[Paleopsych] Newsweek: Fighting Anorexia: No One to Blame

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Fighting Anorexia: No One to Blame

[Interview and an article on "pro-ana" groups appended.]

It's fascinating how the causes and blames for this disease get moved 
around, more so than with most other events and processes that have multiple 
causes. For me, anorexia is the best current example of a "socially 
constructed" disease. I do not deny that it is also a medical condition, but 
we must not think that the brain cannot play an active role. Well, we know 
that. What right-wingers do not want to admit is that the verbiage we take 
in shapes these diseases. Their medical model is germs to disease, or 
bottom-up causation. The wilder pomos say it's strictly mind to disease or, 
more strictly, verbiage to disease.

[But it's plain that anorexia did not exist, in anything remotely like its 
current prevalence, until a few decades ago. To blame it on girls aping 
fashion models is a verbiage account, but that's English major metaphorism, 
and the author of the main article knows that. She does not hide the huge 
hereditary component, but this only means that, *at the present*, the 
hereditability is high. The larger historical problem is why the sudden 

["Socially constructed" connotes English major metaphorism in the minds of 
right wingers, but it is almost certain, in the case of anorexia, that 
changes *society* have far outweigh genetic changes or environmental changes 
like contaminants. "Constructed," though, implies a constructor or a Social 
Planner. I'd like a better term.

[Multiple personality disorders is an earlier example of a socially 
constructed disease. Its entire existence spanned a few decades in the last 
century. Marianne Noble's _The Masochistic Values of Sentimental Literature_ 
convinced me that masochist was socially constructed. She's not merely an 
English major but an English Professor (American U.)! I met her at a party 
for Sarah's choir and got the book. I was one of the first pomo books I had 
read and found it rough going, though today I've picked up enough of the 
jargon to sail through it much more quickly.

[I've decided to alter the meme I'm preparing on what it would take for me 
to abandon my three most cherished hypotheses. The first two, non-creation 
and co-evolution will remain, but I'm going to expand the third from the 
inability to precisely nail down our basic concepts to postmodernism, which 
includes that. It will be hard enough for me to describe what *I* mean by 
that term, and harder still to specify what it would take for me to abandon 
it. All three, as I work out my thoughts, are part of the broad movement 
from Western (mechanistic) to Darwinian (stochastic) Civilization.

[As you wait impatiently for my meme, tell me what it would take for you to 
abandon your three most cherished hypotheses.]


The age of their youngest patients has slipped to 9 years old, and doctors 
have begun to research the roots of this disease. Anorexia is probably 
hard-wired, the new thinking goes, and the best treatment is a family 

By Peg Tyre

Dec. 5, 2005 issue - Emily Krudys can pinpoint the moment her life fell 
apart. It was a fall afternoon in the Virginia suburbs, and she was watching 
her daughter Katherine perform in the school play. Katherine had always been 
a happy girl, a slim beauty with a megawatt smile, but recently, her mother 
noticed, she'd been losing weight. "She's battling a virus," Emily kept on 
telling herself, but there, in the darkened auditorium, she could no longer 
deny the truth. Under the floodlights, Katherine looked frail, hollow-eyed 
and gaunt. At that moment, Emily had to admit to herself that her daughter 
had a serious eating disorder. Katherine was 10 years old.

Who could help their daughter get better? It was a question Emily and her 
husband, Mark, would ask themselves repeatedly over the next five weeks, 
growing increasingly frantic as Katherine's weight slid from 48 to 45 
pounds. In the weeks after the school play, Katherine put herself on a 
brutal starvation diet, and no one—not the school psychologist, the private 
therapist, the family pediatrician or the high-powered internist—could stop 
her. Emily and Mark tried everything. They were firm. Then they begged their 
daughter to eat. Then they bribed her. We'll buy you a pony, they told her. 
But nothing worked. At dinnertime, Katherine ate portions that could be 
measured in tablespoons. "When I demanded that she eat some food—any 
food—she'd just shut down," Emily recalls. By Christmas, the girl was so 
weak she could barely leave the couch. A few days after New Year's, Emily 
bundled her eldest child into the car and rushed her to the emergency room, 
where she was immediately put on IV. Home again the following week, 
Katherine resumed her death march. It took one more hospitalization for the 
Krudyses to finally make the decision they now believe saved their 
daughter's life. Last February, they enrolled her in a residential clinic 
halfway across the country in Omaha, Neb.—one of the few facilities 
nationwide that specialize in young children with eating disorders. Emily 
still blames herself for not acting sooner. "It was right in front of me," 
she says, "but I just didn't realize that children could get an eating 
disorder this young."

Most parents would forgive Emily Krudys for not believing her own eyes. 
Anorexia nervosa, a mental illness defined by an obsession with food and 
acute anxiety over gaining weight, has long been thought to strike teens and 
young women on the verge of growing up—not kids performing in the 
fourth-grade production of "The Pig's Picnic." But recently researchers, 
clinicians and mental-health specialists say they're seeing the age of their 
youngest anorexia patients decline to 9 from 13. Administrators at Arizona's 
Remuda Ranch, a residential treatment program for anorexics, received so 
many calls from parents of young children that last year, they launched a 
program for kids 13 years old and under; so far, they've treated 69 of them. 
Six months ago the eating-disorder program at Penn State began to treat the 
youngest ones, too—20 of them so far, some as young as 8. Elementary schools 
in Boston, Manhattan and Los Angeles are holding seminars for parents to 
help them identify eating disorders in their kids, and the parents, who have 
watched Mary-Kate Olsen morph from a child star into a rail-thin young 
woman, are all too ready to listen.

