Editor’s note: This is Part 2 of a 2-part story. Read Part 1 here.
Alone in the bathroom, Hannah Allen stared at her reflection and finally admitted she had a problem.
“I had just thrown up more than I ever had in my life. It was so painful and I was crying and I remember thinking, ‘Why am I doing this to myself? This is not me,’ “ Hannah, 21, said in an interview with The Tribune.
It was the end of her sophomore year at Cal Poly — where she studies biological sciences and psychology — and a year and a half into her struggle with bulimia, an eating disorder that she calls Ed.
“Ed caused me to do a lot of things I wouldn’t characteristically do. I lied to my parents. I lied to my friends,” said Hannah, who lives in San Luis Obispo. “I was drawn into myself. It keeps you in this cycle of shame that is really demeaning, and it keeps you from speaking out.”
Millions of people — of all genders, sexual orientations, ages, races or social classes — suffer from eating disorders that often begin in high school or college.
Hundreds of Cal Poly students are likely dealing with unhealthy behaviors around food and weight because of an eating disorder, according to the results of a Healthy Minds Network survey that found 10 percent of students surveyed at colleges nationwide in 2018 met the criteria of likely having an eating disorder.
Early intervention increases the likelihood of successful treatment to prevent lifelong symptoms and serious health consequences. Unfortunately, eating disorders such as anorexia, bulimia and binge eating disorder often go undiagnosed and untreated.
Hannah, a high-achieving student and runner, was lucky. Her parents found out about Ed the summer before her sophomore year, when her symptoms became so normalized that she threw up in the kitchen sink in front of her dad.
Shocked and scared for Hannah, her parents intervened and helped her get professional help. She was in denial and was yet to hit rock bottom.
Finally, after an eye-opening moment, Hannah says recovery is working thanks in part to the persistence of Cal Poly counselors who worked with her for months and recommended she get more intensive treatment.
“Ultimately, I was lucky to get the help that I needed when did because I could have caused serious damage that would have been permanent,” Hannah said. “But a lot of girls don’t.”
Bulimia and college sexual assault
Symptoms of eating disorders often first appear during times of stress and transition, according to Libby Parker, a registered San Luis Obispo dietitian who specializes in eating disorders.
Hannah had started counting calories and obsessing over her weight as a freshman student athlete. After she quit the team, the symptoms of Ed — regularly binging and purging — grew as she compared herself to her former teammates.
She was isolated, alone and lying to those around her to cover the shame.
After they found out about Ed, Hannah’s parents made her go to Cal Poly counseling and to see a campus dietitian, but she resented it.
Entering sophomore year, she denied Ed’s impact even as she was trapped in a cycle of binging and purging. With Ed in control, she thought she could manipulate counseling to use it as a tool to help her eat less.
Early into the school year, Hannah was sexually assaulted. The confusion and trauma pushed her deeper into isolation.
She doesn’t talk much about what happened that night at a party with her friends.
“It happened really fast, and I had a lot of shame from it,” Hannah said.
“I remember waking up the next day and feeling that I was worthless. Feelings of shame and that I couldn’t talk to anyone about it. It was really scarring because it was someone that I knew and I just never thought it would happen.”
Resources for those who have been sexually assaulted are available at Cal Poly. But at the time, Hannah didn’t realize what had happened to her was assault. Confused about what happened, her self-esteem plummeted and her symptoms grew as she became increasingly disconnected from herself and her loved ones, and more dependent on Ed.
Multiple studies show a correlation between sexual assault and eating disorders. Binging and purging are used as coping mechanisms for those who have experienced trauma, Dr. Timothy Breweton said in an interview with the National Eating Disorders Association.
“Sadness. Pain. Hurt. Embarrassment. Shame. We don’t want to feel those emotions,” Hannah said. “They’re ugly, so we numb them. That’s what I did with my eating disorder. But if you numb sadness, you’re also numbing happiness.”
She was running faster than ever as a member of the Cal Poly Distance Club, which Ed told her was a sign of progress. But she couldn’t walk past a scale in the gym without stepping onto it. She compared how much she ate to her sister and her friends and regularly threw up, justifying it by telling herself she hadn’t “earned the calories” because she didn’t run one day.
She categorized food as good or bad and told herself she could only eat the good food. But denying herself the “bad” food only made her focus on it more. So she binged.
Meanwhile, her weight fluctuated. She had pain in her esophagus, and she felt fatigued all the time. She felt tired and alone.
“Ed tells me and a lot of other girls lies. He’s that kind of whispering voice that you’re not good enough. He twists thoughts and the way you see yourself,” Hannah said. “I was very anxious.”
Long-term risks of eating disorders are real
The consequences of an eating disorder are harmful. They can cause irreversible organ damage, or even death when the body fails or from suicide.
People with anorexia, characterized by an irrational fear of weight gain, can lose bone density, causing weakness and easy fractures that limit the ability to participate in activities like sports, for example.
With bulimia, stomach acids from vomit can cause tooth decay and staining. Vomiting sends a mixture of food and stomach acids up through the esophagus that can cause bleeding and even a rupture of the esophagus, which can be fatal.
“No one talks about it, but it’s such a big issue. People get injuries, really serious injuries that affect them for the resit of their lives, and they get them at 20,” Hannah said.
