating disorder, and it doesn't matter where in the country you live, you might want to investigate St. Joseph's. The Center is located in Baltimore, Maryland...but people from all over the country go there for help. After the in or out-patient treatment, they will help you arrange for treatment in your own community. And they will help with sorting out your insurance or medicare/medicaid. They have special financial counselors to help with that. Good evening Dr. Brandt. Welcome back to the Concerned Counseling Website.

DrBrandt: Thanks Bob, it is a pleasure to be back.

Bob M: You were here for Stacy's story and her battle with anorexia. How difficult is it to overcome an eating disorder?

DrBrandt: Eating disorders are nasty illnesses....and as we could tell from Stacy's story, they are difficult to recover from.

Bob M: What makes it so difficult?

DrBrandt: There are many reasons. First and foremost, the dangerous behaviors of the illnesses are highly reinforcing. Our culture tends to drive people to continue these behaviors.

Bob M: But why, once you recognize them as dangerous, is it so difficult to stop them?

DrBrandt: I think it varies for the different illnesses. I'll take them one at a time. In anorexia nervosa, starvation itself is potent perpetuating symptom. As people starve, they want to lose more and more weight. They often describe that after they have lost several pounds, something "clicks in" and they want to lose more and more weight. Similarly, the bingeing and purging of bulimia is also perpetuating. People describe feeling "soothed" by the behavior. Because the symptoms are gratifying, they are difficult to give up. The longer they progress, the more difficult it is to give up the primary symptoms.

Bob M: So, what you are saying is, if you catch the symptoms early, there is a better chance of recovery and a better chance of a longer-lasting recovery. Am I correct?

DrBrandt: Yes, early treatment is important and highly effective. But, I have seen many people like Stacy ultimately recover as well.

Bob: For those who want to know: what it is like when you check into the treatment center? What is a typical day like?

DrBrandt: First, patients undergo a series of psychological and medical assessments. Then, they are engaged in a multi-modality treatment that entails efforts to block the primary symptoms of the disorder while trying intensively to understand the meaning of the symptoms. Most patients are in a combination of various groups, individual therapy, and nutritional counseling. Most are in family therapy as well. If indicated, medication is utilized.

Bob: Here are some audience questions:

Heatsara: I have restricted my calorie intake to 100 calories a day...but am lucky if I eat 80. I am trying to get back to 88 pounds where I was a year ago. I am 5'8. The thing is I passed out and got a bloody nose at swim practice today. I am scared to death. I don't know what to do? No matter how hard I try, I cannot eat!!!

DrBrandt: You need rapid attention. There are serious medical manifestations of your ongoing starvation.

Julia: Whoever can answer, please help me. I have been having huge problems, and I haven't been able to eat right etc. I am afraid to talk to any of my doctors becasue they write everything down and they have threatened to admit me. I feel I can not trust anybody. I don't want to be admitted, but I want help. I am really scared.

DrBrandt: I suggest you try to get on the same "team" as your physicians. You have a serious problem and you need help.

Trina: Dr. Brandt - It seems like average inpatient or outpatient stays for ED treatment last 3 weeks - are there any actions to change this and force Insurance co's. to allow for longer-term treatment?

DrBrandt: The length of inpatient hospitalization can vary widely, but many of our patients are only inpatients for several days. They often then transfer into our partial hospitalization program for longer-term treatment.

Jenna: How difficult is it to get help when you don't fit any "clinical" definitions for eating disorders? I know I'm sick, but I'm afraid no one will help me. I'm not underweight, but I have lost 70pounds since this started last November.

DrBrandt: Your rapid loss of weight suggests that something is wrong even if you don't fit into any specific category. You deserve a thorough evaluation and appropriate treatment. No two people are alike.

Bob: Is there like a cookie-cutter approach to treating someone with an eating disorder or does each person need a separate treatment plan?

DrBrandt: Because of the wide variability of symptoms and their origin, each patient needs an individualized treatment plan. Having said that, I would add that there are some common components of most treatment. In our program, we try to focus on providing structure for patients to block their starvation or bingeing and purging, and at the same time work in intensive psychological therapies. It is this approach that we have found to be most effective.

Bob M: I want to post a comment from an audience member. It was a followup to a question about how to let your family/friends know about your eating disorder:

Jenna: In response to UCLOBO...I was afraid of that too. But I was very honest when I told my best friend. I told him what was wrong and what I needed. Simply, I needed someone to listen and a shoulder to cry on. I didn't need someone to force feed me, or nag me...just someone to love me. I helped him get information on the disorder and I let him have a couple days to deal with the well of emotions that my confession brought forth. Let your friends be there for you...you'd be surprised how how strong they will be.

Donnna: Why is it that we always feel the need to fall back on the behavior rather than to deal with the real issues?