At a National Institute of Mental Health conference last spring, anorexia's 
youngest victims were a small part of the official agenda—but they were the 
only thing anyone talked about in the hallways, says David S. Rosen, a 
clinical faculty member at the University of Michigan and an eating-disorder 
specialist. Seven years ago "the idea of seeing a 9- or 10-year-old anorexic 
would have been shocking and prompted frantic calls to my colleagues. Now 
we're seeing kids this age all the time," Rosen says. There's no single 
explanation for the declining age of onset, although greater awareness on 
the part of parents certainly plays a role. Whatever the reason, these 
littlest patients, combined with new scientific research on the causes of 
anorexia, are pushing the clinical community—and families, and victims—to 
come up with new ways of thinking about and treating this devastating 

Not many years ago, the conventional wisdom held that adolescent girls "got" 
anorexia from the culture they lived in. Intense young women, mostly from 
white, wealthy families, were overwhelmed by pressure to be perfect from 
their suffocating parents, their demanding schools, their exacting coaches. 
And so they chose extreme dieting as a way to control their lives, to act 
out their frustration at never being perfect enough. In the past decade, 
though, psychiatrists have begun to see surprising diversity among their 
anorexic patients. Not only are anorexia's victims younger, they're also 
more likely to be black, Hispanic or Asian, more likely to be boys, more 
likely to be middle-aged. All of which caused doctors to question their core 
assumption: if anorexia isn't a disease of type-A girls from privileged 
backgrounds, then what is it?

Although no one can yet say for certain, new science is offering tantalizing 
clues. Doctors now compare anorexia to alcoholism and depression, 
potentially fatal diseases that may be set off by environmental factors such 
as stress or trauma, but have their roots in a complex combination of genes 
and brain chemistry. In other words, many kids are affected by 
pressure-cooker school environments and a culture of thinness promoted by 
magazines and music videos, but most of them don't secretly scrape their 
dinner into the garbage. The environment "pulls the trigger," says Cynthia 
Bulik, director of the eating-disorder program at the University of North 
Carolina at Chapel Hill. But it's a child's latent vulnerabilities that 
"load the gun."

Parents do play a role, but most often it's a genetic one. In the last 10 
years, studies of anorexics have shown that the disease often runs in 
families. In a 2000 study published in The American Journal of Psychiatry, 
researchers at Virginia Commonwealth University studied 2,163 female twins 
and found that 77 of them suffered from symptoms of anorexia. By comparing 
the number of identical twins who had anorexia with the significantly 
smaller number of fraternal twins who had it, scientists concluded that more 
than 50 percent of the risk for developing the disorder could be attributed 
to an individual's genetic makeup. A few small studies have even isolated a 
specific area on the human genome where some of the mutations that may 
influence anorexia exist, and now a five-year, $10 million NIMH study is 
underway to further pinpoint the locations of those genes.

Amy Nelson, 14, a ninth grader from a Chicago suburb, thinks that genes 
played a role in her disease. Last year Amy's weight dropped from 105 to a 
skeletal 77 pounds, and her parents enrolled her in the day program at the 
Alexian Brothers Behavioral Health Hospital outside Chicago. Over the 
summer, as Amy was getting better, her father found the diary of his younger 
sister, who died at 18 of "unknown causes." In it, the teenager had 
calculated that she could lose 13 pounds in less than a month by restricting 
herself to less than 600 calories a day. No salt, no butter, no sugar, "not 
too many bananas," she wrote in 1980. "Depression can run in families," says 
Amy, "and an eating disorder is like depression. It's something wrong with 
your brain." These days, Amy is healthier and, though she doesn't weigh 
herself, thinks she's around 100. She has a part in the school play and is 
more casual about what she eats, even to the point of enjoying ice cream 
with friends.

Scientists are tracking important differences in the brain chemistry of 
anorexics. Using brain scans, researchers at the University of Pittsburgh, 
led by professor of psychiatry Dr. Walter Kaye, discovered that the level of 
serotonin activity in the brains of anorexics is abnormally high. Although 
normal levels of serotonin are believed to be associated with feelings of 
well-being, these pumped-up levels of hormones may be linked to feelings of 
anxiety and obsessional thinking, classic traits of anorexia. Kaye 
hypothesizes that anorexics use starvation as a mode of self-medication. 
How? Starvation prevents tryptophane, an essential amino acid that produces 
serotonin, from getting into the brain. By eating less, anorexics reduce the 
serotonin activity in their brains, says Kaye, "creating a sense of calm," 
even as they are about to die of malnutrition.

Almost everyone knows someone who has trouble with food: extremely picky 
eating, obsessive dieting, body-image problems, even voluntary vomiting are 
well known. But in the spectrum of eating disorders, anorexia, which affects 
about 2.5 million Americans, stands apart. For one thing, anorexics are 
often delusional. They can be weak with hunger while they describe physical 
sensations of overfullness that make it physically uncomfortable for them to 
swallow. They hear admonishing voices in their heads when they do manage to 
choke down a few morsels. They exercise compulsively, and even when they can 
count their ribs, their image in the mirror tells them to lose more.

When 12-year-old Erin Phillips, who lives outside Baltimore, was in her 
downward spiral, she stopped eating butter, then started eating with 
chopsticks, then refused solid food altogether, says her mother, Joann. 
Within two months, Erin's weight had slipped from 70 to 50 pounds. "Every 
day, I'd watch her melt away," Joann says. Before it struck her daughter, 
Joann had been dismissive about the disease. "I used to think the person 
should just eat something and get over it. But when you see it up close, you 
can't believe your eyes. They just can't." (Her confusion is natural: the 
term anorexia comes from a Greek word meaning "loss of appetite.")

Anorexia is a killer—it has the highest mortality rate of any mental 
illness, including depression. About half of anorexics get better. About 10 
percent of them die. The rest remain chronically ill—exhausting, then 
bankrupting, parents, retreating from jobs and school, alienating friends as 
they struggle to manage the symptoms of their condition. Hannah Hartney of 
Tulsa, Okla., was first hospitalized with anorexia when she was 10. After 
eight weeks, she was returned to her watchful parents. For the last few 
years, she was able to maintain a normal weight but now, at 16, she's been 
battling her old demons again. "She's not out of the woods," says her 
mother, Kathryn.