But under the haze of Ed, “All you can think about is food and what your body looks like and your weight,” Hannah said. “Where am I going to purge? Am I running fast enough? Am I fat? Are my thighs touching? I felt trapped by what people thought of me.”
Obsessive, all-consuming thoughts like that are common for people with eating disorders.
Libby Parker, who treated Hannah during this time period, said bulimia “has its own rules and rigidity.”
“A lot of it is made worse through malnutrition. The brain starts to shrink and thinking becomes more and more rigid. It allows lies to become truth,” Parker said in a phone interview with The Tribune. “It will say you’re not thin enough. It can make you believe that professionals or family are against you, and that they want you to become fat.”
“Eating disorders can become your best friend. It’s like an abusive relationship you know you need to get out of,” Parker said.
That’s why Hannah describes recovery as liberating.
“It’s like the chains are broken,” she said.
“It’s hard to see when you’re going through it. In the thick of it, Ed is the thing that you think is going to free you. Once you realize recovery is the only thing that’s going to free you, then you’re really free,” Hannah said.
Treatment for eating disorders is worth it
Dismantling the thought patterns that develop with an eating disorder takes time and work — and it’s completely worth it, Hannah said. That’s what she learned after she finally decided to break up with Ed.
In May of her sophomore year, she went out with a friend and ate two doughnuts — not an obscene amount by most people’s standards, but to Hannah it was a catastrophe. That night, she saw Ed’s face in her own reflection.
Crying and alone, she was in pain from the amount of vomiting, and she realized that all the information her counselor and dietitian at Cal Poly had been telling her about eating disorders was true. She realized how much they had helped her.
“Emotionally, I realized I’m not happy and I’m starting to have health problems. I’m having problems with my family, and I’m always stressed out. I thought, ‘This is not how my life is supposed to be,’ “ Hannah said.
She called her mom, Carmon Allen, who said she didn’t want to see Hannah hospitalized and reminded her, “You can die.” The next morning Hannah called her counselor at Cal Poly and agreed to go into an intensive outpatient program — a months-long virtual program through the Eating Recovery Center in Colorado.
Treatment sessions happened through webcam 13 hours a week. Three times a week for three hours, she had group sessions with other people with eating disorders. They ate meals together, virtually, and held each other accountable.
Hannah met virtually with a therapist and a nutritionist two hours a week each.
Hannah didn’t purge the entire three months of the program. She learned to be open and honest with herself and others about her difficult moments, harmful thoughts and destructive behaviors.
“They encouraged vulnerability and that’s really powerful,” Hannah said. “When you see your vulnerabilities are beautiful, they’re all of a sudden so less scary and you accept yourself.”
The secret comes out
Back at school, Hannah opened up to her friends and unveiled the secret that she had kept hidden for so long. She told them about Ed, the lies he told her and the things he made her do. The response she got was overwhelmingly positive.
She also learned that her friends, classmates and other runners struggled with their own eating disorders — and that the problem was not just hers, but campus-wide.
“Some of my friends, when I talked to them about it, said, ‘Wait, you have that? I went through that’ or ‘I’m struggling with something similar,’ “ Hannah said. “Not only did we bond and connect over it, I was able to say ‘What you’re going through is completely normal.’ ”
She finally felt some relief from the obsessive thoughts about food, her body and what people thought of her. Instead, she learned to focus on and appreciate what her body can do for her. Hannah is grateful for the legs that allow her to hike and run, she said.
Hannah is sharing her story because she wants others to see that there is hope.
“I want everybody who’s going through Ed to experience the amount of liberation and complete joy you feel after you realize recovery is possible,” Hannah said. “It is so entirely worth it. Everyone deserves to live.”
But, she warns, recovery is not linear and relapse is a part of recovery.
Hannah has reverted to old behaviors in difficult times. The last time she purged, she said, was summer 2018 — a year after she completed her treatment program.
For a while, “every meal is a battle,” Hannah said. “It was hard for me to break out of the cycle. Obviously, it’s taken me a couple of years. If you want to change a habit, you’re going to need to work at it every day and you’re going to have to want it.”
Her support system was essential.
“It’s been a roller coaster ride. Not just for Hannah, but for the entire family,” her mom, Carmon, said.
Hannah’s mom used to stay up at night, terrified at the thought of losing her daughter. But things are looking up.
Christmas went really well this year, Carmon Allen said. She no longer has to hide Hannah’s trigger foods, like ice cream, and the family is open about the challenges they’ve faced together.
“It truly is at the grace of God that we caught her and she was willing to get help,” Allen said. “Hannah is coming out stronger through this and it really is a bump, in the long scheme of things. She is ready for the challenges of life.”
Hannah has learned to cook meals at home, she’s rediscovered the joy of running, and she goes out to food with friends and even eats sweets.
“I’m not afraid of food anymore,” Hannah said in the new year. “I’m doing great.”
Want help for an eating disorder?
If you think you or a loved one might have an eating disorder, help is available. Talk to a trusted medical professional, call the National Eating Disorders Helpline at 800-931-2237, visit the National Eating Disorders Association website at www.NationalEatingDisorders.org or contact crisis support via text (send NEDA to 741741).