Stories of Recovery
CAN I HELP HER?
Treating the “Untreatable”:
Patients with Eating Disorders, Substance Abuse and Trauma
The Odyssey from Survivor to Thriver
By Tamie Gangloff
January 31, 2008
I have recovered from Alcoholism, an eating disorder, post traumatic stress disorder, trauma, self-harm, severe mental, physical and sexual abuse. I refuse to believe that I am an anomaly and that I am the only one like me. My story is not unique, but I believe that my recovery process may be. I am very passionate about my recovery and want to help others obtain freedom from the bondage of their eating disorder and alcoholism.
In order to understand my treatment and recovery process, I feel it is necessary for you to have a glimpse into my history to gain an insight into what I have been through.
My first memory is of sleeping on a couch with my sister, at my mom’s office because mom and dad had a fight. I believe I was 3 years-old at the time. The next significant memory is when I was 5 – dad was chasing mom around the apartment trying to hurt her. Many of my childhood memories are of this type. I also have a lot of times where I have no memory at all.
I remember meeting dad’s first girlfriend when I was 7, and it was very upsetting to me. Dad had started a pattern of infidelity – moving in with his girlfriend, moving back home – each time becoming more violent than the last.
I had learned at a very young age, that if I were to be loved, I had to be thin. Mom was always overweight and dad always ridiculed her and blamed his adultery on her weight. My grandmother had been a model and was anorexic. She had put my mom on diet pills when she was 9 – and throughout my childhood, she was paying for Mom to try this diet and that. She would call and ask if the diets were working and if she had finally lost weight. As a side note, about 5 years ago, my mother successfully lost weight in a very healthy way, through Weight Watchers and has maintained that healthy weight ever since.
I was raped, for the first time, at 14. I remember making a conscious decision not to eat, although I had started restricting prior to that time. Also, at this point in my life, I had been wearing a back brace for my scoliosis. I was not wearing it that night, but I was extremely self-conscious of my body. The brace had weakened my stomach muscles and I felt very unattractive. The rape was discussed briefly at home – mom took me to the doctor, then it was ignored. I was left to my own devices to seek help.
I remember lying down on the kitchen floor, sucking in my breath and grabbing at my waist. I would then hold up my hands (still holding the grip I had had around my waist). I wanted to really see how small I was. The scale told me how much I weighed and I felt that the mirror was unreliable— this would be accurate and show me the truth.
At the time, I did not think anything of it. I do not know how old I was, maybe twelve or thirteen. I was invisible to those around me, so no one noticed that I was slowly disappearing. I do remember getting a sense of satisfaction out of others telling me I was too thin.
For me, when I had my eating disorder, I was not a person- I was a collection of unmanageable symptoms. I have to say that my greatest nemesis were the laxatives. I abused laxatives for six years, give or take a little.
My laxative love affair started in my senior year of high school. My grazing after school had turned into binges – bags of cookies, boxes of cereal, etc. I am not sure if everyone has laxatives in their home. For some reason, we did. I asked Mom if it was a problem for me to take a few; she said yes. I think I forgot to mention that I took the “few” all at one time following a few bags of Soft Batch cookies. My belly was flat when I woke up in the morning –like magic! I did not know that I had not actually gotten rid of the food. I had just forced it through my system faster and had gotten really dehydrated. My mind saw and felt a flat tummy and that is what I became addicted to.
At the time in my life where my laxative abuse was at its worst, I was also drinking and smoking (legal and illegal substances) on a regular basis. I was also experiencing panic attacks almost daily. I discovered that burning myself with a lit cigarette seemed to snap me out of panic or a flashback. It felt better to feel physical pain. So, now I was self-mutilating in addition to being suicidal. I was so buried in my symptoms that the reasons for them were indistinguishable.