While adults can drift along in a state of semi-starvation for years, the 
health risks for children under the age of 13 are dire. In their preteen 
years, kids should be gaining weight. During that critical period, their 
bones are thickening and lengthening, their hearts are getting stronger in 
order to pump blood to their growing bodies and their brains are adding 
mass, laying down new neurological pathways and pruning others—part of the 
explosion of mental and emotional development that occurs in those years. 
When children with eating disorders stop consuming sufficient calories, 
their bodies begin to conserve energy: heart function slows, blood pressure 
drops; they have trouble staying warm. Whatever estrogen or testosterone 
they have in their bodies drops. The stress hormone cortisol becomes 
elevated, preventing their bones from hardening. Their hair becomes brittle 
and falls out in patches. Their bodies begin to consume muscle tissue. The 
brain, which depends at least in part on dietary fat to grow, begins to 
atrophy. Unlike adult anorexics, children with eating disorders can develop 
these debilitating symptoms within months.

Lori Cornwell says her son's descent was horrifyingly fast. In the summer of 
2004, 9-year-old Matthew Cornwell of Quincy, Ill., weighed a healthy 49 
pounds. Always a picky eater, he began restricting his food intake until all 
he would eat was a carrot smeared with a tablespoon of peanut butter. Within 
three months, he was down to 39 pounds. When the Cornwells and their doctor 
finally located a clinic that would accept a 10-year-old boy, Lori tucked 
his limp body under blankets in the back seat of her car and drove all night 
across the country. Matthew was barely conscious when he arrived at the 
Children's Hospital in Omaha. "I knew that I had to get there before he 
slipped away," she says.

With stakes this high, how do you treat a malnourished third grader who is 
so ill she insists five Cheerios make a meal? First, say a growing number of 
doctors and patients, you have to let parents back into the treatment 
process. For more than a hundred years, parents have been regarded as an 
anorexic's biggest problem, and in 1978, in her book "Golden Cage," 
psychoanalyst Hilde Bruch suggested that narcissistic, cold and unloving 
parents (or, alternatively, hypercritical, overambitious and overinvolved 
ones) actually caused the disease by discouraging their children's natural 
maturation to adulthood. Thirty years ago standard treatment involved 
helping the starving and often delusional adolescents or young women to 
separate psychologically—and sometimes physically—from their toxic parents. 
"We used to talk about performing a parental-ectomy," says Dr. Ellen Rome, 
head of adolescent medicine at the Cleveland Clinic.

Too often these days, parents aren't so much banished from the treatment 
process as sidelined, watching powerlessly as doctors take what can be 
extreme measures to make their children well. In hospitals, severely 
malnourished anorexics are treated with IV drips and nasogastric tubes. In 
long-term residential treatment centers, an anorexic's food intake is 
weighed and measured, bite by bite. In individual therapy, an anorexic tries 
to uncover the roots of her obsession and her resistance to treatment. Most 
doctors use a combination of these approaches to help their patients get 
better. Although parents are no longer overtly blamed for their child's 
condition, says Marlene Schwartz, codirector of the Yale eating-disorder 
clinic, doctors and therapists "give parents the impression that eating 
disorders are something the parents did that the doctors are now going to 

Worse, the state-of-the-art protocols don't work for many young children. A 
prolonged stay in a hospital or treatment center can be traumatic. Talk 
therapy can help some kids, but many others are too young for it to be 
effective. Back at home, family mealtimes become a nightmare. Parents, 
advised not to badger their child about food, say nothing—and then they 
watch helpless and heartbroken as their child pushes the food away.

In the last three years, some prominent hospitals and clinics around the 
country have begun adopting a new treatment model in which families help 
anorexics get better. The most popular of the home-based models, the 
Maudsley approach, was developed in the 1980s at the Maudsley Hospital in 
London. Two doctors there noticed that when severely malnourished, 
treatment-resistant anorexics were put in the hospital and fed by nurses, 
they gradually gained weight and began to participate in their own recovery. 
They decided that given the right support, family members could get 
anorexics to eat in the same way the nurses did. These days, family-centered 
therapy works like this: A team of doctors, therapists and nutritionists 
meets with parents and the child. The team explains that while the causes of 
anorexia are unclear, it is a severe, life-threatening disease like cancer 
or diabetes. Food, the family is told, is the medicine that will help the 
child get better. Like oncologists prescribing chemotherapy, the team 
provides parents with a schedule of calories, lipids, carbohydrates and 
fiber that the patient must eat every day and instructs them on how to 
monitor the child's intake. It coaches siblings and other family members on 
how to become a sympathetic support team. After a few practice meals in the 
hospital or doctor's office, the whole family is sent home for a meal.

"I told my daughter, 'You're going to hate this'," says Mitzi Miles, whose 
daughter Kaleigh began struggling with anorexia at 10. "She said, 'I could 
never hate you, Mom.' And I said, 'We'll see'." The first dinner at the 
Miles home outside Harrisburg, Pa., was a battle—but Mitzi, convinced by 
Kaleigh's doctor she was doing the right thing, didn't back down. After 45 
minutes of yelling and crying, Kaleigh began to eat. Over the next 20 weeks, 
Kaleigh attended weekly therapy sessions, and Mitzi got support from the 
medical team, which instructed her to allow Kaleigh to make more food 
choices on her own. Eleven months later, Kaleigh is able to maintain a 
normal weight. Mitzi no longer measures out food portions or keeps a written 
log of her daily food intake.

