Eating Disorders [1 ed.] 9781608708598, 9781608708536

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Roughly 11 million Americans struggle with eating disorders, and the majority of sufferers are between the ages of twelve and twentyfive. Those statistics make eating disorders a particularly devastating teen issue. Yet anorexia and bulimia-and the teens who are living with them- are frequently misunderstood. In Eating Disorders, discover the realities of dealing with these illnesses by following the stories of three real-life teenagers who have experienced one. Using their personal accounts, explore warning signs, side effects, treatment options, and longterm solutions to this troubling teen issue.

The author would like to thank all of the sources who contributed to her research and understanding of eating disorders. She extends her sincere gratitude to her editor, Christine Florie, whose support and guidance in writing this book proved invaluable.

To protect the privacy of sources, only first names are used throughout the book. Any first names that are asterisked (*) indicate the use of a pseudonym. Published in 2014 by Cavendish Square Publishing, LLC 303 Park Avenue South, Suite 1247, New York, NY 10010 Copyright © 2014 by Cavendish Square Publishing, LLC First Edition No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the prior permission of the copyright owner. Request for permission should be addressed to Permissions, Cavendish Square Publishing, 303 Park Avenue South, Suite 1247, New York, NY 10010. Tel (877) 980-4450; fax (877) 980-4454. Website: cavendishsq.com This publication represents the opinions and views of the author based on his or her personal experience, knowledge, and research. The information in this book serves as a general guide only. The author and publisher have used their best efforts in preparing this book and disclaim liability rising directly or indirectly from the use and application of this book. CPSIA Compliance Information: Batch #WS13CSQ

All websites were available and accurate when this book was sent to press. Library of Congress Cataloging-in-Publication Data Marsico, Katie, 1980– Eating disorders / Katie Marsico. p. cm. — (Real teens . . . real issues) Summary: “Provides comprehensive information on eating disorders, including first-person interviews, signs and symptoms, physical dangers, recovery, and solutions”—Provided by publisher. Includes bibliographical references and index. ISBN 978-1-60870-853-6 (hardcover) ISBN 978-1-62712-129-3 (paperback) ISBN 978-1-60870-859-8 (ebook) 1. Eating disorders—Juvenile literature. I. Title. RC552.E18M366 2013 616.85′26—dc22 2011012790

editor: Christine Florie art director: Anahid Hamparian series designer: Kristen Branch Expert Reader: Dr. Nicole Hawkins, Director of Clinical Services, Center for Change, Orem, Utah Photo research by Marybeth Kavanagh Title page illustration by Corinne Florie

Cover photo by Julie Nicholls/CORBIS The photographs in this book are used by permission and through the courtesy of: Corbis: Mirko Iannace, 4; SuperStock: age fotostock, 7, 27; Cusp, 17; Glasshouse Images, 19; Kablonk, 57; Landov: P. Widmann/DPA, 10; Thierry Lopez/Maxppp, 14; Getty Images: Blasius Erlinger/The Image Bank, 12; Nucleus Medical Art/Visuals Unlimited, 30; David Grossman/Workbook Stock, 34; Penny Tweedie/Stone, 40; The Image Works: Dinodia, 21; Alamy: Bubbles Photolibrary, 23; Nir Alon, 32; Corbis Bridge, 38; AGStockUSA, 46; Caro, 60; Photo Edit Inc.: Michael Newman, 48; David Young-Wolff, 55; Newscom: Design Pics/Ben Welsh, 51. Most subjects in these photos are models. Printed in the United States of America

Notes 63 Glossary 71 Further Information 72 Bibliography 73 Index 77

People who suffer from eating disorders often have unrealistic ideas about their body image.

S Eventeen-year-old Katie never

felt she fit the accepted image of someone suffering from an eating disorder—a stick-skinny girl whose bones showed through her skin. Nevertheless, the Connecticut teenager now admits that her behaviors and attitudes were a powerful clue that she was indeed struggling with this mental illness. “From age nine, I’d stand in front of the mirror and pinch my body where I thought I was fat,” says Katie. “I remember crying for hours and thinking how ugly I was.” As Katie grew older, things only got worse. 5

Eating Disorders “I made myself throw up, or purge, for the first “From age nine, I’d time [in] my freshman stand in front of the year of high school,” she mirror and pinch my recalls. “Even then, though, body where I thought I convinced myself I I was fat. I remember wasn’t bulimic because crying for hours and I only purged two or three thinking how ugly times a week.” I was.” — Katie By late 2008, Katie was throwing up more often and remembers feeling more depressed than ever by December 24. After she celebrated Christmas Eve with her family, she secretly forced herself to vomit. Before the evening was over, Katie swallowed a handful of her father’s prescription sleeping pills.

Startling Stat M edical

experts say it is becoming more common

for girls to start struggling with issues such as anorexia and bulimia between the ages of eleven and thirteen .

6

Painful Memories

of the

Girl

in the

Mirror

Physical, emotional, and social issues all contribute to eating disorders. With help, they can be treated and prevented. 7

Eating Disorders When she tried to throw those up but failed, she panicked and told her parents. Her father immediately took her to the hospital, where doctors monitored her and released her the next day. Katie soon began an inpatient program for people who suffer from eating disorders at the Walden Behavioral Care Center, in Waltham, Massachusetts. Her two-week stay there and the two months of intensive outpatient treatment that followed at the Renfrew Center of Greenwich in Old Greenwich, Connecticut, changed her life. “I refound myself in the hospital,” she reflects. “I realized the eating disorder had totally swallowed my identity.” Years later, Katie continues to see a psychiatrist and receives treatment for a mood disorder and depression. Addressing these issues has allowed her to focus on overcoming her eating disorder. It has also given Katie a whole new perspective on the girl she sees reflected in the mirror. “The eating disorder is definitely a part of me,” she says. “But I am not an eating disorder, and I will work hard to make sure it never has that much control over me again.” 8

Painful Memories

of the

Girl

in the

Mirror

An Overview of Eating Disorders Katie’s story is both tragic and inspiring, but her struggle with an eating disorder is shared by millions of Americans. According to a recent statistic provided by the National Eating Disorders Associ“As many as ation (NEDA), “As many 10 million females as 10 million females and and 1 million males 1 million males are fighting are fighting a life and a life and death battle with death battle with an eating disorder such as an eating disorder anorexia or bulimia.” such as anorexia The NEDA defines eator bulimia.”—(NEDA) ing disorders as conditions that “include extreme emotions, attitudes, and behaviors surrounding weight and food issues.” They are a form of mental illness that has harmful effects on both the mind and the body. The most widely recognized eating disorders are anorexia and bulimia. Anorexia, which is formally called anorexia nervosa, often involves sufferers starving themselves and exercising too much. Such behaviors can result in dangerous and dramatic weight loss. 9

Eating Disorders

Anorexics often view themselves as overweight even when they are actually underweight.

