Q&A Fighting with Food

You give some vivid descriptions of vomiting in this book. Why?

Nicole Johns had hardly eaten for days when she drove to a gas station in a blizzard, bought dozens of stale doughnuts, and then crammed them into her mouth as she sped back home, planning to make herself throw up before her roommate arrived. Diagnosed with an Eating Disorder Not Otherwise Specified — a deadly mix of diet pills, starvation, and vomiting — Johns struggled for eight years before checking herself in to rehab when she was a graduate student, at age 22. In her new book, Purge, she describes her brutal war with food.

Q: You give some vivid descriptions of vomiting in this book. Why?

A: I wanted to convey the sense of violence toward yourself, along with the self-hatred and shame that go along with an eating disorder. I especially want to debunk the myth that these are glamorous diseases or that only 16-year-olds in L.A. have them. There's nothing less glamorous than having toilet water splash up in your face while you're making yourself throw up.

Q: How did all this start?
The first time I made myself throw up was when I was 14. It was after school; when I got home, I ate a lot of cinnamon-sugar Pop Tarts, and I felt really gross. So I just wanted to get rid of it — to correct what I'd done. But my eating disorder probably started before that. I'd always felt driven to succeed, not only academically but also socially and physically — to be pretty.

Q: What kinds of health problems did you develop over the years?
I went to the ER countless times, mostly for dehydration and electrolyte problems. I'd depleted my body's supply of potassium, and I felt horrible. I had dizziness, chest pains, headaches. I started having really bad acid reflux — it came to the point where I'd throw up involuntarily. I also had heart irregularities. The doctors warned me that I could have a heart attack.

Q: That didn't scare you into stopping?
It made me stop and think, but I still thought, It won't happen to me.

Q: What made you check in to rehab?
I just hit rock-bottom. I passed out and hit my head and got a concussion, and the doctors kept me in the hospital for observation. People in my life were saying, "Nicole, you need to get help."

Q: How long were you there?
I was there for about three months; my grad-school student health insurance covered it.

Q: So eventually rehab worked?
It definitely helped me recover, especially the group therapy, but it's not an overnight process. A big myth is that you get treatment and you're magically cured — you eat a hamburger and you're fine. There's no happily ever after. It can be a lifelong struggle.

Q: Have you ever relapsed?
Right after my treatment, I stopped eating and dropped 15 pounds. After that, there was a random time when I purged. I still think about my weight and what I eat, but I consider myself recovered. I'm not engaging in eating-disordered behaviors.

Q: How's your health now?
My heart rhythms corrected themselves. I'm very fortunate. But I had to have major surgery on my esophagus to correct my acid-reflux problem.

Q: Any advice for others?
The most important thing is to try to overcome the shame and ask for help — from friends, family, whoever is close to you.

Abigail Pesta is an award-winning investigative journalist who writes for major publications around the world. She is the author of The Girls: An All-American Town, a Predatory Doctor, and the Untold Story of the Gymnasts Who Brought Him Down.