The Problem with the Problem

Arianna Hartloff has battled symptoms of eating disorders since middle school but has never been formally diagnosed or treated. One person among the five percent of the U.S. population that has symptoms of undiagnosed bulimia, she felt her problem was nothing to worry about–until it got out of hand.

By Alex Kincaid

This story was written for Ball Bearings using The Atavist. Please note: The Atavist no longer supports this content. The story originally incorporated embedded videos, slideshows, and other multimedia features. 

A LIFE OF IMPERFECTION

Arianna Hartloff sat down at the table alone. The sound of others talking lingered in the background, but she was quiet. Sleep deprived. Annoyed. She wanted to be anywhere but here. Her homework needed to be done. She wanted to read her books. The nurses were watching closely. No one was allowed to go to the restroom. She knew breakfast would be served any minute.

She needed help with her depression and anxiety, but what her mother, friends, and the doctors at the St. Vincent Stress Center didn’t know was that she had purged six days a week for two months that year. Before that she had been starving herself off and on since sixth grade. But now, she had no choice but to help herself. She had kept her problem a secret from everyone. She intended to keep it that way.

* * *

Arianna has been battling symptoms of anorexia nervosa and bulimia nervosa since middle school–starving herself at times, and at others, purging her food. We know 30 million people in the U.S. have an eating disorder, but we don’t know how many people are suffering without it being diagnosed. There are estimates that suggest five percent of the United States has undiagnosed bulimia, but if people don’t come forward with their symptoms, there is no way to calculate just how many people are suffering undiagnosed.

At the start of sixth grade, Arianna started dating. She wanted to be popular, have a boyfriend, and be the attractive queen bee of her social circle. But one day, her boyfriend kissed her friend behind her back. The consequences went deeper than just betrayal.

This middle school drama turned into feelings of being worthless, hopeless, and desperate. She developed an extreme dissatisfaction in her appearance–something had to be wrong with her. She wasn’t good enough for anyone.

This is when she started to purge. Arianna was only a few weeks into sixth grade and for two full weeks she had symptoms of bulimia–she would intentionally throw up her food after meals. The drive for an ideal body overpowered the voice in her head telling her it was wrong. She knew what bulimia was–but she didn’t have that. This was different, she told herself. She didn’t have a problem.

Adolescence is a common time for eating disorders to develop because of the many biological and psychological changes that occur simultaneously, said Laura Savat, the community outreach specialist for The Emily Program, which is the largest outpatient eating disorder treatment program in the nation.

After just two weeks of purging, Arianna stopped. A guilty conscious weighing on her mind, the decision was easy. 

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“Don’t be so wasteful,” her mother would tell her. “There are starving kids in Africa.”

Arianna had been taught that throwing out food was wrong, so she started eating less to compensate for the food she would otherwise be wasting. Individuals can fluctuate between symptoms that are characteristic to different eating disorders for a variety of reasons, but mostly because at the core of the symptoms, the problem is the same. There is an unhealthy relationship with food. 

* * *

Arianna’s health class that year didn’t convince her to stop this unhealthy behavior. It only encouraged her.

Normally, she brought a book to read during class–anything to escape into a world different from her own for a little while. But for the lecture on nutrition, she forgot one. She had nothing to distract her–inconveniently on the lecture that would do more harm than good. 

The teacher told the class to eat smaller portions, not to overeat, and to always drink water before meals so that less food is consumed. Although there is truth in what he discussed, for a young girl who had body image issues and unhealthy, disordered eating patterns, the message was skewed. 

Arianna was developing less of an appetite and was eating food very sparingly. She had been for around a month. She had no intention to stop. Her weight was dropping quickly. People noticed. It was brushed off as a growth spurt, because she was also getting taller.

She idly took notes, sitting in the front row, as the teacher showed them pictures of healthy people–people who were skinny, toned, and idealistic.

“This is what it looks like to be healthy,” he said.

Her eyes were locked on the images before her. They were beautiful, fit, happy. Most strikingly, they didn’t look like she did. Her mind started to wander. Her life would be so different–so much better–if only she looked as good as them.