10

Painful Memories

of the

Girl

in the

Mirror

Anorexics have a distorted body image and generally continue to see themselves as heavy or fat even when they are far thinner than what medical professionals consider healthy. People struggling with anorexia are usually terrified by the idea of gaining weight. Similar fears overwhelm individuals suffering from bulimia, or bulimia nervosa. Bulimics typically binge and purge. Bingeing involves eating a great amount of food in a short time period. The intense guilt or worry about weight gain that follows a binge often makes bulimics feel desperate for a way to “undo” their overeating. Purging is an extremely unhealthy way to satisfy this urge. People who purge essentially force food out of their bodies as quickly as possible. Some bulimics rely on vomiting or excessive exercising to do this. Others abuse medications that cause users to have increased bowel movements and to urinate more frequently. No matter what shape someone’s eating disorder takes, though, it is important to remember that symptoms can and do vary from person to person.

11

Eating Disorders

Bulimics purge after eating to try and avoid gaining weight.

12

Painful Memories

of the

Girl

in the

Mirror

Startling Stat A ccording

to a recent study , approximately

percent of high school – aged girls purge .

The Scope of a Troubling Teen Issue Research conducted by the South Carolina Department of Mental Health (SCDMH) indicates that as many as 95 percent of people who have an eating disorder are between twelve and twenty-five years old. Teenagers often hear that their entire futures lie ahead of them. Yet living with an eating disorder can rob them of their health, happiness— and sometimes even their lives. Eating disorders have the highest mortality rate of any mental illness because they take an enormous toll on both physical and emotional health. “People do die from eating disorders,” says Jenni Schaefer. She is the best-selling author of Life Without Ed and Goodbye, Ed, Hello Me— books that address how conditions such as 13

13

Eating Disorders

Isabelle Caro, a French model and actress, died in 2010 from complications from anorexia. At the height of her illness she weighed 55 pounds.

anorexia and bulimia have the power to completely overtake sufferers’ identities. “I don’t mean to sound morbid, but I “The harsh truth is believe that reality is something teenagers need to that, if left untreated, know. The harsh truth is eating disorders kill.” —Jenni Schaefer that, if left untreated, eating disorders kill.” 14

Painful Memories

of the

Girl

in the

Mirror

In addition to her work as an author, Jenni Schaefer is an ambassador for NEDA. She

also has personal experience battling an eating disorder. Schaefer therefore recognizes the

enormous impact that this issue has on teens. In our culture—which glorifies the thin ideal—eating disorders . . . are commonplace among teenagers. Sadly, most teens don’t

even know that, because hurting our bodies

to meet unrealistic standards is blindly

accepted by people everywhere and is

actually promoted by the diet industry. To combat this . . . we need to teach teen-

agers that . . . someone’s ideal weight is

actually where their body naturally lands when they are eating and exercising in

a balanced way. It is the weight where a person feels his or her best—happy,

strong, and at peace.

15

ighteen-year-old Jordan describes Emost of what she remembers about the start of

her eating disorder as “a blur.” However, the Nebraska teenager can clearly recall the emotions and social challenges she experienced in sixth grade— about a year before her battle with anorexia and bulimia began. “Middle school was a really hard transition for me,” she reflects. “I didn’t have many friends. I was having issues with my new boyfriend, so I . . . cut myself—possibly a little for attention, mostly because of my loneliness.” Within a year, Jordan was also starting to starve herself and eventually began purging. 16

It is not uncommon for depression and stress to accompany eating disorders.

Before long, she was growing increasingly depressed, as well. Jordan had already begun seeing a therapist for her cutting in junior high. Yet, by the time she reached eighth grade, she was admitted to

Startling Stat R esearch

suggests that as many as

80 percent

of thirteen - year - old girls have attempted to lose weight .

17

Eating Disorders the Eating Disorder Program at Children’s Hospital and Medical Center in Omaha, Nebraska. “I guess the realization that I had to go to a hospital for a month so that I could be forced to eat was a wake-up call to me,” she says four years later. Jordan still consults with a psychiatrist and a dietician to cope with the ongoing challenges of her eating disorder. She argues that there are undoubtedly multiple reasons why people develop these illnesses. “To this day, it is a mystery to me whether my depression or my eating disorder came first,” she says. “Was I depressed because I wasn’t feeding myself properly, or was I starving myself to cope with my deep depression? God only knows. . . . I think the media also plays a significant role when it comes to eating disorders. . . . There are many contributing factors.”

Not Only About Eating Jordan’s conclusion that there are several reasons why teens have eating disorders is correct. What complicates matters further is that sufferers are also often dealing with other comorbid conditions— 18

Paving

a

Path

to

Sickness

diseases and medical problems that tend to affect people at the same time. “Depression and anxiety are mental illnesses that are comorbid with eating disorders,” says Claudia Welke, MD. Welke is a psychiatrist and the director of Child and Adolescent Training at NorthShore University HealthSystem in Highland

Eating disorders are not always about body image. They can be a result of other medical issues sufferers experience at the same time.

19

Eating Disorders

Startling Stat E xperts

estimate that about two - thirds of people

with an eating disorder also suffer from an anxi ety disorder at some point in their lives .

Park, Illinois. She is also a clinical instructor at the University of Chicago Pritzker School of Medicine in Chicago, Illinois. In her practice, Welke has observed that depression and anxiety can lead to the low self-esteem and body-image issues that people with eating disorders usually describe having. In turn, conditions such as anorexia and bulimia can cause sufferers to feel more depressed and anxious. Medical researchers also believe that having a sibling or parent with anorexia or bulimia makes a person more likely to receive a similar diagnosis. Experiencing abuse or being raised by adults who place a strong emphasis on weight loss and body image probably raises the risk level as well. Finally, many experts think having an eating disorder is simply a response to the 20

Paving

a

Path

to

Sickness

Some experts believe that the media causes people to set unrealistic standards about their ideal body image.

unrealistic pressures and expectations that teenagers face in today’s society. “[Media] message[s] equate thinness with happiness and success,” explains author Jenni Schaefer. “But the truth is that I was unhappiest when I was at my thinnest. Eating disorders are mental 21

Eating Disorders

“Eating disorders are mental illnesses that affect your mind and every single part of your body, every single part of you.” —Jenni Schaefer

illnesses that affect your mind and every single part of your body, every single part of you.”

Clues That Hint at a Deadly Condition

There are countless tragic and terrifying stories to back up Schaefer’s statement, which is why it’s so important to know the warning signs of an eating disorder. Since purging and extreme dieting and exercise cause dehydration and affect blood pressure and blood sugar, one common physical symptom may be frequent fainting spells. Anorexics and bulimics also sometimes mention feeling cold all the time because these same behaviors lead to changes in body temperature. In addition, Jordan recalls her face being swollen as a result of throwing up so much and says her hands were frequently cut and scratched. These injuries were due to her forcing her fingers down her throat during purging. Warning signs of an eating disorder can also appear in a person’s attitudes toward food, weight 22

Paving

a

Path

to

Sickness

One of the signs of an eating disorder is a sudden change in eating habits.

