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The Psychological Disorder that has Girls-and Boys-Dying To Be Thin

This Swedish ad accurately depicts the skewed self-view of many people with eating disorders

This Swedish ad accurately depicts the skewed self-view of many people with eating disorders

Part 16 of Our Award-Winning Series “Our Children’s Health”

If you walked in on your teenage daughter and caught her looking at pictures on her computer of Nicole Richie or Mary-Kate Olsen, would you think anything of it? Or would you assume she was checking the latest gossip? What if the faces on those frail bodies were not famous; would that make you look twice?


Liza Fascia of Monmouth County, N.J., wasn’t worried at first. She thought her then-14-year-old daughter Ashleigh was browsing the latest fashions. Every time she peered over her daughter’s shoulder, Ashleigh seemed to be looking at celebrities, models and clothing. Taking her daughter’s super-girlie obsession with runway models and the newest clothes at face value, Fascia assumed that Ashleigh was like other teens, until she took a closer look. Fascia’s own home computer was acting up one August afternoon, and she needed to do research immediately for her job as a freelance writer. She borrowed her daughter’s laptop and discovered a computer memory trail that horrified her.

“First there were just pictures of really skinny models. Then I found pictures of girls that looked dead. I mean, literally, skin and bones, and nothing else—no muscles, it was like they had flaps of skin.” But nothing could have prepared Fascia for the bookmarked sites on the computer. Fascia found that Ashleigh had been visiting pro-ana websites. Pro-ana (pro-anorexia) sites are support groups that promote anorexia nervosa—you read correctly, these sites PROMOTE anorexia—as a lifestyle choice as opposed to an eating disorder. And the content of the sites is more than disturbing.

“My heart dropped when I saw some of the things that these sites said,” says Fascia. Ashleigh’s mother saw sayings meant to encourage and support girls who wanted to be anorexic, sayings like: “When you get hunger pains, curl up in a ball. It really helps them go away.”

In horror, Fascia read on, through the “Reasons Not to Eat”section:

1. You will be FAT if you eat today. Just put it off one more day, hour, minute and second.

2. Bones are clean and pure. Fat is dirty and hangs on your bones like a parasite.

3. When you start to get dizzy and weak you’re almost there.

4. People will remember you as the beautiful thin one, not the ugly fat one.

The closer Fascia looked at her daughter, the more she saw.

“I felt like a shade had been lifted and I could finally see out the window, and what I thought was green grass all along was really a brick wall,” says Fascia.“My daughter had an eating disorder and I had no idea. And the worst part was that these monsters were helping her.” Fascia realized that her teenage daughter was anorexic.


Anorexia nervosa is a psychological eating disorder that causes sufferers to have a distorted body image. Often, they see themselves as overweight, even when they’re dangerously thin, according to the American Psychological Association. Anorexics frequently refuse to eat; they exercise compulsively and develop unusual habits such as refusing to eat in front of others. They lose large amounts of weight and may starve to death.

Other common eating disorders include bulimia nervosa, in which sufferers eat excessive quantities of food, then purge themselves of food and calories with laxatives, enemas or diuretics, or by vomiting and/or exercising. Often acting in secrecy, bulimics feel disgusted and ashamed while bingeing, yet relieved of tension and negative emotions once their stomachs are empty.

As with people who have bulimia, those who have binge eating disorders experience frequent episodes of out-of-control eating. The difference is that binge eaters don’t purge their bodies of excess calories.


Fascia asked herself how her daughter got to this point. She also wondered what kind of person could run a pro-ana website. Often, these sites’ webmasters suffer from eating disorders—like Patty,* a recovered anorexic/bulimic who used to co-run a pro-ana site.

“It’s very lonely, having an eating disorder,” says Patty. “You start to isolate yourself from everyone except other people who have an eating disorder—they understand. That’s why you would join a [pro-ana community]. Nobody is going to tell you to just go eat a sandwich.” Patty, who makes sure to distinguish that not everyone with an eating disorder hates themselves or their bodies—as therapists have told her—says that in her life, her family puts a lot of emphasis on perfection, and restrictive eating was her outlet.

“When you can’t scream on the outside, you scream on the inside,” she says. “That’s anorexia.” The now-27-year-old student was once hospitalized after eating nothing for 10 days.

Patty explains that there are different types of pro-ana/pro-mia (short for bulimia) sites. Some, like the one she used to run, would ban the disconcerting photos of sickly, skinny girls, often referred to as “thinspiration,” or “thinspo,” like the ones Fascia found on her daughter’s computer. Patty’s site, RubysGloomyPlace, was taken off the server, she says, and now runs under a different name—which is kept secret. “Sites are very protective of who they let in because they get shut down all the time,” says Patty, explaining that some visitors are seeking a quick fix, a way to lose 10 pounds in two days, or to fit into a bathing suit or a prom dress. True anorexics resent those “posers,” and don’t welcome them into the community, she adds.

So, who’s to say who is a true anorexic and who is a weight watcher or health-conscious gym goer? This ambiguity makes anorexia difficult to diagnose and deal with.

