It’s a story that Lisa Boltman is not proud of. But she shares it publicly, in the hope that her experiences will make people better understand the demons she’s been battling for the past 20 years and prevent others from following the same path towards a chronic, potentially fatal eating disorder.
The 43-year-old mother of three said she was in her 20s when, on a whim, she decided to try taking laxatives to treat her bloated stomach. No one could have predicted that this seemingly innocuous decision would spiral into a full-blown disorder that haunts her to this day. At the height of it, she was eating more than 200 laxatives at one time.
The effects of overdosing on laxatives are extreme. As the body fights the overdose, a person will suffer from nausea, vomiting, cramping, diarrhea and dehydration.
Boltman, who speaks publicly about her journey and documents her daily struggle on her blog, Skeletons In My Closet, describes the aftermath of a laxative overdose as “brutal.”
“There are no words that can adequately describe the horror your body goes through,” she said. “My stomach starts growling. My mouth gets so dry. I am weak, tired and look like a malnourished ghost. I can’t move. I can’t talk and my body is shivering.”
Boltman said that she continues to struggle with the disease, even during periods of recovery.
“It is hard to try and have a life while you are trying to fight an eating disorder (ED). There is not room for both of you. One will always win. ED usually prevailed because he had the stronger, more powerful voice,” she wrote on her blog.
She explained that despite the immobilizing pain, the addiction offered her the “extreme empty feeling” she craved, distraction from her stresses, relief from not having to fight the urge any longer and a respite from feelings of guilt for eating something she felt she shouldn’t have. In addition to the physical toll it took on her body, she described how overdosing on laxatives would often keep her in bed, or on the bathroom floor, for 24 to 72 hours at a time.
“When I took laxatives, my life was on hold. Nothing happened. It was at a stand still,” she wrote.
“And guess what? All of the things I was avoiding were waiting for me when the laxatives wore off.… Every single time, I promised myself it was the last time. Twenty years later, I was still telling myself that very same thing.”
According to a 2014 report from the House of Commons standing committee on the status of women called “Eating disorders among girls and women in Canada,” eating disorders, particularly anorexia nervosa, have the highest mortality rate of any mental illness.
“The high mortality rates are a result of life-threatening medical complications and the frequency of suicide among people with eating disorders. The overall mortality rate for anorexia nervosa is estimated at between 10 and 15 per cent, while mortality for bulimia nervosa is estimated at about five per cent,” the report stated.
Eating disorders can lead to health complications, including heart attacks, cardiac arrhythmias, severe electrolyte imbalances, organ damage, osteoporosis, muscle loss and death. Up to 1,500 Canadians die from these disorders each year.
Dr. Leora Pinhas, who has been working in the field of eating disorders for about 20 years, co-authored a study in 2008 that compared non-Jewish and Jewish Canadians’ attitudes and behaviours related to eating disorders.
The study involved 1,130 female and 1,145 male high school students aged 13 to 20 from the Greater Toronto Area, who completed a demographic and religious practice questionnaire, together with the Eating Attitudes Test (EAT), a self-reported questionnaire that screens adolescents for syndromal eating disorders.
“Jewish females reported significantly more disordered eating behaviours and attitudes, compared with their non-Jewish female counterparts. Twenty-five per cent of Jewish females, as compared with 18 per cent of non-Jewish females, scored above the clinical cut-off for the EAT,” the report concluded.
“No differences in vulnerability to disordered eating were found within the group of Jewish females or males related to their degree of religious observance. (But) more Jewish males were trying to lose weight than non-Jewish males.”
In an interview with The CJN, Pinhas explained that many perceive eating disorders as only affecting white middle school girls, which means that it often takes much longer to identify them in boys.
“The younger you get, the more even the numbers are. In the adult population, the number is something like 10 women for every man, but part of that is that men don’t come to treatment and that figure is thought to be a real underestimate.
As you get to the younger ages, it’s more like three-to-one or five-to-one, but again, boys are less likely to come to treatment,” Pinhas explained.
Adding to the argument that Jews may be more susceptible to eating disorders than the general population, Dr. Yael Latzer, research director at Rambam Health Care Campus’ Eating Disorders Institution, told the Associated Press in 2011 that “Israel has one of the highest rates of anorexia, bulimia and binge eating in the world,” and that eating disorders are underreported among Orthodox Jewish women because of the stigma attached to them.
“No organization tracks the numbers of eating disorders among Jewish women, which experts say is partly because of a cultural reluctance to divulge the illness,” said Latzer.
According to a 2015 Times of Israel article, the number of women in the IDF who reported cases of eating disorders increased 200 per cent over the previous 10 years.
In a 2015 article in Psychology Today, Caryn Gorden – a New York-based psychologist who teaches, lectures and writes about eating disorders in the Orthodox Jewish community – said that, “Nothing intrinsic to Orthodox Judaism causes an eating disorder. However, incompatible demands to observe a traditional, spiritual way of life, while functioning in a modern, secular world may put certain women at risk.”