23

Eating Disorders

Remember that a person’s weight is not

always a good clue as to whether or not he or she has an eating disorder. It can

be, especially if other symptoms that hint at a problem are present. People with

eating disorders sometimes lose weight rapidly or seem to experience frequent

and noticeable weight changes. Yet it is incorrect to assume that everyone who

has an eating disorder appears obviously underweight or ill.

24

Paving

a

Path

to

Sickness

loss, and body image. People suffering from this mental illness tend to talk nonstop about feeling or looking fat or their fear of becoming overweight. They may also avoid social activities that involve eating or obsessively count the calories or fat grams found in various foods. Similarly, sufferers often appear anxious about maintaining an exercise routine or a certain weight. Other warning signs include constantly using the washroom or demanding privacy after meals. Many anorexics and bulimics also lie about diet, exercise, and the reason for any changes in their appearance. They may become angry or defensive if questioned about their weight—or whatever signs possibly suggest a condition such as anorexia or bulimia. In the meantime, sufferers are usually headed toward a downward spiral that puts their physical and mental health at enormous risk.

25

S eventeen-year-old Danielle

considers herself lucky to be alive. By February 2010, her eight-month battle with anorexia had taken an obvious and frightening toll on her body. The New Jersey teenager weighed a mere 67 pounds when a test revealed she was suffering from irregular heart rhythms. This prompted doctors to admit her to the Children’s Hospital of Philadelphia (CHOP), in Philadelphia, Pennsylvania, on February 9, 2010. There is little doubt that her eating and exercise patterns leading up to that date set the stage for disaster. “I [would eat] a few bran flakes with 26

Startling Stat M any

anorexics weigh at least

15

percent less

than what doctors consider their healthy , or ideal , body weight to be .

literally a splash of milk for breakfast, a few pieces of gum and endless diet iced teas, and maybe an eighth of a cup of cottage cheese and an eighth of a cup of oatmeal for dinner,” Danielle recalls. Combined with her strict exercise routines, her extremely limited diet caused her body to begin

Eating disorders can lead to severe health issues requiring hospitalization. 27

Eating Disorders shutting down. Doctors at CHOP confirmed that Danielle’s life was in danger and immediately sent her to the pediatric intensive care unit. “They told me that my liver wasn’t functioning properly and that my kidneys were [failing],” she says. “I was extremely dehydrated and anemic. My heart was way out of whack and . . . dropped to thirty-nine [beats per minute] at night.” (The average heart rate for a healthy sixteen-year-old ranges from sixty to one hundred beats per minute.) “They told me that my Fortunately, Danielle liver wasn’t functioning used her stay in the hosproperly and that my pital to begin a serious kidneys were shutting recovery effort. She was down. I was extremely released from inpatient dehydrated and anemic. treatment on March 5, My heart was way out 2010, but continues to of whack . . .” participate in outpatient — Danielle therapy through CHOP. “I will not let anorexia control me for the rest of my life,” she promises. “I won’t let this take over my thoughts and keep me from living the life I choose to live. It is just not 28

A Matter

of

Life

or

worth it. Eating disorders . . . are a matter of life or death. And I want to live and actually make my dreams come true.”

Brutal on the Body

Death

“Eating disorders . . . are a matter of life or death. And I want to live and actually make my dreams come true.” — Danielle

Danielle’s experience demonstrates how physically destructive an eating disorder can be. One of the main reasons that conditions like anorexia and bulimia have such harmful side effects is that they limit the body’s ability to function. Eating disorders rob sufferers of important nutrients that fuel the body. Anorexia and bulimia also upset a person’s balance of fluids and minerals called electrolytes. This can affect body temperature, blood pressure, and heart rate. It can even lead to heart and kidney failure. Depriving the body of proper nutrition often results in anemia as well. Anemia occurs when the body produces a decreased number of red blood cells, which it uses to transport oxygen to various tissues. This condition, along with the dehydration 29

Eating Disorders

Anorexia and bulimia lead to osteoporosis, a condition that weakens the bones. This illustration shows healthy bone matter (left) and bone matter affected by osteoporosis (right).

that many anorexics and bulimics experience, can trigger dizziness and fainting. In addition, it is not uncommon for anorexia and bulimia to weaken muscles, swell joints, and lead to osteoporosis. Osteoporosis causes a person’s bones to grow fragile, which puts them at risk for breaking easily. People with eating disorders 30

A Matter

of

Life

or

Death

frequently suffer from hormone imbalances, too. Anorexics and bulimics sometimes also experience hair loss and brittle nails. Eating disorders can even dry out or discolor the skin, or cause it to bruise more easily.

How the body responds to an eating disorder

depends on several factors. These include how

long the illness has been going on, how severe it is, and what particular behaviors shape it.

For example, if a sufferer mainly binges and

purges, he or she may be of average or aboveaverage weight. This is because vomiting does not get rid of all the calories that a bulimic takes in during a binge. In addition, the

cycle of bingeing and purging typically leads to swelling, or bloating, because it upsets the body’s balance of fluids.

31

Eating Disorders

Repeated purging by bulimics often causes tooth decay.

Bulimics may also suffer from physical side effects related to the stomach acid they force up during vomiting. This acid can cause tooth decay and soreness of the throat. Both bulimics and ano“Physically, my body rexics tend to experience simply deteriorated. I a variety of stomach prodidn’t feel anything. . . . blems, as well. I was numb.” “Physically, my body — Danielle simply deteriorated,” says 32

A Matter

of

Life

or

Death

Startling Stat A

recent study revealed that up to

20 percent

of anorexics are likely to die as a result of their sickness .

Danielle when summing up what having an eating disorder did to her health. “I didn’t feel anything. . . . I was numb.”

Impacts on Mood and Mental Health As Danielle discovered, conditions like anorexia and bulimia can negatively affect every part of the body—including the brain and nervous system. Poor diet and behaviors such as purging and exercising too much put a strain on the sufferer’s ability to think clearly. People who are dealing with eating disorders often suffer from poor memory and a lack of concentration. They sometimes appear irritable or moody for no apparent reason. In addition, the same mental illnesses that make someone more likely to 33

Eating Disorders

Depression and stress can set in as a result from tension regarding food, body image, and fear of gaining weight.

develop an eating disorder can worsen because of anorexia or bulimia. Tensions surrounding food, fear of weight gain, and frustration over body image usually only fuel problems like depression and anxiety. .