The symptoms, however, are clear: They are the same as starvation symptoms.

“There’s a continuum that goes from normal eating to eating disorders, and somewhere in the middle there’s something called disordered eating,” says Judith Ruskay Rabinor, Ph.D., director of the American Eating Disorders Center in Lido Beach. So, for those Patty refers to as each “poser who fakes an eating disorder for attention,” there are anorexics who are flying under the radar. According to the National Eating Disorder Association (NEDA), 35 percent of “normal dieters” progress to pathological dieting. Of those, 20 to 25 percent progress to partial or full-syndrome eating disorders. Even those who fall in the normal weight range can have an eating disorder, says Rabinor.

Some may wonder what a story about an adult with an eating disorder has to do with the subjects of Our Children’s Brains. These eating disorders are rarely developed later in life. According to the National Institute of Mental Health, adolescent and young women account for 90 percent of cases. In fact, according to Rabinor, many of her patients consider their eating disorder a “family disorder that starts in our heads.”

“Usually an eating disorder will have its origin in some kind of family dynamic and is triggered by emotional problems; generally, somebody learns how to deal with a problem by using or misusing food. Kids become adults who learn how to fill a hole in their soul with food,” says Rabinor, the author of A Starving Madness: Tales of Hunger, Hope and Healing in Psychotherapy.


Jacob* has always been health conscious: He played sports in high school, had a two-year tryst with vegetarianism, and lifts weights and exercises regularly. To the average observer, his obsession with what he calls a “healthy” weight is normal, even beneficial. When other men his age began to get that signature mid-30s spare tire, Jacob was perfecting his six-pack abs. Planning a night of drinking and eating with friends, though, sends the 33-year-old into a tailspin of calculating the calories in light beer and the fried chicken he might eat. Jacob has learned tricks to make it appear as if he’s been eating all night, to not attract any unwanted attention. “I keep a full plate at all times—everyone assumes that I keep filling it up. Every once in a while I take a forkful of salad. For the most part, nobody even questions me,” he says. But those close to him know full well that he is obsessively watching what he eats. And even Jacob admits that he falls into the 10 percent of men and boys who have an eating disorder.

Anorexia makes headlines often: starving female models; after-school-special-type stories of high school girls’ bingeing and purging; even moms trying to lose baby weight. But rarely do we hear about boys and men like Jacob, who stands 5-feet-6-inches and weighs just under 120 pounds—a number he finds appallingly high.

“I am constantly counting calories,” says Jacob, an Internet marketer who works gruelingly long hours in Manhattan, and subsists on only coffee and water all day. “When I don’t eat anything all day, it makes me feel happy—I love when I can drink a bottle of water and feel the liquid making its way down my stomach—then I know I have nothing in my stomach.”

Dealing with a male who has anorexia can be difficult, says parenting expert and author Ann Pleshette Murphy.

“Boys are often afraid to ask for help because they think eating disorders are a girl thing,” says Murphy, former Parents magazine editor in chief, who adds that boys who suffer from eating disorders often have low self-esteem—both a symptom and cause of the disorder.

These words resonate with Jacob. His ongoing weight battle revolves largely around his overall appearance and self-worth. “I have low self-esteem,” he admits (the ruggedly attractive, self-diagnosed anorexic also admits he has never sought help for his issues). “I worry about what strangers think about me, or when I’m walking in the mall, I wonder why girls aren’t checking me out. It all adds to it.”

Experts like Rabinor agree.

“You have to examine the behaviors associated with your eating: Are you changing your life around in order to maintain certain weight or diet? How much of your life is devoted to thinking about weight and what you’re eating, or not eating? There’s isn’t one clear criteria. Ask yourself the ABCs of eating disorder; that’s a quick check,” says Rabinor.

The ABCs, she says, are “Affect”: What are your feelings about food? Does the thought of eating give you anxiety? Can you actually enjoy a meal?; “Behavior”: Are you exercising nonstop? Do you purge or vomit after eating? What are your eating patterns?; “Cognition”: How much time do you spend thinking about food and your weight?

“Even if you are a ‘normal’ weight—if you are consumed with thoughts about food, eating it or avoiding it, you could still have a disorder,” says Rabinor.

Such thoughts may not always make sense. Jacob says he doesn’t always think he’s fat, but worries about eating in front of others because of the way his face appears, saying, “Eating looks ugly.” He thinks about calories and fat content all the time, but he can’t remember exactly when he started worrying so much about weight.

Others cannot forget when they became consumed with concern about fat.


Alex* confesses that she’s had issues with food and her weight for as long as she can remember.

“My mom was often on me about what I ate,” she says, then quickly adds, “but I was a chubby kid.” Alex is a tall, leggy 26-year-old blonde with a pretty smile. Looking at this seemingly confident girl, one would never guess that she struggled with her weight as a child—and, even more surprisingly, continues struggling. Alex rattles off some “characteristics” she has that contribute to her eating disorders—she is anorexic and bulimic—such as insecurity, sensitivity to others, and low self-esteem.

Not surprisingly, eating disorders reflect poor self-esteem, says Darlene Aiken, CEO of Inner Beauty Solutions, a Central Islip-based empowerment and leadership program for girls.