Our society sends mixed messages about what is healthy and what is unhealthy, which encourages this obsession with food and body image. Dieting is one of the top risk factors for developing an eating disorder–something American society promotes endlessly.

Arianna had mostly absent adult figures in her life, so there was no one to check up on her at home to make sure she was even eating. 

Her mother and father divorced when she was six. She hasn’t seen her father much since, because he moved to Texas with his girlfriend, and then to New York. Arianna never liked his girlfriend; she didn’t mind not having them around.

“I hated her so much,” Arianna said. “She essentially took my father away from me.”

Today, she only sees her father around once a year. 

Arianna lived with her mother and, occasionally, her older sister lived at home, too. Lynnette Britt is eight years older than Arianna. She ran away from home a lot when her sister was young. Her goal was to escape her broken home any way she could. She told Arianna that when she turned eighteen, she would get custody of her. She loved Arianna most of all, and didn’t want her to endure the home life she had been stuck with.

Lynnette said she and Arianna have always had a special connection. Because of the age difference, she thought of Arianna as more of a child than a sister. She was protective of her, and wanted her to have the best life that she could. 

Arianna developed a somber demeanor during this time. She didn’t talk to her mother often. Lynnette said that anyone who paid attention could see that something about her was off. But during this time, she was in and out of her sister’s life, and so she didn’t really know what was going on either. This only made Arianna’s new lifestyle of avoiding food easier. No one at school would ask her to eat, and neither would anyone at home. 

You’re probably wondering what exactly was going on at home to make Lynnette run away and to allow Arianna to stop eating without anyone noticing. There was a lot going on at home, but that’s a separate story to tell. The important thing is that Arianna’s home life wasn’t ideal, and it contributed to her unhealthy eating patterns. 

Eating disorders can arise in more ways than people tend to realize, said Allison Kreiger Walsh, founder of the nonprofit Helping Other People Eat, H.O.P.E. Often, eating disorders arise as a coping mechanism for an underlying problem. For some individuals, like Allison, who is a survivor of anorexia nervosa and bulimia nervosa, eating disorders are a form of control, as eating is one thing in their lives that they have power over.

Arianna left her health lecture on nutrition feeling more determined than ever. She decided she would start to eat even less, and eventually she would be good enough–at least for someone. Like the people in the photos, she would have it all. 

“Everyone tells us to listen to our teachers,” said Arianna. “I was just doing what I was told.”

An Uphill Battle

Six months later, Arianna had stopped eating.  Each day she had some soda and juice, but mostly water. If she felt particularly weak, or if she thought people might notice, she ate a piece of fruit, maybe some vegetables–not much more.

Although she didn’t talk about it, she noticed simple, daily tasks were becoming more difficult. She couldn’t even go on her after school walk with her friend without feeling winded and out of breath. It was a struggle to walk and talk. She needed frequent breaks to sit down and rest.

The body can use liquids, like juice, efficiently because there is nothing to digest, said Amanda Kruse, a wellness nutritionist at Ball State University. However, the body cannot sustain it. Any nutrition is used up quickly, and once it’s gone, it’s gone. 

Similarly, if a person is eating only fruits and vegetables, they are missing out on a lot of nutrition their body needs. Amanda never recommends an individual eat less than 2,000 calories a day. She said most people don’t realize the amount of calories needed for the body to perform basic life functions. 

Arianna’s body was running on empty. 

One afternoon, despite the fact that Arianna was not feeling normal, her friend Zoe convinced her to go on their usual after school walk–a four or five mile hike along the White River that would last a few hours.

The two were in different years in school, so they didn’t see each other until the afternoon. Their usual hike was a way for them to catch up and relax after a long day of classes. They would start in the woods behind Arianna’s apartment complex and follow the river until it intersected with the interstate.

The two would trudge along the muddy paths while avoiding the fallen branches and shrubs in their way. It was never a big deal to walk for miles at a time–at least, not usually. 