Many years later, the scars from the cigarette burns have healed, but I will never forget them and how it seemed to be my only option. I was doing every maladaptive, addictive thing I could come up with, including shopping and being promiscuous. Alcohol made my mind foggy and made me forget. Pot made me calm and relaxed. Laxatives and restricting gave me a sense of control. Burning myself relieved the panic. Controlling men gave me the illusion that they were not actually controlling me. Smoking cigarettes made me feel calm and cool. I thought that a ‘bad girl’ image would protect me, but it did not seem to work that way. I hated who I was, what had happened to me and what I had become. I would do absolutely anything not to feel.
No matter what I put in my body or did to my body, there was a scared little girl begging to be saved. No one saved her when I was a kid and I sure was not capable of saving, protecting or ever acknowledging she was there. I suffocated her, starved her, scarred her, abused her, worse than anyone else could have done. The only time I knew she was there was when she screamed so loud that I couldn’t even stop the noise by covering my ears anymore. The pain was awful; suicide was an option. I did not take enough pills to end my life, but that was my intention. I felt suicidal on most days.
I was afraid of what was happening to me, so I took time off of school to get some help. In the summer of 1995, I was in a day treatment program, for two weeks, at an eating disorder treatment center in Philadelphia. Two weeks was such a short time and not even a beginning for me. A few months later, I went into inpatient treatment there for two weeks. It was there that I gained an understanding about my eating disorder and was also introduced to Alcoholics Anonymous. I was not ready to admit that I had a problem with alcohol and I was not ready to give up my eating disorder. Each time I was in treatment, I learned a little more and gained insight into my illness and the underlying issues.
In January of 1997, I had attempted suicide for the third time. I was finally able to admit that, in addition to having an eating disorder, I was an alcoholic. I went back into the eating disorder treatment center for two more weeks; this time I was much more willing than I had been in the past. In March of 1997, I went into a drug and alcohol rehab. Soon thereafter, I was done. My sobriety date is May 5, 1997 – I have over 10 years of sobriety from drugs and alcohol.
I believe that without my sobriety, I could not have recovered from my eating disorder. By the time I had five years of sobriety, I had been in a relapse with my eating disorder for quite some time – this time I was only restricting. I was able to give up laxatives in early sobriety by putting them in the same category as drugs and alcohol.
In September of 2002, I was diagnosed with level 3 dysplasia and I was told that it was necessary to remove those cells immediately before they became cancerous. Before they took me back for surgery, I remember telling my mom that it ‘freaked me out’ that they would be doing something to me there while I was unconscious. I am sure some would debate this, but I believe that this surgery is what triggered my Post Traumatic Stress Disorder (PTSD).
The day after my surgery, I was angry, raging and crawling out of my skin. I thought it must have been the anesthesia. I was yelling and throwing things. A few days later, I called my boyfriend because I thought I was dying – I was sure I was having a heart attack. My chest hurt, my stomach burned, I could not breathe and my heart was pounding so hard, I could barely hear anything else. When he told me I was having a panic attack, I told him he must be lying because “I don’t have panics attacks anymore, not since I got sober!”
From that day on – I had panic attacks a few times a day. I had night terrors a few times a night. I could not sleep and I stopped eating. It was as if someone opened a door in my head and I could not close it. My life was a daze of anxiety, insomnia and anorexia. I could not function and I could not work. Anorexia was still an instinctual response to my extreme stress and pain.
I talked to a therapist I knew in the program (Alcoholics Anonymous) and she validated that surgeries, like the one I had, could definitely trigger repressed memories of sexual abuse. I did not have any visual memories, but a lot of body and feeling memories. I could not talk to Dad anymore. I had always remembered the severe physical and emotional abuse from him, but had no memory of the sexual abuse until this time.
I made a call to Renfrew, my previous treatment center – because I knew what I had to do. In my assessment for the Intensive Outpatient Program (IOP) – we uncovered what had been hidden behind all of my symptoms for years – PTSD. Tasha was that therapist. If I had to choose, out of the many people that have helped me, I would have to say that it was Tasha that saved my life.