34

A Matter

of

Life

or

Death

In fact, it is not uncommon for anorexics and bulimics to eventually turn to other forms of selfdestructive behavior. Some cut themselves or abuse drugs or alcohol in an effort to relieve whatever deep emotional pain they are experiencing. As the number of people who die from eating disorders shows, a portion of sufferers don’t stop hurting themselves before it’s too late. In 2010, researchers with the National Association of Anorexia Nervosa and Associated Disorders (ANAD) revealed that Americans struggling with these mental illnesses were fifty times more likely to kill themselves. What is almost as distressing is that many individuals who die from eating disorders—whether through suicide or complications such as heart failure— “I got to a point spend their final days hating where I never even what they see in the mirror. “I bothered to look in got to a point where I never the mirror.” even bothered to look in the — Danielle mirror,” says Danielle. “Before CHOP, I don’t think I really could have seen what the eating disorder was doing to me anyway.” 35

Jordan admits Ethatighteen-year-old anorexia and bulimia put her health at risk

and probably worsened her depression. Yet these conditions also affected the Nebraska teen’s dayto-day life on a more basic level. Unlike her friends, Jordan had little interest in going to parties or “Emotionally, I felt cheering on her high school’s isolated. The scale football team. and toilet were my She recalls feeling tired best friends.” constantly and as if her eating — Jordan disorder overpowered most of her personal relationships. 36

Startling Stat R esearch

shows that bulimics binge an average of

eleven times per week .

“Emotionally, I felt isolated,” reflects Jordan. “The scale and toilet were my best friends. I spent Friday nights home alone so I could binge and purge.” Jordan’s anorexia and bulimia put a strain on the people around her as well. Once her family and friends became aware of the severity of her problem and she began treatment, it sometimes seemed as if her eating disorder constantly overshadowed their lives. When she has relapsed—a common occurrence for those recovering from an eating disorder—both Jordan and everyone around her have experienced intense frustration. “My family and friends have always been very supportive,” she emphasizes. “But they wonder, ‘When will this end?’ I understand where they are coming from, but unless one has personally suffered from an eating disorder, it’s impossible to fathom how hard it is. They are learning that it is an ongoing process that I still struggle with from time to time.” 37

Eating Disorders

Family members may become frustrated as they try to understand the treatment and recovery process.

An Isolating Illness Jordan’s account is one example of why eating disorders can be especially devastating to teens’ social lives and personal relationships. While most teenagers enjoy action-packed social schedules, those with anorexia or bulimia frequently describe their illnesses consuming their entire identities 38

Social Side Effects

Startling Stat R ecent studies indicate that almost 50 percent of A mericans personally know someone who has an eating disorder .

during high school. Extreme concerns about food and weight become more important than having a social life or honest, open relationships. To emphasize this point, author Jenni Schaefer compares struggling with an eating disorder to living with an abusive partner or spouse. “You want to leave, but you can’t,” she explains. “Your eating “Your eating disorder disorder becomes your becomes your sole relasole relationship in life. tionship in life. It keeps It keeps you isolated.” you isolated.” Unsurprisingly, the — Jenni Schaefer secrecy and denial that sufferers experience becomes part of a vicious cycle that further isolates them from the people who care about them. It makes friends and family members suspicious 39

Eating Disorders

Teens who suffer from eating disorders find themselves isolated.

40

Social Side Effects and worried. In turn, people dealing with an eating disorder often resent this concern. For sufferers, any outsiders become a threat to their time in front of the toilet, on the scale, or alone with their problem.

Rebuilding Strained Relationships Admitting to having an eating disorder doesn’t mean that teenagers’ relationships are immediately healed or that they can easily regain the trust of family and friends. Parents and peers often experience everything from shock and horror to anger and frustration when they learn what has been going on. Some teens with anorexia or bulimia may eventually reach a point where they are able to openly admit their problem. Others are caught behaving in a manner that confirms they have an eating disorder. Either way, it is not uncommon for friends and family members to initially respond by panicking or even denying the seriousness of the situation. Many are upset that they didn’t see signs of an eating disorder sooner. Meanwhile, sufferers are suddenly forced to deal with their own fears and emotions as well as those of their parents 41

“

I had hoped and thought that it would all go

away as soon as Jordan started seeing a therapist and receiving treatment,” says her twenty-one-

year-old sister, Kelly*. “I soon found out that this was not the case. It was really difficult watch-

ing my baby sister struggle with her body image

to the point of starving and purging. . . . I didn’t

understand why she would do that to herself and throw so much away.”

Kelly also notes that she experienced a wide

range of emotions as Jordan attempted to get

better. “I was very worried for her, of course, but I was also super frustrated . . . that she didn’t

seem to see how much it was affecting the rest

of our family,” she says. “I wanted her to at least ‘fix’ herself for them, but it doesn’t work like

that. [Now] I look to the future, when Jordan will discover what her purpose in life is. I constantly worry that her eating disorder will get in the

way, but I know that she is a strong individual who can do anything she puts her mind to.”

42

Social Side Effects and friends. This is part of why acknowledging an eating disorder and determining how to address it can be an overwhelming experience. “It was really difficult,” Jordan says of facing her family’s reaction to her battle with anorexia and bulimia. “I felt like they kept saying it was hard for them without acknowledging that it was hard for me also.”

43

When Danielle was admitted to

the Children’s Hospital of Philadelphia (CHOP) on February 9, 2010, it was not the first time she had received treatment for her eating disorder. Yet it took an extended stay in a pediatric intensive care unit for the New Jersey teenager to seriously commit to recovery. “I was not ready for treatment any other time,” she explains. “I knew it was going to take me hitting rock bottom to understand that I needed to get better. I was a lot more ready to begin recovery [at CHOP].” Danielle says the severity of her anorexia by February 2010 was part of the reason

44

for her more determined approach to treatment and “I knew it was going recovery. At the same time, to take me hitting rock however, she also credits bottom to understand her changed outlook to that I needed to get the staff at CHOP and better.” — Danielle the nature of their therapy program. “CHOP was such a great place for me to be during my worst times,” she recalls. “The people there were always so caring, and they didn’t ever treat me like I was just some thing they were checking and poking and prodding. I was always a person. They gave me exactly what I needed, emotionally and calorically.” While at CHOP, Danielle saw doctors who addressed the physical complications of her eating disorder. A psychiatrist treated her as well and taught her to deal with underlying emotional issues related to her anorexia. A nutritionist and various counselors, including an art therapist, made up the rest of her health-care team. Though CHOP ultimately provided Danielle with what proved to be a successful treatment approach, she recognizes 45

Eating Disorders

Counseling is often an effective therapy technique that is used to treat eating disorders.

that every patient is unique. The fact that eating disorders affect millions of different people has led her to the conclusion that “everyone needs different things in order to recover.” 46

The Realities

of

Recovery

Startling Stat R esearchers

believe that only one in ten people

with eating disorders receives treatment for his or her illness .