Critics point out that the Maudsley approach won't work well for adults who 
won't submit to other people's making their food choices. And they charge 
that in some children, parental oversight can do more harm than good. Young 
anorexics and their parents are already locked in a battle for control, says 
Dr. Alexander Lucas, an eating-disorder specialist and professor emeritus at 
the Mayo Clinic in Minnesota. The Maudsley approach, he says, "may backfire" 
by making meals into a battleground. "The focus on weight gain," he says, 
"has to be between the physician and the child." Even proponents say that 
family-centered treatment isn't right for everyone: families where there is 
violence, sexual abuse, alcoholism or drug addiction aren't good candidates. 
But several studies both in clinics at the Maudsley Hospital and at the 
University of Chicago show promising results: five years after treatment, 
more than 70 percent of patients recover using the family-centered method, 
compared with 50 percent who recover by themselves or using the old 
approaches. Currently, a large-scale NIH study of the Maudsley approach is 

Mental-health specialists say the success of the family-centered approach is 
finally putting the old stigmas to rest. "An 8-year-old with anorexia isn't 
in a flight from maturity," says Dr. Julie O'Toole, medical director of the 
Kartini Clinic in Portland, Ore., a family-friendly eating-disorder clinic. 
"These young patients are fully in childhood." Most young anorexics, O'Toole 
says, have wonderful, thoughtful, terribly worried parents. These days, when 
a desperately sick child enters the Kartini Clinic, O'Toole tries to set 
parents straight. "I tell them it's a brain disorder. Children don't choose 
to have it and parents don't cause it." Then she gives the parents a little 
pep talk. She reminds them that mothers were once blamed for causing 
schizophrenia and autism until that so-called science was debunked. And that 
the same will soon be true for anorexia. At the conclusion of O'Toole's 
speech, she says, parents often weep.

Ironically, family dinners are one of the best ways to prevent a vulnerable 
child from becoming anorexic. Too often, dinner is eaten in the back seat of 
an SUV on the way to soccer practice. Parents who eat regular, balanced 
meals with their children model good eating practices. Family dinners also 
help parents spot any changes in their child's eating habits. Dieting, says 
Dr. Craig Johnson, director of the eating-disorder program at Laureate 
Psychiatric Hospital in Tulsa, triggers complex neurobiological reactions. 
If you have anorexia in the family and your 11-year-old tells you she's 
about to go on a diet and is thinking about joining the track team, says 
Johnson, "you want to be very careful about how you approach her request." 
For some kids, innocent-seeming behavior carries enormous risks.

Children predisposed to eating disorders are uniquely sensitive to media 
messages about dieting and health. And their interpretation can be starkly 
literal. When Ignatius Lau of Portland, Ore., was 11 years old, he decided 
that 140 pounds was too much for his 5-foot-2 frame. He had heard that oils 
and carbohydrates were fattening, so he became obsessed with food labels, 
cutting out all fats and almost all carbs. He lost 32 pounds in six months 
and ended up in a local hospital. "I told myself I was eating healthier," 
Ignatius says. He recovered, but for the next three years suffered frequent 
relapses. "I'd lose weight again and it would trigger some of my old 
behaviors, like reading food labels," he says. These days he knows what 
healthy feels like. Ignatius, now 17, is 5 feet 11, 180 pounds, and plays 

Back in Richmond, Va., Emily Krudys says her family has changed. For two 
months Katherine stayed at the Omaha Children's Hospital, and slowly gained 
weight. Emily stayed nearby—attending the weekly therapy sessions designed 
to help integrate her into Katherine's treatment. After Katherine returned 
home, Emily home-schooled her while she regained her strength. This fall, 
Katherine entered sixth grade. She's got the pony, and she's become an avid 
horsewoman, sometimes riding five or six times a week. She's still slight, 
but she's gaining weight normally by eating three meals and three or four 
snacks a day. But the anxiety still lingers. When Katherine says she's 
hungry, Emily has been known to drop everything and whip up a three-course 
meal. The other day she was startled to see her daughter spreading sour 
cream on her potato. "I thought, 'My God, that's how regular kids eat all 
the time'," she recalls. Then she realized that her daughter was well on the 
way to becoming one of those kids.

With Karen Springen, Ellise Pierce, Joan Raymond and Dirk Johnson

Live Talk Transcript: Fighting Anorexia  - Newsweek Society - MSNBC.com

    NEWSWEEK general editor Peg Tyre joined us for a Live Talk on this
    week's anorexia cover story on Thursday, Dec. 1.

    Anorexia, which affects 2.5 million Americans, isn't simply an eating
    disorder-it's a mental illness with a higher mortality rate than even
    depression. Patients who starve and deny themselves essential
    nutrients can cause long-term damage to their bodies. The disease's
    youngest victims, who are getting younger and younger, are also its
    most vulnerable. NEWSWEEK's Peg Tyre reports that the face of anorexia
    is no longer just the "type-A girls from privileged backgrounds" who
    confront pressures from parents, schools or coaches. Instead, they are
    more likely to be minorities, boys or middle-aged. There's also a
    genetic link to this disease, much like alcoholism and depression. As
    for treatment, researchers are saying parents need to be part of the
    process, instead of being viewed as contributing to the disease. Tyre,
    a NEWSWEEK general editor, will answer your questions on anorexia
    during a Live Talk on Thursday, Dec. 1, at noon ET.