She said that some of her patients face significant pressures to look beautiful when seeking a shidduch (an arranged marriage).
“The pressure to make a good shidduch, and overvaluing a thin bride, can objectify young women and foster body dissatisfaction that may further the development of an eating disorder,” Gorden wrote.
Devorah Levinson – director of the eating disorder division at Relief Resources, a non-profit mental health referral agency that caters to the needs of the Orthodox Jewish communities in Canada, the U.S., Israel and the U.K. – states on its website that it receives more than 650 new calls a month. Levinson said that about three per cent of those calls are about eating disorders.
American psychologist and eating disorder specialist Esther Altmann also wrote about why many ultra-Orthodox adolescent girls, despite being part of insular communities, are falling victim to the disease.
“The expectation and pressure to marry and start a family at a young age may exacerbate the problem. Girls approaching marital age may feel they are not ready to assume responsibilities of rearing their own children, or may fear becoming sexual with a marital partner. Feeling that they cannot challenge parental expectations, they may instead rebel by trying to control their bodies,” Altmann said.
Torontonian Shevi Urbach, whose twin sister Tammy Speisman died in 2012 at the age of 32 after battling her eating disorders for almost two decades, witnessed the pressure that Orthodox girls are under to look attractive to potential suitors.
“We were taught in the high school we had attended that if you’re overweight, you won’t find a guy who will marry you. Can you imagine the pressure? I saw it with my own eyes. Girls would stop eating, or just have water all day to stay thin. Also, in the all-girl Orthodox schools, there is a lot of competition between the girls – who has the prettiest hair, clothes, shoes and, especially, who is the thinnest,” Urbach said.
Her sister, who started showing symptoms when she was 14, battled the disease for about 18 years, and it took a hefty toll on her body.
Urbach said that the family is not entirely sure what exactly caused her death, but “we believe her heart couldn’t take it anymore.… She would induce vomiting, which definitely caused damage to every part of her body. There was a time when she was at a weight of 69 pounds. You can imagine how sickly she looked. Very scary time.”
Urbach believes that one of the catalysts that lead to her sister developing an eating disorder was the bullying she endured as a child.
“On the way home from school, a group of boys would surround her, calling her names like ‘fat’ and ‘ugly.’ … It definitely had an impact on her self-esteem,” Urbach said, adding that she has her own body image issues, but often wonders why her twin developed an eating disorder, while she did not.
Rabbi Chaim Strauchler, the spiritual leader of Toronto’s Orthodox Shaarei Shomayim Congregation who has been part of a campaign to raise awareness about eating disorders in the community, said that he’s skeptical of the argument that Orthodox woman are more at-risk because of pressures related to the shidduch process.
“I think in our society as a whole, the same pressures are there. So whether it’s a shidduch, or whether it’s meeting someone in a secular environment, the degree to which we are affected by appearances is something … that I think affects the Orthodox world as much as it affects the secular world,” he said.
Rabbi Strauchler, who recently moderated a panel discussion on eating disorders in the Jewish community, said the issue is very much on his congregation’s radar.
“There was a terrible tragedy in my community, in which a granddaughter of one of my members died from an eating disorder. That is very much something that is on my community’s mind,” he said.
Pinhas said she recognizes that the shidduch process causes some women to feel the need to lose weight, but believes there are many other contributing factors.
Jews “tend to be a success-oriented, perfectionistic, detail-oriented group of people and I have always said, the temperament that gets you an eating disorder is also the temperament that can get you through medical school.… They’re smart, hard working, like to get a job well-done and they persevere and will tolerate physical discomfort in their process of trying to reach their goal. They’re generally good kids, very sensitive to what other people want and try to meet those expectations,” Pinhas said.
“If a teenager diets long enough and hard enough at a particular developmental stage, she can give herself an eating disorder. It’s like you fall off the edge of a cliff. Kids from all walks of life can develop it. It’s an equal-opportunity illness.”
The role food plays in Orthodox Jewish life can also be a contributing factor.
In Hungry to be Heard, a documentary about eating disorders in the Jewish community produced by the Orthodox Union in 2010, a male victim who called himself Moshe described how gathering at the Shabbat table each week was a painful ritual for him, rather than a celebratory one.
“Throughout my eating disorder, Shabbos was always the hardest day – always, to this day. Whether you’re hungry or you’re not, you’re going to sit down and eat a big meal. And it was a big argument when I was younger that I would play basketball on Shabbos and the reason was I just couldn’t sit with all that food.… It was my way to get away from it,” he said.
Boltman insists there was nothing in her happy childhood that pushed her towards an eating disorder. “I just think it was this perfectionism in me,” she said.
Nowadays, she says that sharing her story helps with her recovery.
“Telling my story is a way of me telling people I can’t just stop. It’s not a lifestyle, it’s not a choice, I’m not doing this for fun,” Boltman said. “The more people I reach and the more people say, ‘OK I get it now,’ makes me feel like I have to keep going.”
The second part of this series will examine the stigma related to eating disorders and the lack of resources available in Canada to combat this life-threatening disease.