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The Bulimic Brain

Jacky Duong has been fighting the urge to throw up since she was fourteen, and recent research suggests the battle is largely with her brain.



The nagging impulse was urgent and familiar. It drew Jacky Duong into the brightly lit kitchen of her North Berkeley apartment, where she stood contemplating the fridge. Having recently returned from a Saturday night dinner at a friend's house, the 21-year-old Cal student was feeling pleasantly satiated — but not stuffed. She could certainly eat more. Should she do it?

Her parents would be horrified. So would her friends, and her therapist. But a voice in the back of her head, small and insistent, nudged her on. Be reckless, it said. Lose control. Give in. Duong tried to push the feeling down, but it wanted to come up. She thought about the tray of brownies, the leftover potato salad, and the Tupperware of curry she had made the night before. She thought about not thinking. Then, she opened the fridge.

Give in.

Duong doesn't give in as often as she used to. Like many other women (and men) in America, she's considered to be "recovering" from bulimia nervosa, having received extensive treatment and therapy, much of it at the Alta Bates eating disorder clinic in Berkeley. Her treatment has helped her shed much of the guilt and secrecy that comes with the behavior. Now, chatty, perceptive, and disarmingly sarcastic, she is able to relate her history with barely a trace of discomfort, gesturing with her hands over the half-eaten slice of pie that sat on the cafe table during a recent interview. At one point she even quipped, "You'd better watch out, because this pumpkin tart is coming right back up."

Still, after four years of therapy, her progress appears to be modest. She is able to resist the bingeing urge, she estimates, "maybe one out of five times. ... And when I do overcome the other side," she said, leaning forward, her teardrop-shaped eyes lined with kohl, "it's like an achievement — like I'm winning a battle."

But that battle may never be easy for Duong, and recent research at Stanford and Columbia universities is starting to shed light on the reasons why. Although much is still unknown about bulimia, recent studies seem to suggest that the fight Duong is waging is largely with her brain. As young women with bulimia grow older, destructive impulses like bingeing and purging may become more powerful while parts of the brain that govern impulse control may weaken. And according to the studies, the bulimic brain is more likely to succumb to a variety of self-destructive impulses, making the disorder a sort of psychological Hydra. Over time, these impulses may turn into compulsions, or bad habits, much like drug addiction. In other words, the young woman originally from a Southern California suburb may be fighting her demons for a long time.

For Duong, the binge-and-purge cycle is a seductive voice, one that has dug its way deep into her mind. "It subconsciously creeps up; it helps when you feel lonely, when you feel sad," she said, referring to her disorder as though it brings her relief at times. "It gives you something to do."

The voice has been inside her head for seven years, she said, stirring her latte. She says that as she struggles with the urge to eat and throw up, the tension mounts. She feels agitated, on edge. But when she finally decides she can no longer resist, "all the anxiety melts away."

Entering binge mode, as she calls it, is like going into a frenzy. The cognitive science major at UC Berkeley is drawn to the fridge like a child to a shop window laden with sweets. "At first it feels great, because you're distracting yourself like crazy. And then when you throw up, you're just like ... empty." She reformed her statement: "You do it to avoid feeling empty, but you just go back to the same spot."

Jacky Duong is a woman who is very aware of her appearance. She knows how to put an outfit together. At the moment, she's wearing brown boots over jeans and a waist-cinching plaid pea coat. Her short black hair catches the light. Judging by the way she holds herself, you might think she is someone who is comfortable with — even likes — the way she looks.

But growing up, her body was little more than a burden. At six years old, she says, she was acutely aware that she had begun to "chub up." She knew it because her mother reminded her often.

Her mother "had a lot of issues of her own," she said. "She would say things like, 'You're fat because you're ugly, just like your dad.' Then she would go crazy and beat the shit out of me."

Besides the physical abuse, Duong remembers being called names like "fat elephant" and squeezed into skimpy outfits for swim and ballet classes, where she felt vulnerable and exposed. "I was ashamed of myself, constantly," she recalled. "I had no self-esteem."

Before her sophomore year of high school, she took her dissatisfaction with her body into her own hands. She had seen an episode of 20/20 on girls who suffered from eating disorders, and it gave her the idea to purge. The first time, she did it in the shower.

"The chick on TV ended up in the hospital, but that didn't even occur to me," she said. "I just thought, 'That's a good idea.'"