    Peg Tyre: Hi All,  Peg Tyre here. I'm the author of No One To Blame -
    Newsweek's cover story on anorexia. I'll try and answer your questions
    in the next hour.
    Brooklyn,NY: When an individual gets anorexia, is it a disease that
    just comes up all of a sudden or is a disease that they have had for
    years but had not turned up until something triggers it?
    Peg Tyre: What I learned is that many people seem to have a latent
    vulnerability to the disease that is triggered by environmental
    factors. In terms of symptoms, many victims I talked to reported that
    it seemed to "come out of the blue." Others said it had been building
    for a long time.
    Midland, GA: I was anorexic, in and out of hospitals and doctors
    offices for numerous years.  Though it was not easy, I have now
    learned how not to obsess about food and weight.  Actually, I am now
    trying valiantly to gain a few pounds!;  I have an 18 month old
    daughter. What I would like to know is if there are any behaviors that
    we as parents need to avoid in raising her as a healthy happy girl.
    And how I can start teaching her how to love herself and have a
    healthy bady image.
    Peg Tyre: Congratulations! It sounds like you have done what many
    anorexics long to do-put it in their past!
    And congrats, too, on starting a family. We all worry about our
    children and their eating. It's such a primal concern. But for you, it
    will be a bit more fraught. Anorexia, as you probably know, tends to
    run in families. So you're going to have to keep a sharp eye on her.
    But, and here's the hard part, you are going to have to find a way to
    be normal (at least in front of her) about food. If I were you, I'd
    find a good therapist who you can discuss this with-you'll have so
    many questions as your daughter grows and goes through different
    phases. Good luck!
    Indialantic, FL: Hi, do you have any sense of how funding for this
    disease compares to other disorders such as AIDS ?
    Peg Tyre: I was astonished at how little research dollars are actually
    being spent on eating disorders. I think because of the heavy stigma
    that is placed on families, most families of anorexics tend to lay low
    and suffer in silence instead of coming out and trying to raise money.
    These families often think (and are sometimes told) it is something
    they caused!
    Oklahoma City, OK: What percentage of teens are affected with
    Peg Tyre: Good question. The answer is that there are no good  numbers
    for eating disorders. There is no central reporting on eating
    disorders and very little follow up over time. That said, the rate of
    anorexia is and always has been low-less than 1%. For eating disorders
    in general, the rates are much higher.
    St. George's, Grenada: Is it likely for a person suffering from
    Anorexia to die?
    Peg Tyre: Anorexic can be a fatal disease for many people. Some
    studies say 10% of them die, some studies say 20%, some say 5% every
    decade. Mostly they die of suicide or starvation.
    Honolulu, HI: Which treatment centers in the US use the Maudsley
    Peg Tyre: There are very good programs at the Univ. of Chicago, at the
    Comprehensive Eating Disorder Program at the Lucile Packard Children's
    Hosptital in Pao Alto, Ca., at Columbia University in NY and at Mount
    Sinai also, in NY.
    Austin, TX: In covering this story, did you encounter any information
    about the insurance industry and its willingness to cover the expense
    of treatment for eating disorders?  In my
    experience, which was years ago, there was almost no coverage. Just
    wondering if the new information about biological connections has
    heloed with this.
    Peg Tyre: Many families shared their struggles with their insurance
    companies who by and large, don't recognize this and pay for treatment
    in the way they might.
    Summerville, SC: What advice can you give to parents of an anorexic
    who is no longer a teenager and refuses to go to drs appt or therapy?
    My daughter went through treatment at 14 and went into recovery in
    about 6 months. After a relatively healthy 3 years, she is struggling
    and dipping in and out of relapse.
    It is just so hard when she is making her own decisions now, and isn't
    open to my parental advice.
    Peg Tyre: I'm sorry. That sounds like a very difficult situation. My
    advice to you would be to get in touch with Cynthia Bulik, a professor
    at UNC in Chapel Hill and ask her for advice. She is an ED specialist.
    Charlotte, NC: How come it's nobody's fault if a kid is anorexic, but
    parents, society, and supersized sandwiches and biggie fries are
    responsible for childhood obesity? These are symptoms of the same
    thing, a whacked out relationship with food. Obesity occurs in
    families, too, and starts before 10 years old.  The people with
    "eating disorders" as described in this article are just the skinny
    victims.  Clearly the implication is that there is blame to go around
    for fat.
    Peg Tyre: You raise some interesting points. I'm not sure, though,
    about connecting anorexia to obesity in this way. If you had a kid who
    ate without stopping until they died-who heard voices telling them to
    eat more-who refused to move so that they wouldn't burn a calorie-that
    might be the flip side of anorexia. Obesity is a different animal that
    what we are talking about with anorexia.
    Columbia, PA: I eat a meal a day a have for years and always thought I
    may have anorexia, but I'm not hungry, that is why I eat 1 meal.  Is
    this anorexia and can it be involuntary.
    Peg Tyre: I think most anorexics would tell you that it is
    involuntary. It is not something they are doing. I don't know you or
    your medical history and I'm not a doctor. I also can't see you so I
    don't know if your bones are showing. But if you are worried about it,
    ask your physician. Describe your eating patterns. He or she should be
    able to tell you quick enough.
    Houston, TX: Did you find anyone investigating Anorexia possibly being
    linked to PANDAS (pediatric autoimmune neuropsychiatric disorders
    associated with streptococcal infections? Some groups have been
    investigating sudden and dramatic onset
    Peg Tyre: Glad you  brought this up. This is a really interesting area
    of research that I simply didn't have space for. There are doctor who
    have made links between kids getting strep or a bacterial infection
    and then, coming down with anorexia. They have also tied PANDAS as it
    is called to the onset of obsessive compulsive disorder. It it really
    outside the box-to suggest that a bacterial infection (or perhaps its
    treatment) may be causing these profound behavioral and neurological
    changes. But I think it is an exciting avenue of inquiry. It is about
    time doctors started to take a fresh look at it!
    Pittsburgh, PA: I am in my 30s and suffered severe anorexia. I was
    treated at Remuda Ranch. Although this is an outstanding article, it
    is important to note that the family situations described by Hilda
    Bruch in The Golden Cage e.g. controlling, narcissistic parents, ARE
    still relevant for some patients. In the opinion of my doctors and
    therapists, incl those at RR, my ED was caused in large part by my
    family situation. All of the points made in the article eg genetic
    susceptibility, are valid. However, I would caution that in some
    patients a family based treatment approach e.g the Maudsley method, is
    not suitable. My father hit me with a belt when I would not eat.
    Clearly the method of parental control of meals that is described
    would have been completely inappropriate in my case, and undoubtedly
    in others also.
    Thank you for the good information in the article.
    Peg Tyre: I'm very sorry you had to endure what you did. It is
    heartbreaking to hear about it. You make a good point-and one I tried
    to emphasize in the article-the family based method is clearly not
    right for every family-especially for those with a history of
    addiction or violence. However, it does offer some new hope for an old
    intractable problem.  Good luck to you!
    Minneapolis, MN: Since anorexia is a brain disorder, likened to
    depression and alcoholism for its genetical predetermination to some
    degree, has there been any research on the use of anti-depressants,
    mood-stabilizers, and/or anti-psychotics as a way to aid the
    symptomology of this disorder?
    Peg Tyre: I haven't found any good long term studies that suggest that
    anti-depressants or other psycho-active drugs are helpful. That said,
    I know clinicians often prescribe anti-depressants/anti-anxiety drugs
    to anorexics. Often, anorexics suffer from depression or anxiety and I
    guess some doctors are trying to treat both.
    Ft. Worth, TX: After suffering from and overcoming anorexia, I still
    face severe anxiety and depression.  Is this just because of my
    genetic makeup?  What can I do to combat these issues and feel
    accepted by my family?  (I am currently 19 yrs old and attend a
    Peg Tyre: There are good studies that show that anorexics often suffer
    from depression and anxiety as well. Both of those conditions are
    treatable with the right drugs and a good therapist. Find a good
    doctor. (University health services should be able to refer you.)
    Indialantic, FL: A followup question, please. Who are the people to
    to get involved in a serious fundraising effort, including
    corporations that may want to consider sponsorship ?
    Peg Tyre: I think the National Eating Disorder Association is probably
    your best bet.
    Rochester, NY: Let's say there are two girls. One has been anorexic
    for 15+ years. The other girl for six years. Both  try to get better
    but always fall back into their old habits. Would the 1st girl be
    considered chronic and the other one not ready? Or would they both be
    considered chronic? There is no defition of what constitute chronic
    anorexia, so if you could answer my question, it would be great.
    Peg Tyre: I think they would both be considered chronic.
    Greensboro NC: Why are there only a handful of clinics worldwide to
    help those with this disease? And why are they so expensive?
    Peg Tyre: There are more than a handful but you are right, most of
    them are very very expensive. It is a difficult disease to treat-many
    parents end up re-mortgaging the house to get their kids in treatment.
    I'm surprised more families don't lobby for better coverage from their
    insurance carriers.

