Patti Wigington
Micaela is fifteen years old, and two years ago she weighed only 80 pounds. Her parents didn't realize there was a problem. In fact, it wasn't until a therapist called Micaela's parents into the office that they learned she had an eating disorder.
"They just figured I wasn't developing," Micaela said. "And of course, I wasn't."
Micaela was one of thousands of American teenagers who suffer from anorexia nervosa, a condition that is becoming more and more common.
In a Mayo Clinic study in 1999 determined that in young women from 15-24, the incidence of anorexia and bulimia is on the rise. Nearly ten million people ‚ almost all of them female ‚ are suffering from eating disorders in this country, and almost 90% of them are less than 20 years old.
Nearly all anorectics are female, most are white, and most come from middle to upper-class families.
The American Academy of Family Physicians (AAFP) defines anorexia as a refusal to maintain a normal body weight. This is accompanied by a fear of weight gain and, most importantly, a change in the perception of self.
While everyone around an anorectic sees them as too thin, the anorectic views herself as fat and out of shape.
Sadly, in a society which thrusts size one models or actresses into the limelight, a teenager who is average-sized may still feel that she's hopelessly obese. The low self-esteem that comes along with this fear can be damaging.
Tom Linscheid, Ph.D., Director of Psychology at Columbus Children's Hospital, Columbus, Ohio, said that often anorexia and bulimia don't start out as true disorders. "Sometimes you may have a girl who just wants to lose 10 or 20 pounds, and she may develop an extreme fear of gaining back even one or two pounds. It's part of the phobic nature of this disease."
In his 25 years treating girls (and a few boys) with anorexia, Linscheid has encountered anorectics as young as nine and ten years old.
While some anorectics may dramatically restrict their food intake, others fall into the equally damaging routine of binging and purging. This type of anorexia nervosa is commonly known as bulimia.
Bulimia is characterized by bouts of excessive eating (binging) followed by self-induced vomiting or use of laxatives and enemas (purging).
Although Micaela briefly tried self-induced vomiting, she was not bulimic. "I realized I hated throwing up. It was a whole lot easier just to starve myself."
Linscheid says that the dangers of anorexia and bulimia are both physical and emotional. Poor nutrition and weakness are only the tip of the iceberg.
Extreme weight loss often results in a amenorrhea in female adolescents, which is a stopping of the menstrual cycle. According to the AAFP, this process leads to the decrease of two estrogen-related hormones. This in turn can compromise fertility, and these girls may have trouble conceiving children later in life.
Another common risk of anorexia and bulimia is osteoporosis, due to a decrease in bone density. In patients who vomit regularly, the lining of the esophagus can be damaged, and regurgitated stomach enzymes can destroy tooth enamel.
The scariest part of all is that in extreme cases, patients can die. In 1983, popular singer Karen Carpenter died of heart failure brought on by starvation. She was thirty two years old. Carpenter's death brought awareness of eating disorders into the eye of the American public, although anorexia was identified by European doctors as far back as the 1870's.
Experts have differing opinions on what causes a person to become anorectic. The most popular explanation is that of cultural expectations. This theory posits that eating disorders are caused by societal demands that emphasize slimness as the most important aspect of female perfection.
Personality type may also be linked to eating disorders. People with a strong sense of body dissatisfaction, extreme need for perfectionism, and anxiety about their own identity may be predisposed to develop anorexia or bulimia.
Linscheid says, "These tend to be kids who never allow themselves to celebrate success, even thought they're often overachievers."
When Linscheid encounters a male patient, it's usually an athlete in a sport in which smaller size is emphasized, such as wrestling. "Many of these [male] patients are not true bulimics," he explained, "because they're purging but they're not binging. Their food intake is normal."
Interestingly, anorectics often display behavior patterns that are similar to those of obsessive-compulsive disorder: excessive orderliness, attention to detail, and self-righteousness.
Finally, some professionals suggest that anorexia and bulimia are in fact a way of rebelling against a family or parent that is controlling or rigid. For a teen girl, an eating disorder can be a passive way of nonconforming.
Micaela admits that some of the reason for her disorder lies in her turbulent relationship with her mother. "My mother is a very hostile person, and she's overweight. I wanted to be thin and sweet, so I wouldn't have to be like her."
Micaela's therapist was the one who told her parents she was anorectic. "They were sad and scared when they found out. But mostly they just came off as pissed off and furious," she recalls. "It was like anger was all they knew how to show me."