“Self-esteem is the basis by which we all operate. It is instrumental in everything we do. If your self-esteem is not intact, everything else is going to crumble, because that’s the foundation. And your family sets the tone for self-esteem,” says Aiken.

So it doesn’t seem hard to imagine why Alex, a clearly beautiful and fit-looking woman, looks in the mirror and sees a fat, ugly duckling.

“I was conscious of my weight at a young age when I shouldn’t have been, so, in a sense, that was the start,” recalls Alex. “I think my mom put ideas in my head some way or the other. As an adult now, I feel like she was trying to help me but went about it the wrong way or something, I don’t really know—I still struggle with trying to figure out why,” says the full-time nanny.

Alex bears the scars of a childhood marred by weight obsession.

“I have memories of my aunts and uncle making fun of me and making comments when I was a kid.  And I’m talking a kid, like 8 or 9 years old,” says Alex, who recalls a time when she was 10, and she and her cousins were waiting in the car for her aunt at the library. When her aunt came out she said to Alex, “I got you a book.”

“I was so excited because out of everyone she got me something. She handed it to me and it was a diet book,” says Alex. Then later that day, her uncle offered her cookies and soda.

“It was always so confusing,” says Alex, “the messages they were sending me.”

Alex says she quickly internalized the taunting and mixed messages, and at 13 started taking laxatives, beginning a long and painful cycle of starving, bingeing and purging. She became a closet eater, feeling she had to hide her eating from her mother.

Recently Alex’s parents renovated her childhood home, and she stumbled across a letter she wrote to her mom. It said, “I promise, promise, promise to go on a diet and start losing weight.” She was 8.

Aiken, who conducts a workshop on positive body image, says, “At an early age, children are bombarded with all ideas about what beauty should be. It’s up to parents to counterbalance that.”

But, some parents, like Fascia, a single mom, might not notice what is happening in their own homes. Her daughter suffered from anorexia right under her roof. Positive reinforcement is not enough, says Fascia, who often told Ashleigh that she was beautiful and that she loved her.

“My mom did everything for me,” says Ashleigh. She is now 16 and on her way to recovery. “I didn’t want her to think it was her fault. That’s why I never told her.”

Fascia begs parents to educate themselves.

“They tell you the signs for drug abuse, they tell you the signs for alcohol abuse—why don’t parents know what to look for when your kid is starving to death?” Fascia asks.


Anorexia has one of the highest mortality rates of any mental health condition—5 percent to 20 percent of individuals suffering from anorexia will die, according to NEDA. But recovery is possible.

Ashleigh’s mother sought counseling immediately; intensive therapy has helped the once-74-pound teenager gain 13 pounds, putting her at the bottom of the normal weight class, Fascia says. And while mother and daughter are trying hard to keep Ashleigh healthy, the teen admits that it’s difficult sometimes, especially when she sees “really skinny girls who seem to have everything they want—I think, ‘I can do that too.’”

Alex says that she is proud of her full recovery, and hasn’t seen her therapist since her birthday last year.

Patty, who bottomed out at 82 pounds—35 pounds less than she should have weighed—now eats regularly and is at a normal weight; she looks sexy, healthy and fit. She says she stopped running the pro-ana website because, “You can’t get better when the only people you associate with are other people with eating disorders. You can’t stay part of the community forever—and I wanted to get better.” Patty battles small relapses often, though. On a bad day, or if something sets her off, she stops eating for a day or two until she says she “feels better about herself.”

Jacob thinks eventually he’ll get help, but doesn’t believe his health or his weight is a priority right now. “Nothing bad has happened to me so far. I’ll worry about it when it does.”

Additional reporting by Melissa Wasserman

* Names have been changed.

Warning Signs of Anorexia Nervosa

Is it possible that your child is suffering and you don’t know it? According to NEDA, because of the secretiveness and shame associated with eating disorders, many cases are probably not reported and a majority of individuals who suffer go untreated.

Here are some common warning signs that indicate that a person may be suffering from anorexia, as compiled by NEDA:

• Dramatic weight loss.

• Preoccupation with weight, food, calories, fat grams and dieting.

• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.).

• Frequent comments about feeling “fat” or overweight despite weight loss.

• Anxiety about gaining weight or being “fat.”

• Denial of hunger.

• Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).

• Consistent excuses to avoid mealtimes or situations involving food.

• Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.

• Withdrawal from usual friends and activities.

• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health Consequences

Anorexia nervosa involves self-starvation. The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all its processes to conserve energy. This “slowing down” can have serious medical consequences:

• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower.

• Reduction of bone density (osteoporosis), which results in dry, brittle bones.

• Muscle loss and weakness.

• Severe dehydration, which can result in kidney failure.

• Fainting, fatigue and overall weakness.

• Dry hair and skin; hair loss is common.

• Growth of a downy layer of hair (“lanugo”) all over the body, including the face, in an effort to keep the body warm.


The National Eating Disorder Association (NEDA)

NEDA-LI Chapter

Center for the Study of Anorexia
and Bulimia

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