DrBrandt: We feel that the development of a healthy support network is an extremely important component of treatment for an eating disorder. The behaviors become a gratifying, soothing (but potentially deadly) way of dealing with underlying conflicts and issues.

Bob M: Let me go back to telling your family-- mom, dad, husband, wife---can you give us a step-by-step approach to telling your family and friends and how to ask for help? For many people that is a very scary thing!

DrBrandt: Yes indeed!!! I think open, honest communication is essential. We have found that it helps if a person with an eating disorder tries to communicate the underlying feelings...as opposed to engaging the family in an overfocus on meals, body weight, shape, appearance, calories etc. I have seen many patients receive a tremendous amount of appropriate support from family and close friends who truly want to help. If there is a lot of apparent conflict and power struggles, then the help of an objective outsider (a therapist) is usually necessary.

Bob: What about people who are dealing with compulsive overeating? What is treatment like for them?

DrBrandt: Treatment for compulsive overeating starts with a complete assessment by a psychiatrist and a nutritionist. Often there are coexisting illnesses like depression or anxiety that require attention. Patients are usually treated in a combination of individual psychotherapy. Nutritional counseling that focuses on healthy, normal eating, and NOT on weight. and if binge eating is a part of the problem, medications might be utilized. We are opposed to the use of diet pills, fen-phen, and other weight loss agents. But we often utilize the proven anti-bulimic medications like the selective serotonin reuptake inhibitor drugs (Prozac, Zoloft, Paxil, etc.).

Julia: What are some of the signs of relapse?

DrBrandt: The signs of relapse are often the reemergence of old behaviors...social withdrawal...dieting...bingeing...overfocus on appearance and weight, etc.

JoO: This sounds weird -- but is it possible to 'walk the walk' and get to a certain point and then step into your own path and stop your healing because it's a safe though painful place to be?

DrBrandt: Yes, JoO. I think that is common. Sometimes people get to a place in treatment where they become resistant. They are afraid to take the next steps toward recovery because it is scary to give up what is familiar.

Becca: I have a friend that is showing some signs of an eating disorder, but how can I be sure? She has a list of things that she wants to change i.e..her wrist, her knee, weight in general...long list...but hasn't actually shown signs of not eating, etc.

DrBrandt: Becca, it is hard to know what your friend is doing when you are not around. We have had patients who were actually able to conceal their symptoms from friends and family for years! The fact that she is so dissatisfied with herself is a sign of a problem.

Bob: So, how, as a friend or family member, do you confront the person suspected of having an eating disorder?

DrBrandt: I think a direct and honest approach is the best method. For example, "I see some things about you that are changing and have me very very concerned. Perhaps we need some help to sort out the reasons that you seem so unhappy with yourself." Open, direct, honest communication of concerns with caring.

Becca: But they get so angry if you say anything. How do you get them to listen?

DrBrandt: Unfortunately, anger comes up a lot in people dealing with these illnesses, and in their friends, families, significant others as well. When angry feelings are flaring up a lot, we often find that objective, outside input from a therapist is needed.

Bob M: And so how do you get the person to go to see a therapist, if they are in denial? or do you just have to wait until they are ready?

DrBrandt: This is an excellent question and a real life problem. I encourage parents and friends to say things like: "I understand you don't think you have a problem, but people with eating disorders often are the last to know that they do have a serious problem. If you think you are healthy, why not get that checked out by a professional? Your unwillingness to get checked out makes me think that you recognize you have a problem." One needs to systematically confront the patients denial and defenses. If this doesn't work then one needs to assess the persons current degree of illness and risk.

Tiggs2: If you were diagnosed with anorexia nervosa and gained the weight needed, are you still anorexic?

DrBrandt: Gaining weight is an important part of recovering from anorexia, but unfortunately, recovery requires more than weight gain. Dealing with the underlying thoughts, feelings, and ideas that led to the starvation is a critical component of recovery.

livesintruth: Dr. Brandt, I'm suffering from a major relapse with bulimia and anorexia tendencies, but have been unable to get the inpatient or residential treatment that is necessary due to insurance reasons. What are some other intensive methods of treatment or is there a way to deal with insurance companies when the situation gets severe?

DrBrandt: We work with insurance companies on a daily basis, explaining to them our rationale for treating our patients. We have found that, in many cases, we are able to help them understand the critical need for appropriate treatment.

Bob: In addition, I believe, the hospital can outline other medical reasons for admission and not the eating disorder specifically as the cause. There are ways to work with insurance companies and the financial counselors at St. Joseph's are experts at it.

JoO: Dr. Brandt -- saying this is all very well, but often it is the parents who are the problem and will not acknowledge therapists as it is shame-based to see a therapist.

DrBrandt: Yes, at times family conflict, or issues between parents and children are central. We spend a lot of time trying to convince parents about the need for intensive treatment. But often we have been able to help them "see the light."

Bob M: Good Night

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