KUTZTOWN, Nov. 21—“The appearance is glamorized, but the disorder is stigmatized,” says Cheryl Birchard, a graduate assistant at Kutztown University’s Women’s Center, “and that’s what makes this very complicated.”
Sarah Landstrom (not her real name), 23, is 5’8” and 130 lbs and has struggled with bulimia since she was 16. When asked how it started, Landstrom replied, “I worked at a health food store and learned more about healthy eating, but then I became so focused on what was good and bad food that I was afraid to eat any food. I just became more and more obsessed.” Another factor, Landstrom reports is, “I had an anorexic friend in high school, and I thought that if she wanted to be thinner that bad, then maybe I should too.”
Normally, Landstrom eats “maybe an apple, or a cup of soup.” “On a bad day, I might not even eat at all,” she says. “It’s very stressful, I don’t have any energy and I don’t feel like I can go anywhere or do anything, and it just gets more frustrating.”
This contrasts with Kaylin Wesley (not her real name), 19, who is 5’3” and 102 lbs. She reports that, “If I eat just one chip, I will drink a lot of water and go throw it up. I will throw that one chip up.” Wesley has been bulimic since she was 16. She says it began when she and a friend decided to just lose weight. However, Wesley has faired better than her friend, who was hospitalized six times in two years.
According to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), an eating disorder (ED) is “characterized by severe disturbances in eating behavior.” There are two specific diagnoses, Anorexia Nervosa and Bulimia Nervosa. Anorexia is typically characterized by self-starvation and excessive weight loss, bulimia by a binge and purge cycle of eating, whether through vomiting, excessive exercise, or use of laxatives. An estimated 7% of Americans are affected by EDs, according to the National Institute of Mental Health.
Landstrom, according to the DSM-IV, has Eating Disorder Not Otherwise Specified (ED-NOS). This is a third category, and is the catch-all for people that do not meet every specification outlined for anorexia or bulimia in the DSM-IV. This includes people with binge-eating disorders or those who meet all the requirements of anorexia or bulimia but are still a normal weight.
Wesley reports that having an ED is very emotionally taxing. “I get emotional about it sometimes. Not that I can’t lose weight, but because I’m not losing it fast enough. I’ll cry if I feel fat.” But it can also be a source of dealing with stress. “If I get in a fight or if I’m really stressed,” says Landstrom, “then I’ll make myself sick.” Wesley says that “having just one person you are really close with really helps a lot. When one of you just wants to give in, you can support each other.”
When asked her goals, Wesley replies, “I really like the movie Nightmare before Christmas. I want to look like Jack. I will do whatever it takes,” she says forcefully. “It involves a lot more than sitting around and not eating. You have to set goals and know how much you wanna lose. It’s more active than people think. And it takes a lot of self control.” Wesley has set a goal of being 95 lbs by Christmas and then moving into the 80s.
Wesley and Landstrom agree their EDs are primarily internally driven, but they compare themselves to other girls too. “I look at pictures of people like Mary Kate [Olsen] and I want to look like that,” says Wesley. “I just see their perfect features and imagine them on my body. It may sound stupid, but you can call it ‘thinspiration.’” Wesley is also afraid of being fat. “I know that I’m not obese, but I’m fatter than I want to be. I’m disgusted by fat, I don’t want it on me, or in me, or anywhere near me.”
Landstrom cites family problems as a contribution to her ED. She says her parents are going through a divorce, and affirms that her ED is a way of dealing with the stress.
When asked about getting nasty comments, Landstrom recalls one incident where she received a birthday card covered in pictures of donuts thrown all over it with a caption that read “This is what happens when it all goes to your hips,” from her aunt. Landstrom recalls, “My boyfriend looked at her and said, ‘Wow. That’s a really insensitive card.’ And I thought it was pretty insensitive too.”
She also gets comments from friends who know of her disorder. “My one friend said to me ‘I’ll get you a pie for your birthday… wait, you do eat pie, don’t you?’ And people make comments at family functions and just expect me to constantly eat healthy food, so it doesn’t really make me think of getting any better,” adding that it just draws her attention more to what she is eating.
Wesley, on the other hand, says “When people say that I’m too skinny, I take it as a compliment,” adding that her mother, aunt, and boyfriend’s boss just say she looks disgusting. Wesley also says that she gets occasional comments such as “go eat a sandwich.” “I’d go eat a sandwich,” Wesley replies, “but do you have any idea how much that would set me back? I eat a piece of bread and I can’t eat for three days.”
Landstrom says she doesn’t have a minimum weight limit, but hopes she will be better before she gets to that point. Wesley states she hasn’t set a limit yet, saying, “I feel like I’m more in control than my ED is.” She says she wants to merely keep her body functioning. “If you can see my ribcage,” she says, “that’s what I want. If I can wear kid’s clothes, that’s what I want.” When asked if she was afraid of dying, she answered passionately and immediately, “I won’t.”
Grace Hill, Women’s Center Coordinator, says EDs are very complicated disorders. She says they are very personal, and how it begins or the ideology that sustains it varies according to the person. Birchard says, “The only common thing that really ties it together is the definition in the DSM.” Hill adds that people with EDs commonly have a distorted body image as well.
According to Hill, EDs “affect your teeth, hair, skin, and your insides.” The long term affects vary with how quickly the ED is identified and treated, according to the Eating Problems Service, based in the United Kingdom. In victims of anorexia, their organs will begin to consume themselves for energy as starvation progresses, with the liver and intestines being affected first, followed by the heart and kidneys. Other side effects include a significantly increased risk of osteoporosis, heart failure, and loss of sex drive. Victims of bulimia frequently have damage to the esophagus and increased tooth decay, they can loss the ability to produce a bowel movement without laxatives, and can have organ problems related to fluctuating potassium levels.
“Recovery isn’t just a physical thing,” Hill says. “A lot of it is mental. It requires a change in thinking and visualization of yourself. Its more than just forcing someone to eat.” Further adding that it’s something that has the appearance of choice, but victims often feel powerless confused when they attempt recovery. “When you’re in recovery,” Hill says, “they try to get you to realize that you do have a choice, and you can choose to get better if you really want to.”