    Peg Tyre: I want to put in a plug here for the ongoing NIMH study
    which is looking at the role genetics plays in anorexia. If you have
    anorexia, and you think it might run in your family, and you want to
    be part of an important study that will cost you  nothing and may help
    future generations-you can go to [51]www.angenetics.org or phone
    412-647-9794 to get more information about it.
    Oklahoma City, OK: This is a 9th grade class called Basic Life
    Skills.  We have been studing eating disorders.  We wrote questions to
    ask, here is one: Do anorexics still feel hungry, or do they become
    immune to the pain of not eating?
    Peg Tyre: Good question: some say that they are not hungry. In fact,
    they feel full-one said "like I just ate two thanksgiving dinners"
    almost all the time. Others feel hungry but ignore it until their body
    stops sending them the "I"m hungry"  message all the time.
    Philadelphia, PA: I have a friend of the family, whose 19 year old
    daughter has an eating disorder due to anxiety and compulsive
    behavior.  The mother's problem is finding adequate care for her age
    group and then fighting with the insurance companies to pay for an
    extensive period of time in a facility.  Right now she upgraded her
    insurance to $1200 a month to pay for another 30 days of treatment.
    This has hit the family hard financially because they have a co-pay on
    top of this.  They plan on taking a second mortgage to pay to keep
    their daughter well.  Is there any help for these kids and families?
    Peg Tyre: This is such a big problem. Why don't you get in touch with
    NEDA. They might have resources to help you. There is also a small
    foundation I've heard of called the Freed Foundation which may have
    some $$.
    Silver Spring, MD: The 'Pro-Ana" movement appears to be flourishing
    amongst various internet communities, often with at about 4-6 new
    'members' per day. Given that children are fairly technologically
    advanced, is there any research on what impact this peer support
    network is having on treament?
    Peg Tyre: I don't know if I'd call it a movement. I guess you are
    talking about those websites where very sick, delusional anorexics
    write defiantly about wanting to be thin.
    What most people don't realize is that for most people, anorexia isn't
    a lifestyle choice. It is a mental illness, and like alcoholism, it is
    often characterized by denial. And yes, for many young people (and
    older as well) denial feeds denial. What most people fail to remember,
    though is that these "pro-ana" types are just in the throes of a
    terrible debilitating disease.
    Rockville, MD: Your article states that "Not only are anorexia's
    victims younger, they're also more likely to be black, Hispanic or
    Asian, more likely to be boys, more likely to be middle-aged."   What
    documentation or statistical information do you have to back up this
    Peg Tyre: There aren't alot of good surveys on this -  but I spoke to
    about two dozen clinicians around the country. What I found is that
    their patient base has really changed-younger, less white, sometimes
    older as well.
    Greenfield IN: I was anorexic and bulimic when I was in middle and
    high school.  I bottomed out at 59 pounds.  I got therapy and seemed
    to be doing better.  But as I gained the weight back it almost killed
    me and I would eat and then feel so guilty that i would force myself
    to throw up.  I still have the urge to throw up every time I eat
    something.  I have stopped eating when I can get away with it and if I
    cant I want to throw up afterwards.  Sometimes I still go to the
    bathroom turn on the water and throw up.  I dont know what to do and I
    dont want to tell my boyfriend for fear he will be upset and worry.  I
    cant do that to him.
    Peg Tyre: Thanks for writing. As you know, eating disoders can be a
    chronic problem and it sounds like you're still doing battle with
    yours. You must be feel very isolated and alone. Why don't you get
    back in touch with that therapist-or get in touch with one of the
    clinics or experts I mentioned earlier. They might be able to help
    you. Good luck.
    Wocester, MA: I know that these articles on anorexia are focusing on
    biological predispositions to it.  It somewhat bothered me how strong
    the point was, mostly in the Berrien article, that parents didn't
    cause the anorexia.  It bothers me because it seems that parents could
    read this and feel releaved of any responsibility and not examine
    there own behaviors.
    I am currently trying to recover from anorexia which I'm pretty sure
    surfaced when I was more and adult than a child.  And I do believe
    that I was predisposed to it.  However, I have come to see how having
    a mentally ill sibling and his outbursts toward me and my parents'
    responses to both him and me really ignited this.  It's not means to
    blame or take responsibility off of me, but it helps me see that it's
    not such a shock my anorexia surfaced.
    So basically, my question to you is shouldn't parents not just focus
    on "fixing" the child and seeing the child as the problem but also to
    examine that maybe the child is an indication of a larger family
    problem?  Like I said, I'm just afriad these articles will foster
    misunderstanding and further the stigma that the child is somehow
    "defective" all on his/her own.