An Overview of Overcoming the Illness Danielle’s opinion is reflected by the wide variety of available treatment plans for eating disorders. Doctors, psychologists, nutritionists, and social workers are just a few of the healthcare professionals who can assist people trying to overcome conditions such as anorexia and bulimia. For teens like Danielle, the threat an eating disorder poses to physical well-being makes it necessary to receive inpatient care at a hospital or residential center. Other teens may be healthy enough to participate in outpatient treatment. Either way, recovery plans might include individual therapy, group sessions, and family counseling. Doctors sometimes use medical monitoring devices to track weight gain and to ensure that patients’ bodies are healing properly. 47

Eating Disorders

Some recovery plans include group therapy sessions.

Most programs also aim to educate teens about what caused their eating disorder. They address the underlying issues that triggered the problem as well as the best strategies for long-term recovery. Some doctors prescribe medications to treat other mental illnesses—such as depression and anxiety—that may be complicating an eating disorder. Many experts believe that a person’s readiness to face and overcome an eating disorder also plays 48

The Realities

of

Recovery

“A lot of kids know they have a problem but aren’t ready to let go of their eating disorder. They can do the walk and talk the talk, but some patients simply aren’t prepared to change.” —Claudia Welke, MD a great role in the recovery process. “A lot of kids know they have a problem but aren’t ready to let go of their eating disorder,” explains Claudia Welke, MD. “They can do the walk and talk the talk, but some patients aren’t prepared to change.”

Staying Committed to Staying Well Even teens who are committed to beating an eating disorder don’t have an easy road ahead of them. Recovery takes time—both in an immediate and long-term sense. As Danielle discovered, some treatment programs require full-day attendance. At the very least, most encourage patients to make getting better their top priority. This can be extremely difficult for teens who are also 49

Twenty-eight-year-old Victor is living proof that eating disorders do not affect just

girls and women. During college, he began

a strict diet and an intense exercise routine that caused him to lose 120 pounds in just

six months. In 2006, Victor started seeing a

therapist, who diagnosed him with anorexia. “By March 2008, I made the decision to

hospitalize myself in an eating disorder program,” he says. “It was the hardest thing in

my life, but I somehow dedicated myself to it. . . . This was the start of my recovery.”

As an adult who has survived his battle

with anorexia, Victor is eager to share his

insight with teenagers. “I would tell them to

hold on because it will get better,” he emphasizes. “It may seem like things are really bad and that all hope is lost, but there is always hope. . . . Each day, each second is a new one to turn things around.”

50

The Realities

of

Recovery

Recovery from an eating disorder requires a serious commitment to healing.

experiencing pressure to keep up their grades and participate in social activities. Meanwhile, suffering from anorexia or bulimia means living with the reality that there is no way to predict how long it will take to recover. 51

Eating Disorders

Startling Stat R esearch

suggests that more than one - third of

women who receive treatment for an eating dis order relapse within nine years .

Some experts such as Schaefer indicate that the average time is three to seven years. Yet when teens are trying to overcome anorexia or bulimia, their recovery time often depends on how ill they are and their level of commitment to getting well. For some sufferers, recovery can actually be a lifelong effort. Danielle is honest about her ongoing battle with her “I truly believe that eating disorder. Yet she also there will come a time has hope for the future. “I when I won’t care that truly believe that there will I don’t know exactly come a time when I won’t how many calories are care that I don’t know in this dinner or that exactly how many calories piece of cake. I will just are in this dinner or that enjoy it.” — Danielle piece of cake,” she says. “I will just enjoy it.” 52

S eventeen-year-old Katie believes

that people who want to fight the spread of eating disorders should begin their efforts at the most basic level. As the Connecticut teen explains, this can be as simple as showing the appropriate support to a friend or sibling. Yet she also emphasizes that it involves having patience—and understanding that it’s okay not to understand. “My friends were as supportive as they could be,” she recalls. “But they didn’t understand. Living with and trying to overcome an eating disorder is truly a unique experience.” Katie therefore says that 53

Eating Disorders people should open their ears and “listen to their “Eating disorders are friends.” diseases that tell you Author Jenni Schaefer that you don’t have them. But that’s exactly adds that it’s also necessary for friends and family why we need more members to know how people to speak out— and when to speak up. sufferers don’t see the She does not deny that illness themselves.” this can prove difficult — Jenni Schaefer when a loved one is not ready to acknowledge or discuss his or her problem. “Eating disorders are diseases that tell you that you don’t have them,” she explains. “But that’s exactly why we need more people to speak out—sufferers don’t see the illness themselves.”

Raising Awareness and Reshaping Social Messages Like Katie, eighteen-year-old Jordan also appreciates the role supportive friends and family members can play in helping overcome eating disorders. Yet the Nebraska teenager believes 54

Schaefer encourages people to always say

something, preferably

in a private setting, if they suspect a friend

or family member has an eating disorder. “Use ‘I’ statements

rather than those that start with ‘you,’” she

recommends. “For example, you might try

saying, ‘I’m here for you,’ instead of ‘You’re killing yourself by throwing up.’ When you

speak to your friend or family member, you

should also focus on changes in their behavior and mood, versus what you’ve noticed about

their weight or appearance.” If such a conversation fails to convince someone to get help,

Schaefer suggests that people share their con-

cerns with a teacher, counselor, parent, doctor, or another responsible adult.

55

Eating Disorders that another part of the solution to stamping out conditions like anorexia and bulimia is arming teens with more information. “I would say more school and community awareness is definitely needed,” Jordan notes. “And not only in terms of talking about the risks and warning signs of eating disorders. . . . I think it’s equally important to learn about having a healthy body image and loving yourself.” Claudia Welke, MD, shares Jordan’s feelings and says that increased awareness can and should start at home. “Parents can model appropriate eating habits and exercise routines,” she advises. “They should not talk negatively about their own bodies—and, of course, not about their children’s bodies. Adults should also speak in terms of ‘health,’ rather than in terms of ‘weight.’” From Jordan’s point of view, not following Welke’s recommendations will only strengthen the control that eating disorders already have over U.S. teens. “So many girls are ashamed of their bodies, and for what,” she reflects. “I try to tell my little eight-year-old sister that everyone is unique and that it’s okay that she isn’t a stick figure. But that 56

Exploring Possible Solutions

Parents can play an important part in shaping positive ideas about diet and body image.

57

Eating Disorders

Startling Stat D octors

report treating patients as young as four

years old for eating disorders .

message doesn’t get conveyed very often, so she has a hard time believing me. I think changing that is the most effective step we could take.”

