Diane Keaton’s Struggle With Bulimia

You just finished eating a half gallon of rocky road ice cream when the panic sets in.

“Oh my god, what did I do? I have to get rid of it.”

So you run to the bathroom…

In a new memoir coming out this month, Then Again, Academy Award winning actress Diane Keaton revealed that she struggled with bulimia for five years. She says that it started when she auditioned for the Broadway musical Hair in 1965. The director said she could have the role, IF she lost 10 pounds. Already plagued by self-doubt and body image issues, the then 19 year old became bulimic, although:

“I don’t think it was called bulimia then. It was just this trick you could do. It’s a horrible problem.”

Keaton credits psychotherapy, what she called “talk therapy“, with helping her come to the realization that she did not want to binge anymore. After beating bulimia, the Annie Hall and As Good as it Gets actress went on to star in her breakout role as Kay in Francis Ford Coppola’s The Godfather. It was there that she met fellow actor Al Pacino, with whom she became romantically involved. Other Keaton romantic interests included Woody Allen, Warren Beatty, and even Steve Jobs.

What is Bulimia?

Bulimia is an illness in which a person binges on food or has regular episodes of overeating and feels a loss of control. The affected person then uses various methods — such as vomiting or laxative abuse — to prevent weight gain. Usually, bulimic behavior is done secretly, because it is often accompanied by feelings of disgust or shame.

Many physical conditions result from the purging aspect of the illness, including electrolyte imbalances, gastrointestinal problems, and oral and tooth-related problems.

7 Myths about Bulimia

1. It’s not a real disease.

Bulimia is one of several eating disorders, which are complex medical/psychiatric illnesses. It is considered to have a biologic basis, and co-occur with other mental illness such as major depression, anxiety, or obsessive-compulsive disorder.

2. Bulimia occurs only in females.

Many people think that eating disorders affect only young, upper-class white females. It is true that most bulimics are women (around 85-90 percent). But bulimia affects people from all walks of life, including males, women of color, and even older women.

3. It’s a good way to lose weight.

According to the National Eating Disorders Association, vomiting does not result in ridding the body of ingested food. Half of what is consumed during a binge typically remains in the body after self-induced vomiting. Laxatives result in weightloss through fluids/water and the effect is temporary. For these reasons, many people with bulimia are average or above-average weight.

4. Bulimia only applies to those individuals who eat large quantities of food at one time then vomit afterward

Bulimia is not just about eating too much and then throwing up. A bulimic’s eating habits are out of control. The purging could be accomplished in other ways such as over-exercising, abusing diuretics (“water pills”) and laxatives or fasting.

5. You can’t die of bulimia.

While the rate of death from bulimia nervosa is much lower than that seen with anorexia nervosa, a person with bulimia can die. Vomiting, and laxative and diuretic use can cause electrolyte (sodium and potassium) imbalances. This can have a dangerous effect on the heart and can put the bulimic at risk for sudden death. Stomach acid in the esophagus from frequent vomiting can cause erosions of its lining. This can lead to ulcers which can be life-threatening if they bleed.

6. Recovery from the eating disorder is rare.

No. Someone with bulimia can get better. Treatment for bulimia uses a combination of options:

A doctor may recommend nutritional advice and psychotherapy, especially cognitive behavioral therapy (CBT). CBT is a form of psychotherapy that focuses on the important role of thinking in how we feel and what we do. CBT that has been tailored to treat bulimia has shown to be effective in changing binging and purging behavior, and eating attitudes. Therapy for a person with bulimia may be one-on-one with a therapist or group-based.

Some antidepressants, such as fluoxetine (Prozac), which is the only medication approved by the U.S. Food and Drug Administration (FDA) for treating bulimia, may help patients who also have depression and/or anxiety. It also appears to help reduce binge-eating and purging behavior, reduces the chance of relapse, and improves eating attitudes.

Do you know any one who has dealt with bulimia? Have you?

What has helped you/them? How can family and friends help?


Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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