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Arianna could not believe the ultimatum she received. Especially coming from her best friend. She made the decision to end their friendship–she didn’t need someone snooping around her business when she had it under control. Besides, it was her body and she didn’t want anyone telling her what she should do with it. She didn’t need someone judging her and trying to control her. 

Denial often accompanies eating disorders, and people often fail to recognize they have a problem at all. When people don’t recognize that they have a problem, they are not being accounted for in statistics. This is another reason why there is not an exact number of those individuals who are suffering with eating disorders but do not get diagnosed.

People also deny their eating disorder exists because there are more pressing issues going on in their lives. Laura Savat said often people don’t recognize they have a problem because they are too busy dealing with other, more prominent concerns.

The fact that Zoe started to notice something was off was concerning. Arianna worried others might also try to step in and tell her what to do. She found a way to prevent others from taking notice by simply keeping food around her. No one would question her about food if they saw her with it.

Arianna was now consuming only half a bag of snack-size carrots a day. This lasted for nearly a week. At lunch, she ate each carrot slowly and intentionally. Her appetite was nonexistent. It was difficult to make herself eat the little that she could manage. Each day she bought healthy food at lunch, but it all ended up in the trash. No one asked any questions.

In addition to her dwindling intake of food and troubled homelife, Arianna was facing bullies each day at school for reasons she still can’t name. As if she didn’t have enough to handle, a new compulsion began to consume her time: keeping her weight below ninety-nine pounds. 

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Typically, those suffering with eating disorders spend upwards of fifty percent of their day thinking about food and body image, said Laura Savat. Appearance and food becomes an obsession. 

* * *

A little more than a year went by with Arianna still fretting over her food intake and her weight. But the summer before her freshman year of high school, she started to eat more regularly. She developed a healthier relationship with food–at least, for a short time.

The stress of high school brought back the purging she had not experienced since the sixth grade.

During her sophomore year, she was consuming very little food and then throwing up twice a day, six days a week. This lasted for two months. She knew this behavior was unhealthy, and she recognized that she was not all right. But with every purge came praise. Her weight was dropping. She was thinner. She was closer to perfection–not to mention flooded with compliments from her peers. And so, the purging continued.

Eating disorders can exist without anyone ever suspecting there is a problem. Individuals with eating disorders may hide their behavior, deny they have a problem, or withdraw from social contact completely so no one notices.

Contrary to a common myth about eating disorders–that one has to be stick thin–those with eating disorders may actually be of normal, healthy weight or even overweight, according to the Mayo Clinic. Eating disorders are a mental disorder, something that is not always noticeable from the outside. Only a small percentage of those suffering with eating disorders reach a state of emaciation that is often portrayed in the media as typical of eating disorders. Around one in twenty people will be affected with an eating disorder at some point in their lives, according to The National Alliance on Mental Health.

Arianna’s stress levels during high school skyrocketed. She became depressed, developed anxiety, and also started cutting herself. She had lost control and was drowning in a sea of problems she couldn’t escape.

It’s not uncommon for eating disorders to occur along with other psychiatric disorders. Nearly fifty percent of those suffering with eating disorders also meet the criteria for clinical depression, according to the National Association of Anorexia Nervosa and Associated Disorders.

“Most of our clients actually struggle with something other than an eating disorder,” said Laura Savat. “It’s not a stand-alone problem. Many of our clients also struggle with anxiety, depression, and chemical dependency. A lot of the time with eating disorders there’s trauma involved. They’re harboring something else.”

* * *

Arianna’s mother took her to the St. Vincent Stress Center in Indianapolis, Indiana for help with her depression. She arrived at 3 a.m. after two hours of begging not to go. Once her mother got off work she had planned to take her, but Arianna resisted. 

She sat on the bathroom floor of her home and sobbed. Her mother waited in her bedroom until Arianna came around and decided to cooperate. She had reached the bottom. She couldn’t get much worse than this–it was time to claw her way back up. She got dressed, packed some books, and got in the car to leave, still hesitant of the journey that lay ahead–still hoping that her mother would change her mind and let her stay home. At least her books would provide a little comfort for the four days she’d be gone.