Far More than Vanity Seventeen-year-old Danielle supports Jordan’s point of view but also feels that society needs to see eating disorders for what they truly are. The New “I believe the world Jersey teenager says too needs to realize that many Americans dismiss eating disorders are not these conditions as quirky, vanity issues. They are conceited habits that sufmental illnesses that ferers should be able to have a lot more to them easily correct and control. than wanting to be “I believe the world skinny.” — Danielle needs to realize that eating disorders are not 58

Exploring Possible Solutions vanity issues,” stresses Danielle. “They are mental illnesses that have a lot more to them than wanting to be skinny.” Danielle suggests that magazine publishers could spark positive change if they considered how and why eating disorders kill a portion “Teenagers with eating of their readers. “I disorders aren’t the only believe that [media] ones to have self-esteem companies need to issues. I believe that being really stand for what able to look up to people they put in their who truly love themselves magazines,” she says. could benefit just about “There needs to be a anyone.” — Danielle greater emphasis on including positive role models—healthy men and women who love themselves. After all, teenagers with eating disorders aren’t the only ones to have self-esteem issues. I believe that being able to look up to people who truly love themselves could benefit just about anyone.” Danielle’s ideas, as well as those of Katie and Jordan, are based on personal experiences that have 59

Eating Disorders

Eating disorders can be treated and overcome with proper care and support.

60

Exploring Possible Solutions

Startling Stat R esearch

shows that

53 percent of thirteen - year -

old girls are dissatisfied with their bodies .

altered their lives. They realize that they may be fighting a long and difficult battle for several years. In the meantime, however, they remain committed to overcoming a troubling teen issue—and sharing their struggles and successes in the hopes of helping other teens do the same.

61

As of late 2010 . . .

Katie reported that she was “doing great”

and plans on attending Saint Michael’s College, in Colchester, Vermont.

Jordan said she was “so excited about the

future” and hopes to enroll at either Creighton University, in Omaha, Nebraska, or the University of Nebraska at Omaha.

Danielle indicated that she was going

to attend community college following her high school graduation. She wants to one

day be known as “the person who got out of

hell and is creating a heaven for any person who needs it.”

62

Notes Chapter 1 p. 5, “From age nine, I’d stand . . .”: Katie. Personal interview. 12 October 2010. p. 6, “I made myself throw up . . .”: Katie. Personal interview. 12 October 2010. p. 6, “Medical experts say it is . . .”: statistical data on the peak onset age of eating disorders, “Types of Eating Disorders in Children,” McCallum Place Eating Disorder Treatment Programs, (specific date last updated not available), www. eatingdisordertreatmentinformation.com/ types-of-eating-disorders-in-children.html. p. 8, “I refound myself . . .”: Katie. Personal interview. 12 October 2010. p. 8, “The eating disorder is definitely . . .”: Katie. Personal interview. 12 October 2010. p. 9, “As many as 10 million . . .”: statistical data on the prevalence of eating disorders, “General Information: Facts and Stats,” National Eating Disorders Association (NEDA), (specific date last updated not available), 2010, www. nationaleatingdisorders.org/information-resources/ general-information.php. p. 9, “include extreme emotions, attitudes . . .”: NEDA’s definition of an eating disorder, “General Information: Terms and Definitions,” NEDA, (specific date last updated not available), 2010, www.

63

Eating Disorders nationaleatingdisorders.org/information-resources/ general-information.php. p. 13, “According to a recent study . . .”: statistical data on how many high school–aged girls purge, “Facts about Eating Disorders: What the Research Shows,” Eating Disorders Coalition (EDC), (specific date last updated not available), 2008, www.docs.google.com/viewer?a=v &q=cache:drJB6iNcFeEJ:www.eatingdisorderscoalition. org/documents/TalkingpointsEatingDisordersFact SheetUpdated5-20-09.pdf+approximately+13+ percent+of+high-school-aged+girls+purge&hl=en&gl= us&pid=bl&srcid=ADGEESjkwx4UHQVCx18oBCeEcz1PaoBP8XgJQCv13DEo7ATWA4fz2swVlHPMkNx8JRfd2H36KLdCy7e2lS9PAfIKkFd hMpD49DKsqB7HT684AKTdtG2j2cTz9tniyt60gD7CQnG5Y&sig=AHIEtbTZ8HXKhm6X1YTDnfz W2i7deL25pg. p. 13, “Research conducted by the . . .”: statistical data on the age range of the majority of people who suffer from eating disorders, “Eating Disorder Statistics,” South Carolina Department of Mental Health (SCDMH), (specific date last updated not available), www.state. sc.us/dmh/anorexia/statistics.htm. p. 13, “People do die from eating disorders . . .”: Schaefer, Jenni. Personal interview. 1 December 2010. p. 14, “I don’t mean to sound . . .”: Schaefer, Jenni. Personal interview. 1 December 2010. p. 15, “In our culture . . .”: Schaefer, Jenni. Personal interview. 15 December 2010.

64

Notes Chapter 2 p. 16, “a blur”: Jordan. Personal interview. 26 October 2010. p. 16, “Middle school was a really . . .”: Jordan. Personal interview. 26 October 2010. p. 17, “Research suggests that as many . . .”: statistical data on the percentage of thirteen-year-olds who have attempted to lose weight, “Eating Disorder Statistics,” SCDMH, (specific date last updated not available), www.state.sc.us/dmh/anorexia/ statistics.htm. p. 18, “I guess the realization that . . .”: Jordan. Personal interview. 26 October 2010. p. 18, “To this day, it is . . .”: Jordan. Personal interview. 26 October 2010. p. 19, “Depression and anxiety are . . .”: Welke, Claudia. Personal interview. 5 December 2010. p. 20, “Experts estimate that about two-thirds . . .”: statistical data on the comorbidity of eating disorders and anxiety disorders, “Eating Disorders,” Anxiety Disorders Association of America (ADAA), (specific date last updated not available), 2010–2011, www.adaa.org/understanding-anxiety/related-illnesses/ eating-disorders. p. 21, “[Media] message[s] equate thinness . . .”: Schaefer, Jenni. Personal interview. 1 December 2010. Chapter 3 p. 26, “I [would eat] a few . . .”: Danielle. Personal interview. 23 October 2010.

65

Eating Disorders p. 27, “Many anorexics weigh at least . . .”: statistical data on the weight range of anorexics, “Pharmacological Treatment of Eating Disorders,” National Institutes of Health (NIH), (specific date last updated not available), June 2005, www.ncbi.nlm.nih.gov/pmc/articles/ PMC3000192. p. 28, “They told me that . . .”: Danielle. Personal interview. 23 October 2010. p. 29, “I will not let anorexia . . .”: Danielle. Personal interview. 23 October 2010. p. 32, “Physically, my body simply . . .”: Danielle. Personal interview. 23 October 2010. p. 33, “A recent study revealed that . . .”: statistical data on anorexic mortality rates, “Anorexia Nervosa,” University of Chicago Medical Center (UCMC), (specific date last updated not available), 2011, www.uchospitals.edu/ online-library/content=P00749. p. 35, “In 2010, researchers revealed that Americans . . .”: statistical data on suicide rates among people suffering from eating disorders, “The Hidden Health Crisis on Campus: Eating Disorders,” National Association of Anorexia Nervosa and Associated Disorders (ANAD), (specific date last updated not available), 2010, www.anad. org/news/the-hidden-health-crisis-on-campus-eatingdisorders. p. 35, “I got to a point . . .”: Danielle. Personal interview. 29 November 2010. Chapter 4 p. 37, “Research shows that bulimics . . .”: statistical data