After a few weeks in IOP, they recommended that I go into the day program because I had not been improving. I was in the day program for three weeks. I forced myself to eat, even though I was very sick from reflux (one of my PTSD side effects). Renfrew sent me to Dr. Rothstein, a GI doctor at Pennsylvania Hospital. She asked me if I remembered when my stomach started hurting. I thought very hard – “I think I was 7 or 8”. That had been my first coping skill – stomach pain, nausea, irritable bowel, reflux – you name it. I must say that my body still reacts to stress this way sometimes. Dr. Rothstein was so understanding and caring – she did not treat me like a crazy person (I had that reaction from several doctors in the past). She put me on medication that helped and saw me on a regular basis until I improved.
The day program was amazing and is the reason that I am alive today. Art therapy had a whole new meaning for me; it helped me to gain an understanding of my trauma. I was able to see things I could never have seen. I met Gary and Angela – they became close friends of mine and became family to me. It was having friends like these and other friends of mine in recovery that enabled me to continue to do the difficult work in therapy.
I did a lot of intense work on myself. I went back to IOP for four more weeks – I celebrated my birthday there with pizza and cake! Who would have thought I could eat that and enjoy it?
After IOP, I did a lot of outpatient work, including Tasha becoming my primary therapist. I continued with an individual art therapist and I saw my psychiatrist and medical doctor weekly. Two years later, when my PTSD arose again, I had many of the same symptoms, but I did not use my eating disorder. What was even more amazing is that I did not have a thought to use my eating disorder! Tasha made a lot of calls and saw me two to three times a week! I went to Onsite Workshops for a week of experiential therapy. We had very intense groups there and I was able to process a lot of difficult feelings. For the first time, I physically rescued ‘little Tamie’. Dad yelled and screamed; I stopped breathing. They told me to breathe and that I could not leave her there anymore. I fought for my life and I saved her. My life has not been the same since.
September 19, 2004, I married my best friend, who stuck by me and helped me through so much. Tasha did a reading at the wedding and Gary performed the wedding. They will always have a special place in my heart.
I have done a lot of work on myself and I am always open to more. I still attend AA on a regular basis and I work the steps and work with other alcoholics. I still struggle with life – who doesn’t? Panic and PTSD are a part of me but I have learned how to live with them. I have moments when I ‘feel fat’, but I can quickly identify that I have not just gained 50 pounds, it is because I am having a feeling that I cannot identify or that I do not want to feel. I do not restrict, binge or purge. I do not own a scale nor do I work out obsessively. I can eat pretty much anything I want without panic or guilt.
There was not one thing in particular that helped me to recover, but a compilation of many things. Art therapy helped me to understand ‘safety and containment’ which I feel is a necessity to work through PTSD and trauma. Psychodrama, anger work and other experiential work has enabled me to get in touch with feelings I did not even know existed. I believe that I would not have recovered without doing this work. Meditation and prayer have been an extremely important part of my recovery and I feel it is essential to recovery for all of my diseases and disorders. I needed to address all areas of me at once. In order to become whole, I had to be addressed as a whole person, not in parts. I feel that I did not need long term sobriety to do so; I only needed to be dry for a few days. If I did not address the reasons I sought escape, I would have continued to self-destruct.
I have met many women who are fully recovered from their eating disorders- who are able to live life free of that obsession. I have met thousands of Alcoholics who have recovered from alcoholism – who have solid long term sobriety from drugs and alcohol.
I have only met one other person who has long term sobriety from drugs and alcohol, who had fully recovered from their eating disorder and who has fully recovered from PTSD. I am of the variety that does not have a good prognosis for recovery. If you know of others like me, please send them my way so we can work on a solution and take action.