    Peg Tyre: You raise a really good point here. Eating disorders are
    often a result of genetic vulnerabilities but there are often
    environmental triggers that set it off. And families can pull those
    triggers (heck, they MAKE the triggers). Saying that there may be a
    genetic component doesn't let families off the hood. The point I want
    to make is that scientists don't believe this is something that you
    are chosing to have. And they don't believe that this is something
    most parents gave you on purpose. Any like any serious mental or
    physical disease, your entire family can play some role in helping you
    get better.
    Vernal, UT: I am asking serveral questions, I am devasted I just
    started suspecting something was going on with my daughters eating
    habits.  I went to the grocery store so The Newsweek cover yesterday.
    I bought the magazine.  My husband and I read it last night.  Now we
    are sure there is something going on. I am frozen in fear about
    confronting her and knowing where to go from here.
    Peg Tyre: Please get in touch with some of the experts and facilities
    quoted in the story and in this livechat. My thoughts are with you.
    Washington, DC: Is the current treatment environment beginning to
    adapt to the changing trends mentioned in this article? As a 26 year
    old female with anorexia, there appears to be a lack of specialized
    treatment programs that serve individuals outside of the 'common
    onset' age/gender group.  Do you know of any programs that are
    specifically serving younger or older individuals, or males with this
    Peg Tyre: The children's hospital in Omaha treats younger kids, so
    does the ED program at Penn State. Remuda Ranch, a residential
    program, treats younger kids now, too.
    Effingham, IL: How much has the "Hollywood" influence had on the
    younger children afflicted with anorexia? Since such stars as Lindsay
    Lohan parade the fact they are thinner, does that say to the younger
    fans that they should do the same?
    Peg Tyre: These are not good role models for our children. Do they
    give them unhealthy ideas about the body? Yes. Do they give kids
    unhealthy ideas about eating. Yes. Do they cause eating disoders? In
    some cases yes, but in other cases, the causes are more deepseated.
    Evanston, IL: Hi Peg. First, congratulations on a fabulous,
    well-researched and -written story. I'm not given to crying (being a
    guy), but at several points tears welled up in my eyes. My question
    is-and I was appalled to read this-why do you and the experts think
    this is such an intractable condition, with at 10% the highest
    mortality rate of any mental disorder?
    Peg Tyre: Thanks very much. I think anorexics are difficult to treat
    because the disease affects their brain chemistry and ultimately,
    their ability to think logically about themselves. (Starvation does
    that.) Death rate? For all the boasting on the pro-ana websites about
    it being a lifestyle choice, it is really a miserable life filled with
    isolation and loneliness and frustration. My heart goes out to the
    Alexandria, VA: I nearly died of anorexia in 1995.  I recovered only
    after being sent to Remuda Ranch in Arizona.  Now, ten years later, I
    still fight the disease every single day.  I am five months pregnant
    and wonder if there is any help for recovered anorexics who are
    pregnant?  Gaining weight for the baby has been a constant battle.
    What are your suggestions?
    Peg Tyre: There are good support groups online-also a good therapist
    might help.
    Kansas City, MO: I'm 19 and have struggled with anorexia for eight
    years. I was first hospitalized when I was 12 and have all together
    been in inpatient treatment five times. I got home from treatment two
    months ago, which I left against medical advice. Now I feel as though
    I am doing well with food, I eat three meals a day (that are about
    half of what my dietitian's meal plan for me calls for) and drink two
    Ensure Plus. Everyone around me is saying that I need to be back
    inpatient based solely on my weight right now though and I'm
    desperately confused. Is being 5'4" and 90 pounds really that much in
    need of help?
    Peg Tyre: I'm not qualified to say what you should weight but your
    doctor is. Part of you disease is not being able to make good
    judgements about how much food you should eat and what you should
    weight. Find professionals you trust. Then trust them.
    New York, NY: Are there any programs you know of that treat boys?
    Peg Tyre: The children's hospital in Omaha may be able to  help you.
    Silver Spring, MD: Please,please recommend Lock and LeGrange's book
    Help Your Teenager Beat an Eating Disorder-it's a great resource for
    information on family based treatment.   Laura Collins' book Eating
    with your Anorexic and her website [52]www.eatingwithyouranorexic.com
    are also wonderful resources.  Thanks so much for this important
    article.  My 14 year old daughter recovered using family based
    treatment and it is such a joy to see her happy and healthy again.
    Peg Tyre: Right-If you are interested in the Maudsley Method, please
    check out Laura Collin's book Eating With Your Anorexic. It is
    terrific, brave, heartwarming and very helpful in understanding what
    families of anorexics go through. She also has a website for family
    support [53]www.eatingwithyouranorexic.com