66

Notes on the average number of times that bulimics binge on a weekly basis, “Bulimia Statistics,” Bulimia Help, (specific date last updated not available), 2008, www. bulimiahelp.org/boOK/bulimia-overview/bulimiastatistics. p. 37, “Emotionally, I felt isolated . . .”: Jordan. Personal interview. 26 October 2010. p. 37, “My family and friends have . . .”: Jordan. Personal interview. 26 October 2010. p. 39, “Recent studies indicate that . . .”: statistical data on the number of Americans who know someone with an eating disorder, “Eating Disorder Statistics,” South Carolina Department of Mental Health, (specific date last updated not available), www.state.sc.us/dmh/ anorexia/statistics.htm. p. 39, “You want to leave . . .”: Schaefer, Jenni. Personal interview. 1 December 2010. p. 42, “I had hoped and thought . . .”: Kelly.* Personal interview. 16 December 2010. p. 42, “I was very worried for . . .”: Kelly.* Personal interview. 16 December 2010. p. 43, “It was really difficult . . .”: Jordan. Personal interview. 13 December 2010. Chapter 5 p. 44, “I was not ready for . . .”: Danielle. Personal interview. 23 October 2010. p. 45, “CHOP was such a great . . .”: Danielle. Personal interview. 23 October 2010. p. 46, “everyone needs different things . . .”: Danielle.

67

Eating Disorders Personal interview. 23 October 2010. p. 47, “Researchers believe that only . . .”: statistical data on the prevalence of treatment among Americans suffering from eating disorders, “Eating Disorder Statistics,” ANAD, (specific date last updated not available), 2011, www.anad.org/get-information/ about-eating-disorders/eating-disordersstatistics. p. 49, “A lot of kids know . . .”: Welke, Claudia. Personal interview. 5 December 2010. p. 50, “By March 2008, I made . . .”: Victor. Personal interview. 15 December 2010. p. 50, “I would tell them. . .”: Victor. Personal interview. 15 December 2010. p. 51, “Some experts such as . . .”: statistical data on the average time it takes to recover from an eating disorder, Personal interview with Jenni Schaefer. 1 December 2010. p. 52, “Research suggests that more . . .”: statistical data on the rate of relapse among women who suffer from eating disorders, “Postremission Predictors of Relapse in Women with Eating Disorders,” American Journal of Psychiatry (AJP), December 2005, ajp.psychiatryonline. org/cgi/reprint/162/12/2263. p. 52, “I truly believe that . . .”: Danielle. Personal interview. 23 October 2010. Chapter 6 p. 53, “My friends were as . . .” Katie. Personal interview. 12 October 2010.

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Notes p. 54, “listen to their friends”: Katie. Personal interview. 12 October 2010. p. 54, “Eating disorders are diseases . . .”: Schaefer, Jenni. Personal interview. 5 December 2010. p. 55, “Use ‘I’ statements rather . . .”: Schaefer, Jenni. Personal interview. 5 December 2010. p. 56, “I would say more school . . .”: Jordan. Personal interview. 26 October 2010. p. 56, “Parents can model appropriate . . .”: Welke, Claudia. Personal interview. 17 December 2010. p. 56, “So many girls are . . .”: Jordan. Personal interview. 12 December 2010. p. 58, “Doctors report treating patients . . .”: statistical data on the decreasing age at which people are being treated for eating disorders, “Four Year Olds Seeking Help for Eating Disorders,” EatingDisordersOnline.com, 3 January 2011, www.eatingdisordersonline.com/news/ eating-disorders/four-year-olds-seeking-help-foreating-disorders. p. 58, “I believe the world . . .”: Danielle. Personal interview. 12 December 2010. p. 59, “I believe that [media] companies . . .”: Danielle. Personal interview. 12 December 2010. p. 61, “Research shows that 53 . . .”: statistical data on teen perceptions of body image, “Fast Facts,” University of Washington, (specific date last updated not available), www.depts.washington.edu/thmedia/view.cgi?section= bodyimage&page=fastfacts. p. 62, “doing great”: Katie. Personal interview. 12 December 2010.

69

Eating Disorders p. 62, “so excited about the future”: Jordan. Personal interview. 12 December 2010. p. 62, “the person who got . . .”: Danielle. Personal interview. 23 October 2010.

70

Glossary anemic having too few red blood cells anorexia an eating disorder in which sufferers starve themselves or exercise excessively binge to eat a great amount of food in a relatively short time period bulimia an eating disorder in which sufferers typically binge and then purge comorbid conditions diseases or medical conditions that affect a patient at the same time dehydration an excessive loss of body fluids electrolytes minerals found in blood that, when balanced, help the body function mortality rate death rate nutrients substances the body uses to produce energy and build tissue nutritionist a professional expert on diet and nutrition purge to force food out of one’s body in an unnatural manner, such as through vomiting or abusing laxatives relapsed returned to undesirable behavior 71

Eating Disorders

Further Information books Littman, Sarah Darer. Purge. New York: Scholastic Press, 2009. Schaefer, Jenni. Goodbye, Ed, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life. New York: McGraw-Hill, 2009. Sonenklar, Carol. Anorexia and Bulimia. Minneapolis: Twenty-First Century Books, 2011. dvd Thin. Dir. Lauren Greenfield. Perf. Shelly Guillory, Alisa Williams, and Polly Williams. HBO, 2006. DVD. websites DoSomething.org—Eating Disorders www.dosomething.org/whatsyourthing/ Health+And+Fitness/Eating+Disorders A site with an in-depth explanation of eating disorders, as well as what young people can do to take a stand against them National Eating Disorders Association (NEDA) www.nationaleatingdisorders.org/ A website with statistics, relevant terms, and resources for recovery

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Bibliography books Bradley, Michael. When Things Get Crazy with Your Teen: The Why, the How, and What to Do Now. New York: McGraw-Hill, 2009. Lock, James, and Daniel Le Grange. Help Your Teenager Beat an Eating Disorder. New York: Guilford Press, 2005. Lucas, Alexander. Demystifying Anorexia Nervosa: An Optimistic Guide to Understanding and Healing. New York: Oxford University Press, 2008. Schaefer, Jenni. Goodbye, Ed, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life. New York: McGraw-Hill, 2009. Walsh, B. Timothy, and V. L. Cameron. If Your Adolescent Has an Eating Disorder: An Essential Resource for Parents. New York: Oxford University Press, 2005. online articles “Anorexia Nervosa,” University of Chicago Medical Center (UCMC), (specific date last updated not available), 2011, www.uchospitals.edu/online-library/ content=P00749. “Bulimia Statistics,” Bulimia Help, (specific date last updated not available), 2008, www.bulimiahelp.org/ book/bulimia-overview/bulimia-statistics.