So how does a parent know if their child is suffering from an eating disorder? The first step is to assess your child's eating. A thin child doesn't necessarily have an eating disorder. The National Eating Disorders Association recommends that you evaluate your child's habits as a whole.
Does your child skip meals, obsess about counting calories, carbs or fat grams, or worry about looking fat, even though she isn't overweight? Are you scared that if you confront your child about her eating habits, it will just exacerbate the situation?
If you found yourself saying "yes" just now, your child might be developing patterns that indicate a risk for eating disorders. You may want to consult your family physician for a more extensive evaluation.
There are things parents can do to take a proactive stance, and prevent these risks from developing in the first place. Talk to your children about different body shapes and sizes, and remind them that it's who a person is on the inside that's important. They need to understand that you will love them no matter what size they are.
Evaluate your own sense of appearance and of self. What sort of body image do you, as an adult, have? If a girl sees her mother constantly obsessed with weight loss and exercise, you may be sending the wrong message. Do you make fun of people who are overweight? If you do, you could be sending the message that "fat is bad" and "skinny is good."
Teach both boys and girls to recognize the ways that television, movies, and magazines portray people. Help them to understand the concept of advertising, and take the opportunity to discuss what they're seeing. Ask them if they think a commercial's thin and pretty people make the product better.
Finally, do whatever you can to promote your child's sense of self worth. Encourage your kids to participate in sports or academic activities in which skill or brains are valued more than physical appearance. Be sure to avoid falling into the gender-trap, and let boys and girls have equal opportunities.
If your child is diagnosed with anorexia or bulimia, understand that help is out there. Even the most loving and dedicated parents feel guilty when faced with a child's eating disorder. They may question their skills as parents, or feel confused and inadequate.
According to Dr. Linscheid, treatment at Columbus Children's Hospital uses a two stage method. First, he said, the "re-feeding" approach is used, and the patient is forced to gain weight. Behavior modification is used, with rewards given for pounds gained or calories consumed.
"I had one girl who said she wanted to go home, and she promised to eat cheeseburgers and pizza and gain back her weight, if we would just let her leave. I didn't believe her," Linscheid says. "I went to the cafeteria, got her a cheeseburger, and told her if she could eat just one bite we'd let her go home. She started shaking and literally could not do it."
The second phase of treatment is psychotherapy, if it's needed. Linscheid stressed that one of the complications of weight loss is a decrease in cognitive thinking skills ‚ in other words, once the body is physically better, it's a lot easier to treat any emotional issues. "Sometimes, once we get the weight back on them," he said, "they don't need the therapy at all."
It's important for parents and healthcare professionals to work together with the child to solve the problem.
Linscheid said that changes in health care coverage have created a crisis in treatment options. At Children's Hospital, anorectic patients can only be admitted as inpatients if they have medical complications from the disease. "And obviously," he says, "if you see them on only an outpatient basis, it's hard to make them eat."
He adds that patients who have battled eating disorders earlier are always at risk of backsliding.
Micaela has her good days and her bad days now. She and her mom are still at odds, but Micaela is up to 138 pounds.
Looking back now, Micaela knows she'll never be in such a dangerous position again. "You try to make yourself unstoppable, slender and perfect, but you end up becoming helpless and controlled by everyone else around you," she says. "You think that you'll become healthy and flawless, but you end up sick and obviously, sadly, permanently tainted."
Tips for Kids ‚ How to Eat Well and Feel Good About Yourself
The National Eating Disorders Association recommends trying some of these healthy tips for teens and pre-teens. Encourage your kids to appreciate who they are ‚ no matter what their size is.
• Remember that healthy bodies come in all different sizes and shapes. Someone who is big might be healthier than someone who is thinner.
• Don't tease people about being too fat or too thin. Teasing is unfair, and it makes others feel bad about themselves. Who you are on the inside is important too.
• If you hear a friend say that they're "too fat and need to go on a diet," make sure they talk to a grownup before they do anything. Crash dieting is unhealthy, and can cause a lot of damage to your friend's health.
• Eat when you're hungry ‚ stop when you get full.
• Exercise and stay active to stay healthy. Find a sport or activity you enjoy, and stick with it ‚ you'll feel better physically as well as mentally.
• If you're sad, angry or bored, find something to do other than eating. Sometimes, talking to a friend, parent or teacher can help.
• Try a variety of snacks ‚ one day, eat carrots or cheese, the next day try some celery or yogurt.
Patricia Wigington works as a reporter for a Columbus, Ohio newspaper, writing on health topics.
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