After checking in, her bag full of books was confiscated immediately–nothing but clothing was allowed. She didn’t bring any clothes because after two hours of sobbing, she wasn’t thinking straight when she went to pack her bag. 

A nurse escorted her to her room where she cried herself to sleep. More than once, she was woken up by nurses peeking in the door to check on her and her sleeping roommate. 

At 6:15 a.m. her blood pressure and temperature were taken. Arianna had gotten less than three hours of sleep, and after the nurse was done she slumped back into bed until breakfast at seven. She couldn’t endure this much longer–and it was only day one.

Since Arianna didn’t bring other clothing, her roommate let her borrow a shirt so she wouldn’t have to wear the clothes she had slept in. She put the shirt on without saying much and walked into the dining area. 

The teenagers staying in the stress center with Arianna were segregated by gender. The girls ate in one room, the boys in another. There were only five other girls. They sat together at a small round table, idly chatting while they waited for breakfast. Arianna walked by them, head down, still groggy from her lack of rest. She sat down at a different table by herself. 

Broken, angry, defeated. She knew she couldn’t live like this anymore. She knew she needed help with her depression. She knew she shouldn’t be as anxious as she was. She knew she shouldn’t purge and starve herself. But she had homework to do, she wanted to read her books, she wanted anything but to be stuck here. 

Arianna looked up to find the girls at the other table standing up–her roommate leading the way–and carrying their trays over to her table to sit down. She didn’t say anything. They introduced themselves to her, but she kept quiet. 

Then breakfast arrived. Arianna’s gaze fixed on the plate in front of her. She was emotionless, a shell of the person she used to be. She wanted to feel something other than brokenness for once.

The others ate and carried on conversation. Joking, laughing, smiling, making light of the situations that led them to the stress center. Some suffered with eating disorders, some depression and anxiety, one girl was there because she stabbed her brother. They didn’t dwell on their problems, Arianna noticed. There was an understood respect for each other–they each knew what it was like to have a fucked up past. They bonded over that. 

Something clicked inside Arianna that morning. She had a world of people she could blame for her past, her broken home, her shitty body image–but so did everyone else. For the first time, she felt accepted. Understood. Like she wasn’t the only one. 

The discussion shifted to food. Arianna realized that she hadn’t touched her plate. Afraid the others might notice, she picked up her fork. She stared at the food in front of her and forced herself to take a bite of scrambled eggs. They were delicious. She took another bite and started to laugh with the others. She realized she was actually enjoying herself. 

Although she still had obstacles to overcome, she felt that she had room to breathe now. Her struggles still lay ahead, but they weren’t as daunting. A system of support was set into motion that morning. She didn’t have to make it on her own anymore–she had people who understood to make that journey with her.

“When you see someone else struggling, you don’t know their pain,” said Arianna. “But you know what it’s like to have pain.”

The stress center became a safe haven. It was a world separated from normal society. Arianna felt at ease and secure, for the first time in years, relaxed. Transitioning back home after her four-day stay was actually difficult–the real world wasn’t as empathetic as those who understood her pain and her past. She never saw any of the girls again. They were told not to share contact information, and even though they did, it was harder to find each other online and stay in touch than they thought.

The Road to Recovery

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Arianna is now a junior at Ball State University. One afternoon, she sat in a campus dining hall picking at her plate of food and talking to her fiancée, Alyssa VanSkyock, about the times she has struggled with eating while in college. And how, although the stay at the stress center focused on easing her depression and anxiety, it also helped to heal her body image, self-esteem, and struggles with food. 

When Arianna becomes stressed in college, she gets a severe pain in her stomach that makes it difficult to eat. The pain is persistent and makes her stomach churn. Food is the last thing she wants when she is having a stressful day. Unfortunately, she is usually always stressed about something.

Just this year, she had a bit of a relapse. She intentionally didn’t eat until forced to do so. The pain in her stomach lingered, warding off food at all costs. 

