At the peak of her eating disorder, Stephanie Covington Armstrong threw up 15 times a day. Any food in her stomach made her uncomfortable, and it was only when she vomited that "everything was right with the world," even if only five minutes until she would do it again.
It was like crack, she said. Drugs and alcohol seemed messy but binging and purging offered that same high, the kind of high that would take away the self-hatred that constantly weighed her down.
For seven years, Armstrong's bulimia was her deepest secret. And as a black woman, she said carrying the stigma of an eating disorder was even worse.
"There is that shame of not being a strong black woman," said Armstrong, a Los Angeles playwright and author of the book, "Not All Black Girls Know How to Eat."
"People would ask me, 'What, do you want to be white or something?'"
More than 10 million Americans suffer from some kind of eating disorder, and many of them are not white, young or female, according to the National Eating Disorders Association.
Dr. Wendy Oliver-Pyatt, executive director of the Oliver-Pyatt Centers in Florida, said that, at any given time, at least half of her patients are not what society typically thinks of as someone who has an eating disorder: people older than 40, mothers, men and minorities.
"Minorities, men and older people have an even more difficult time," said Oliver-Pyatt, speaking on behalf of the National Eating Disorders Association. "It's almost culturally accepted for a young white woman to have an eating disorder."
"Many black women are coming from an environment where there is such little control," Armstrong, 45, said. "Who has less control than poor minorities in this country? I've interviewed black women who have said, 'All I have is my food. You're not taking that away.'"
Correlation Between Trauma and Eating Disorders
Armstrong's favorite uncle raped her when she was 13. Already having lived in a fatherless household, she didn't feel worthy enough to come forward with the trauma.
"He was the one male I trusted," Armstrong said. "My thoughts were, 'If he didn't think I was worthy, if he could rape me, then maybe I am not worth anything. Maybe I do lack value.'"
On the outside, Armstrong was driven and bright. She did well in school, but the self-hatred owned her.
At 17, she discovered food helped her cope with feelings of worthlessness.
"It's like gambling," she said. "You win a little something and you're on this high. But, eventually, you need it more than it needs you. It turned on me."
And for years, she continued to lose the gamble. But she chose to be silent rather than go against the symbol of an archetypal strong black woman.
After battling the disease for seven years and becoming suicidal in the process, she finally went in for treatment.
"If my whole life was going to be about throwing up and controlling food, I didn't want to live anymore," Armstrong said.
She relapsed in her late 30s,but unlike in her younger years, after a few weeks of vomiting again, she realized she needed someone to help her cope with the heaviness.
"When I recovered the second time, I had nothing to hide anymore," said Armstrong, who now has a heart murmur because of the the bulimia. "I can safely say now that I'll never throw up again. It doesn't occur to me anymore. I have no desire. It used to be in the back of my mind but it just isn't anymore."
Eating Disorders in Older Women
Oliver-Pyatt said that many older female patients never fully recover from an eating disorder in their younger years. Many of these women report a bad experience while receiving treatment for their condition in their 20s and teens, and now, those same women combat the disease and fly under the doctor's radar for eating disorders.
"A couple years ago, treatment was very institutional-based," Oliver-Pyatt said. "They had a bad experience and were afraid to receive further treatment."
But that's not the only reason older women may suffer from eating disorders.
"For many older women, their kids go off to school and mom starts going to the gym," Oliver-Pyatt said. "They can hide behind this mask of health, and there is a lot of social reinforcement where everyone is applauding their efforts."
"When people start using drugs, no one is giving applause," she continued. "But this person can be out of control and people are saying, 'Good job.'"
Eating Disorders in Men
As an undergraduate major in health and physical education, Troy Roness of Bismarck, N.D., said he began to exercise in a way that seemed out of his control. By age 19, the exercise and anorexia nervosa took over.
"I thought I had found something that I was good at, where I could educate people and be healthy, while also losing weight," Roness, 24, said. "It turned into something very different."
Roness said he exercised several hours a day, attempting to burn off any food he had eaten. Eventually, his family noticed a significant weight loss and change in personality.
"It was like I was on autopilot," Roness said. "I was not emotionally present, but I worried about coming forward because I was teaching health and physical education. And at the same time, guys don't get eating disorders."
More than 1 million men and boys battle eating disorders every day, according to the National Eating Disorders Association. And, many doctors argue, the stigma for a man is worse than that of teenage girl.
"What keeps males from coming forward is that they see it as a female-only issue and they feel people will think they're gay," Roness said.
After two 81-day residential treatment stays, Roness has recovered and now serves on the junior board of the National Eating Disorders Association.
"Now, when I want to run an extra 10 miles, I ask myself, 'Is this because I have to or because I want to?'"
Eating Disorder in Response to Fear
But it wasn't the weight loss that Roness was really after. He said that exercise and anorexia nervosa became a coping mechanism for dealing with emotional strains that came from being a victim of bullying, his parents' divorce and a perfectionist's personality.
While many people say that eating disorders are a way of responding to lack of control in one's life, Oliver-Pyatt said, such an explanation is oversimplifying the seriousness of the illness.
"Yes, it's control, but usually people want control when they feel fear and bad about something," Oliver-Pyatt said. "Digging further, you see that there is a fear and anxiety and they're attempting to manage that fear and anxiety."
Many of her patients have a significant trauma history, whether it is sexual or violent.
"Sometimes the trauma isn't so blatant, though," Oliver-Pyatt said. "Sometimes people are traumatized by things others might not realize, like moving, being bullied, being teased about weight.
"If you just behaviorally change a person's way, but they don't do the deeper work, then the person really hasn't resolved the eating disorder," she said.
But, Armstrong said, do the deep work. Find someone you trust and get the treatment you need.
"The biggest thing with this disease is that it's a secret," Armstrong said. "You have to get support. Tell someone who you feel safe with. Find a place where you can really expose yourself and get help."
If you or someone you know might suffer from an eating disorder, contact the Information and Referral Helpline at the National Eating Disorder Association by calling (800) 931-2237.