AP: Pro-anorexia movement has cult-like appeal
Experts alarmed by Web sites that promote self-starvation
Updated: 1:38 p.m. ET May 31, 2005

CHICAGO - They call her ~SAna.~T She is a role model to some, a goddess to 
others ~W the subject of drawings, prayers and even a creed.

She tells them what to eat and mocks them when they don~Rt lose weight. And 
yet, while she is a very real presence in the lives of many of her 
followers, she exists only in their minds.

Ana is short for anorexia, and ~W to the alarm of experts ~W many who suffer 
from the potentially fatal eating disorder are part of an underground 
movement that promotes self-starvation and, in some cases, has an almost 
cult-like appeal.

Followers include young women and teens who wear red Ana bracelets and offer 
one another encouraging words of ~Sthinspiration~T on Web pages and blogs.

They share tips for shedding pounds and faithfully report their ~Scw~T and 
~Sgw~T ~W current weight and goal weight, which often falls into the double 
digits. They also post pictures of celebrity role models, including teen 
stars Lindsay Lohan and Mary-Kate Olsen, who last year set aside the acting 
career and merchandising empire she shares with her twin sister to seek help 
for her own eating disorder.

~SPut on your Ana bracelet and raise your skinny fist in solidarity!~T one 
~Spro-Ana~T blogger wrote shortly after Olsen entered treatment.

The movement has flourished on the Web and eating disorder experts say that, 
despite attempts to limit Ana~Rs online presence, it has now grown to 
include followers ~W many of them young ~W in many parts of the world.

No one knows just how many of the estimated 8 million to 11 million 
Americans afflicted with eating disorders have been influenced by the 
pro-Ana movement. But experts fear its reach is fairly wide. A preliminary 
survey of teens who~Rve been diagnosed with eating disorders at the Lucile 
Packard Children~Rs Hospital at Stanford University, for instance, found 
that 40 percent had visited Web sites that promote eating disorders.

~SThe more they feel like we ~W ~Rthe others~R ~W are trying to shut them 
down, the more united they stand,~T says Alison Tarlow, a licensed 
psychologist and supervisor of clinical training at the Renfrew Center in 
Coconut Creek, Fla., a residential facility that focuses on eating 

Experts say the Ana movement also plays on the tendency people with eating 
disorders have toward ~Sall or nothing thinking.~T

~SWhen they do something, they tend to pursue it to the fullest extent. In 
that respect, Ana may almost become a religion for them,~T says Carmen 
Mikhail, director of the eating disorders clinic at Texas Children~Rs 
Hospital in Houston.

She and others point to the ~SAna creed,~T a litany of beliefs about control 
and starvation, that appears on many Web sites and blogs. At least one site 
encourages followers to make a vow to Ana and sign it in blood.

People with eating disorders who~Rve been involved in the movement confirm 
its cult-like feel.

~SPeople pray to Ana to make them skinny,~T says Sara, a 17-year-old in 
Columbus, Ohio, who was an avid organizer of Ana followers until she 
recently entered treatment for her eating disorder. She spoke on the 
condition that her last name not be used.

'Helping girls kill themselves'
Among other things, Sara was the self-proclaimed president of Beta Sigma 
Kappa, dubbed the official Ana sorority and ~Sthe most talked about, nearly 
illegal group~T on a popular blog hosting service that Sara still uses to 
communicate with friends. She also had an online Ana ~Sboot camp~T and told 
girls what they could and couldn~Rt eat.

~SI guess I was attention-starved,~T she now says of her motivation. ~SI 
really liked being the girl that everyone looked up to and the one they saw 
as their ~Rthinspiration.~R

~SBut then I realized I was helping girls kill themselves.~T

For others, Ana is a person ~W a voice that directs their every move when it 
comes to food and exercise.

~SShe~Rs someone who~Rs perfect. It~Rs different for everyone ~W but for me, 
she~Rs someone who looks totally opposite to the way I do,~T says Kasey 
Brixius, a 19-year-old college student from Hot Springs, S.D.

To Brixius ~W athletic with brown hair and brown eyes ~W Ana is a wispy, 
blue-eyed blonde.

~SI know I could never be that,~T she says, ~Sbut she keeps telling me that 
if I work hard enough, I CAN be that.~T

Treatment often fails
Dr. Mae Sokol often treats young patients in her Omaha, Neb., practice who 
personify their eating disorder beyond just Ana. To them, bulimia is 
~SMia.~T And an eating disorder often becomes ~SEd.~T

~SA lot of times they~Rre lonely and they don~Rt have a lot of friends. So 
Ana or Mia become their friend. Or Ed becomes their boyfriend,~T says Sokol, 
who is director of the eating disorders program run by Children~Rs Hospital 
and Creighton University.

In the end, treatment can include writing ~Sgoodbye~T letters to Ana, Mia 
and Ed in order to gain control over them.

But it often takes a long time to get to that point ~W and experts agree 
that, until someone with an eating disorder wants to help themselves, 
treatment often fails.

Tarlow, at the Renfrew Center, says it~Rs also easy for patients to fall 
back into the online world of Ana after they leave treatment. 
~SUnfortunately,~T she says, ~Swith all people who are in recovery, it~Rs so 
much about who you surround yourself with.~T

Some patients, including Brixius, the 19-year-old South Dakotan, have had 
trouble finding counselors who truly understand their struggle with Ana.

~SI~Rd tell them about Ana and how she~Rs a real person to me. And they~Rd 
just look at me like I~Rm nuts,~T Brixius says of the counselors she~Rs seen 
at college and in her hometown. ~SThey wouldn~Rt address her ever again, so 
it got very frustrating.

~SHalf the time I~Rm, like, ~RYou know what? I give up.~T~R

Other days, she~Rs more hopeful.

~SI gotta snap out of this eventually if I want to have kids and get a job. 
One day, I~Rll get to that point,~T she says, pausing. ~SBut I~Rll always 
obsess about food.~T

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