It was Labor Day weekend and she went home for a family party. The family ate, but Arianna was anxious about being home. Her stomach pain relentless. To deal with the pain and to combat the stress, Arianna started drinking alcohol without having eaten anything that day.

Her mother handed her a brat and told her to eat it. She didn’t touch it, but each time her mother would walk by the grill and into the house she would pass Arianna and tell her to eat it with a serious look on her face. Eventually, she gave in and ate the brat, but had nothing else for the rest of the day. She kept drinking to alleviate her troubles.

* * *

Recently, her obsession with knowing her weight has become a problem again. She weighs herself constantly when she has access to a scale. She and her fiancée don’t keep one in their apartment for that reason. Arianna thinks it’s starting to get bad again, and that worries her. 

Only around half of people with anorexia and bulimia make a full recovery, according to the American Psychological Association. However, only one in ten people receive treatment for eating disorders. 

Only around thirty percent of people who do receive treatment get adequate treatment, said Laura Savat. On average, clients of The Emily Program take four to eight years to fully recover. During that time, relapses are common. 

“It’s not a 30 day program. It’s not a 60 day program,” said Laura. “It has to be tailored to everyone because everyone is so different.”

Alyssa has a personal rule that if she is going to get food, she will make Arianna food also. She cooks for each of them at least once a day in their apartment. If she is ever hungry, she is sure to make more than enough to share some with her fiancée.

At first, Arianna concealed her problems with food from Alyssa. They didn’t eat around each other that often at first, so it was easy to hide. 

Slowly, Alyssa started to realize that something was off. She would ask Arianna if she wanted food, she would offer her food, or ask if she was hungry. The responses were usually the same. “I’m not hungry, I ate earlier today.” Alyssa knew something was up.

* * *

One night, not long into their relationship, they talked for two hours about their pasts in Alyssa’s car after leaving Scotty’s Brewhouse in Muncie, Indiana. 

Arianna opened up first. She revealed her struggles with food, what it was like to grow up in a broken home, the depression and anxiety, her time in the stress center, and other past traumatic experiences she hadn’t spoken a word about in her life. Alyssa followed, bringing up past experiences she had also locked up deep inside.

Just six months later, the two were engaged. They moved in with each other a few months after that. Arianna still hasn’t told her mother about her engagement.

Arianna says Alyssa keeps her calm and doesn’t let her become overly anxious. When she is having a breakdown or panic attack, Alyssa grabs a fuzzy blanket and an anti-anxiety coloring book filled with detailed mosaic designs. She sits down on the floor with her fiancée and puts her arms around her. “I’m still here.”

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* * *

Alyssa went to Olive Garden with her family near the end of the fall semester of that same year, and while there she got a text from Arianna saying she was hungry. Almost immediately after that she got another one. “No I’m fine. Don’t order me anything.”

But Alyssa ordered her an entrée, stuffed mushrooms, and even pumpkin cheesecake. Back at their apartment, she sat the food in front of her fiancée. Arianna refused to eat it. Some days are harder than others. 

Alyssa picked up a stuffed mushroom and held it inches away from Arianna’s face. 

“Eat the damn mushroom,” she said a bit sarcastically, hoping she would at least taste it.

Arianna complied, and took a bite. She finished her entire meal, and even ate the pumpkin cheesecake–her favorite part. 

Recovering from symptoms of eating disorders involves developing a healthier relationship with oneself, and continuously affirming that one is a worthwhile person. Alyssa reminds Arianna why she is important, boosting her self-esteem and her relationship with herself.

Arianna is still convinced that any form of treatment is unneeded, especially because she has concealed her problems and has handled them on her own for so long. Yeah, she still struggles, but she has more important things to worry about. Some days her weight consumes her thoughts. Some days she relies on Alyssa to make her eat because she can’t bring herself to do it. But treatment is out of the question. She fears that if she were to get treatment she would be taking it away from someone else who needs it more than she does–a risk that’s not worth taking. Besides, treatment is expensive. She doesn’t have that kind of money.

Arianna just takes each day one step at a time.