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Eating Disorders “Eating Disorder Statistics,” National Association of Anorexia Nervosa and Associated Disorders (ANAD), (specific date last updated not available), 2011, www. anad.org/get-information/about-eating-disorders/ eating-disorders-statistics. “Eating Disorder Statistics,” South Carolina Department of Mental Health (SCDMH), (specific date last updated not available), 2006, www.state.sc.us/dmh/anorexia/ statistics.htm. “Eating Disorders,” Anxiety Disorders Association of America (ADAA), (specific date last updated not available), 2010, www.adaa.org/understanding-anxiety/ related-illnesses/eating-disorders. “Eating Disorders,” Focus Adolescent Services, (specific date last updated not available) ,2008, www.focusas. com/EatingDisorders.html. “Facts about Eating Disorders: What the Research Shows,” Eating Disorders Coalition (EDC), (specific date last updated not available), 2008, www.docs. google.com/viewer?a=v&q=cache:drJB6iNcFeE J:www.eatingdisorderscoalition.org/documents/ TalkingpointsEatingDisordersFactSheet Updated5-20-09.pdf+approximately+13+percent +of+high-school-aged+girls+purge&hl=en&gl=us &pid=bl&srcid=ADGEESjkwx4UHQVCx18oBCeEcz1PaoBP8XgJQCv13DEo7ATWA4fz-2swVlHP

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Bibliography MkNx8JRfd2H36KLdCy7e2lS9PAfIKkFdhMpD49 DKsqB7HT684AKTdtG2j2cTz9tniyt60g-D7CQnG 5Y&sig=AHIEtbTZ8HXKhm6X1YTDnfzW2i7deL 25pg. “Fast Facts,” The University of Washington, (specific date last updated not available), www.depts.washington.edu/ thmedia/view.cgi?section=bodyimage&page=fastfacts. “Four Year Olds Seeking Help for Eating Disorders,” EatingDisordersOnline.com, 3 January 2011, www. eatingdisordersonline.com/news/eating-disorders/fouryear-olds-seeking-help-for-eating-disorders. “General Information: Facts and Stats,” National Eating Disorders Association (NEDA), (specific date last updated not available), 2010, www. nationaleatingdisorders.org/information-resources/ general-information.php. “General Information: Terms and Definitions,” The NEDA (specific date last updated not available), 2010, www. nationaleatingdisorders.org/information-resources/ general-information.php. “Pharmacological Treatment of Eating Disorders,” National Institutes of Health (NIH), (specific date last updated not available), June 2005, www.ncbi.nlm.nih.gov/pmc/ articles/PMC3000192. “Postremission Predictors of Relapse in Women with Eating Disorders,” American Journal of Psychiatry (AJP), December 2005, ajp.psychiatryonline.org/cgi/ reprint/162/12/2263. “Hidden Health Crisis on Campus: Eating Disorders,” The ANAD, (specific date last updated not available), 2010,

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Eating Disorders www.anad.org/news/the-hidden-health-crisis-oncampus-eating-disorders. “Types of Eating Disorders in Children,” McCallum Place Eating Disorder Treatment Program, (specific date last updated not available), www. eatingdisordertreatmentinformation.com/types-ofeating-disorders-in-children.html. Personal Interviews Kelly* (December 16, 2010) Claudia Welke (December 5, 2010; December 17, 2010) Danielle (October 23, 2010; November 29, 2010; December 13, 2010) Jenni Schaefer (December 1, 2010; December 15, 2010) Jordan (October 26, 2010; November 12, 2010; December 1, 2010; December 12, 2010; December 13, 2010) Katie (October 12, 2010; December 12, 2010) Victor (December 15, 2010)

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Index Page numbers in boldface are illustrations. abuse of medications, 11 alcohol abuse, 35 anemia, 29–30 anger, 25 anorexia nervosa, 9–11 anxiety, 19–22 assumptions about eating disorders, 24 attitude, changes in, 22, 25 binge, 11 body image, 5–15, 22, 25, 56, 58 body temperature, 22 brain and nervous system, 33–35 bulimia nervosa, 11, 37 Caro, Isabelle, 14, 14

Children’s Hospital and Medical Center, 18 Children’s Hospital of Philadelphia (CHOP), 26 comorbid conditions, 18–22 cutting, 35 defensiveness, 25 definition of eating disorders, 9 dehydration, 22, 29–30 depression, 19–22 drug abuse, 35 electrolytes, 29 emotional challenges, 16–18, 36–43 exercise, 11, 25, 50 77

Eating Disorders fainting spells, 22 Goodbye, Ed, Hello Me, 13–14 hair loss, 31 heart rate, 28 hormone imbalances, 31 how the body reacts to eating disorders, 31 isolation, 38–41 Life Without Ed, 13–14 media’s influence, 21, 59 mental health issues, 33–35 moodiness, 33–35 mortality rate, 13, 33, 35 nails, brittle, 31 78

National Association of Anorexia Nervosa and Associated Disorders (ANAD), 35 National Eating Disorders Association (NEDA), 9 nervous system, 33–35 nutrients, 29 osteoporosis, 30, 30 physical deterioration, 26–33 purge, 6, 11, 22 recovery, 44–52 relapse, 37, 52 relationships, 41–43 Renfrew Center of Greenwich, 8 Schaefer, Jenni, 13–15,

Index 21–22, 39, 54, 55 skin abnormalities, 31 social awareness, 54, 56, 58–59, 61 social challenges, 16– 18, 36–43, 49, 51 solutions, 53–61 South Carolina Department of Mental Health, 13 statistics for people with eating disorders age range for onset, 6 average age, 13 binge average per week, 37 dieting, percentage of girls (13 yrs), 17 estimate of those with anxiety disorder, 20 mortality rate of anorexics, 33 negative body image of

girls 13 yrs old, 61 number of males and females, 9 percentage of those receiving treatment, 47 percentage underweight, 27 percentage who know of someone, 39 purging, percentage of high-school girls, 13 relapse rate, 52 youngest patients, 58 symptoms, 11, 22, 25 tooth decay, 32 Walden Behavioral Care Center, 8 warning signs, 22, 25 Welke, Claudia, 19–21, 49

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About the Author Katie Marsico has authored more than eighty books for children and young adults. She lives in Elmhurst, Illinois, with her husband and children.

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Roughly 11 million Americans struggle with eating disorders, and the majority of sufferers are between the ages of twelve and twentyfive. Those statistics make eating disorders a particularly devastating teen issue. Yet anorexia and bulimia-and the teens who are living with them- are frequently misunderstood. In Eating Disorders, discover the realities of dealing with these illnesses by following the stories of three real-life teenagers who have experienced one. Using their personal accounts, explore warning signs, side effects, treatment options, and longterm solutions to this troubling teen issue.