I know many women who were like I was over ten years ago. I know one woman who is in the process of doing what I have done and she is having some success. Now, at nine years of sobriety, she is working through her trauma and that is enabling her to let go of her eating disorder. We spoke today and she is still struggling with restricting, but is on a much better path than she was last year. I also have a sponsee right now that just left her 19th treatment center. She seems to be, as it states in the Big Book of Alcoholics Anonymous, “incapable of being honest with herself”. She is much like I was years ago. She is unable to maintain any sobriety and is not able to follow a healthy food plan without binging or purging.
Many well-intentioned AA sponsors recommend to their sponsee that they wait on working on their eating disorder until they have some time sober. I have also heard clinicians give this advice. I have heard the advice to stay sober for one year, and then focus on your eating disorder. So many people with both diseases will trade one addiction for another. They get sober but use their eating disorder or self-harm to cope. When drinking, they may not use eating disordered behavior. For me, I had to focus on both because both were killing me – they went hand in hand. I am confused as to why we are asked to wait. It is a fact that eating disorders are the most lethal of all psychiatric illnesses. Would you tell someone newly sober to wait to deal with their cancer or diabetes?
I feel that the 12 steps can be helpful to an eating disordered client once they have been in recovery for some time. It helped me to work through body image issues. However, for me, the 12 steps were not helpful in the acute illness of my eating disorder and PTSD, but it has been essential to my sobriety from alcohol.
I have not met a person that has an eating disorder along with drug and alcohol addiction that does not have trauma to work through. This may be my own generalization, but one based on many people that I have met and who have asked me to help them.
Why aren’t more treatment centers able to address both issues at once?
Why doesn’t the 12 step approach seem as effective in overcoming and eating disorder?
Why do many treatment professionals seem to avoid this type of client?
I feel that the client with an eating disorder, drug/alcohol addiction, PTSD and other psychological disorders is a unique person and needs to be addressed in a way that is different from someone who only suffers from one of these issues. This person needs to be treated as one person and not focus on each disease separately. Why not have treatment centers for this type of client? I have a vision of the type of treatment center.
I see that this type of unique client has unique needs that may take more time to be addressed. A minimum inpatient treatment of three to six months should be required. A day program or intensive outpatient program should also be required for at least a month afterward followed by a lot of care. This client needs a team approach including a psychiatrist, nutritionist, medical doctor, therapist, possibly an individual art therapist and a therapy group. This is a lot of aftercare but all very necessary. Introduction to 12 steps in treatment is very important so the client will follow up with this after treatment is over; this includes attendance at 12 step meetings.
I did not have this type of care available to me, so my journey included many years of therapy and different short stays in treatment. In 1997, I went to rehab for my alcoholism only two months after eating disorder treatment. Had I been in a longer term treatment program that dealt with both issues head on, I may not have needed to go to two separate treatment centers. When I went to rehab, they did not know how to treat eating disorders. So, I made headway with my sobriety but had a setback with my eating disorder. The last time I was in treatment for my eating disorder, my PTSD and trauma was addressed and I began to make some headway. However, I was only in day treatment for three weeks, so it was a small beginning. When I went to Onsite Workshops two years later, I had not relapsed with my alcoholism or with my eating disorder, but my PTSD had made it impossible for me to function in life and work. At Onsite, I was able to do much focused trauma work and that significantly relieved my PTSD symptoms.
I do understand that full recovery for PTSD and trauma takes years of therapy. With a big jump start by having such focused and long term treatment, a client may have a much higher prognosis for long term recovery. The feelings, panic and flashbacks associated with PTSD often precipitate a relapse with the eating disorder, alcoholism or both (this may also include self injury behavior and suicidal ideation).
I feel that, if a holistic, integrated approach had existed, my suffering would not have lasted as long and I would have been able to recover sooner. I am extremely grateful for my long term recovery from all of these issues. I would like to make it possible for others to recover with much less suffering than I had to endure. There are so many men and women that need this type of help. I am not only a survivor; I am a thriver. Let’s help others to become thrivers.