[Paleopsych] Newsweek: Fighting Anorexia: No One to Blame
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Thu Dec 8 02:20:50 UTC 2005
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 onenot the school psychologist, the private
therapist, the family pediatrician or the high-powered internistcould 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 foodany
foodshe'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 upnot 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, too20 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 agendabut 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 communityand families, and victimsto
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
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 killerit 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 illexhausting, 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
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 otherspart 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 psychologicallyand sometimes physicallyfrom 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 nothingand 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 battlebut 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 nearbyattending 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
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
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
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 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
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
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
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 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
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
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,
~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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