More threads by Daniel E.

Daniel E.
Fighting Anorexia: No One to Blame

By Peg Tyre
Dec. 5, 2005 issue (cover story!)

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 affair.

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

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

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

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

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."

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Thanks for that article. I read the whole thing and it was really interesting. It's interesting to think of society as "pulling the trigger" for people who are already predisposed to developing anorexia. But, then the question still remains - How MUCH of a part does society play? I mean, if there are people predisposed to developing anorexia, yet nobody in society ever promoted or believed that being thin was better than being fat, would those people ever develop it? I can't remember where, but somewhere I read that a long time ago, when it wasn't popular to be really thin (maybe Victorian times), some young women still displayed anorexic behaviour.
I guess these questions can never be answered entirely. But, I also wonder why the age has decreased for the onset of anorexia. Is it because people are just developing it at a younger age, or because it's being recognized by more parents and doctors? If people are just developing this younger, then why?
Oh well, too many questions. But, I can say one thing. My mother has a tendency to be a perfectionist. She's not too bad, but even she admits that it's there. My father, although good and gentle, is a very intense person. My grandfather on my mom's side was an alcoholic (he was able to recover). My grandmother on my father's side I believed suffered with a few problems that increased with age - becoming afraid to leave the house and of certain noises, and possibly depression. Although probably all families have people that suffer different psychological problems, seeing it in my family leads me to believe that my anorexia could have been partialy hard wired or genetic.


on the other hand re: the question about how much society contributes to ed's, it's been shown that bulimia is virtually unknown in 3rd world countries or places where people don't generally have enough food. so I'd say that's something to wonder about... are these people still suffering (from an ed) just in different ways? or do ed's just really not exist there?

From what I know, there has been a huge amount of research on many mental ilnesses in the past decades, so a lot more "cases" are seen... greater awareness would definitely account for seeing younger ed patients. but does this mean that say thirty years ago people also had ed's when they were 9 or 10 and people just didn't recognize it as an ed?? I would take a stab and say that kids are growing up sooner now than before, so just in terms of "regular" socialization they're advanced, so maybe that pushed the age of the onset of an ed to be earlier than before.

As sad as it is that someone so young has an ed, the only "positive" factor is that hopefully someone can recognize their problem and get them help earlier... the sooner an ed is recognized and treated, thus the less long standing it is, the better the outcome usually. This whole discusion reminds me of a book I read by Peggy Claude-Pierre and the fact that some of her patients were quite young, one boy as young as four or so... (there's a lot of debate about this book and her theories and practice anyways though).

I think what people have to realize is that an ed is a mental illness that doesn't have an age limit.. I know that there is a "typical age onset" but research has shown that younger and much older people are not "immune" to having an ed, in the latter case, even if they didn't have one when they were "young".


The comment you made about countries where people are starving is interesting. I suppose that no matter how predisposed you might be to having an ed, starving yourself or purging would not be coping strategies to someone who is already starving. If you're not starving to begin with, I guess restricting your food intake could be used as a coping method for gaining control or reducing the overload of seratonin in your brain, or whatever. And, I wonder what the difference is between bulimia and anorexia. Do bulimics usually know about purging behaviour before they start it, thus maybe explaining bulimia as more of a learned behaviour?

David Baxter PhD

Late Founder
The observation puts me in mind of Maslow's Hierarchy of Needs - one cannot attend to needs higher in the hierarchy (control, self-esteem, love, affiliation, etc.) until the basic needs (hunger and thirst) have been satisfied. Where there is an abundance of food, that need is satisfied, even if one chooses not to partake.


Two things I found in one of my texts in relation to this:

Worldwide Phenomenon
Eating disorders are now on the increase in a number of countries around the world, including those in South America, Asia, Africa, and Eastern Europe (Simpson, 2002; Nasser et al., 2001). In such countries these increases have less to do with a fear of gaining weight than with sweeping changes in the social and political status of women.

Saintly Restraint
During the Middle Ages, restrained eating, prolonged fasting, or purging by a number of female saints was greatly admired and was even counted among their miracles. Catherine of Siena sometimes pushed twigs down her throat to bring up food; Mary of Oignes and Beatrice of Nazareth vomited from the mere smell of meat; and Columba of Reiti died of self- starvation (Brumberg, 1988).

Do bulimics usually know about purging behaviour before they start it, thus maybe explaining bulimia as more of a learned behaviour?
I don't think anyone really consciously enters an ed, but as w/ anything else, modelling of behaviour and attitudes about food and appearance definitely have some kind of influence. For ex. if someone's mom always talks about her small figure and restricts her child's diet by punishing her for eating sweets, drinking pop etc. and being obessive about exercise, I'd bet that those attitudes would have some kind of impact on the child. This being said, ed's need to be looked at through a multidimensional risk perspective, so just one factor in itself probably doesn't account for the development of an eating disorder. Isn't bulimia as much of a learned behaviour in terms of coping and adaptiveness than anorexia? I would argue that bulimics know as much or as little about purging behaviours than anorexics know as much or as little about starving; I don't think "knowing" has to come b/f doing.... just my opinion though.


I also know people who have tried to purge at some point in their lives, just because they learned about it. However, they never developed bulimia or any eating disorder. I guess if you're already genetically prone to developing one, any learned behaviour about how to be "sucessful" at it doesn't help.
I tried purging a very long time ago just to see if I could do it - way before my anorexia. But, I couldn't do it then and I never tried to do it later.
I guess there are no clear-cut answers - and yes I guess the risks are multidimensional.


well I guess what I'm trying to say is that just b/c you've heard of purging doesn't mean you'll become bulimic... but I mean, just think of all the "tricks" people w/ ed's have and how they acquire these tricks, through books, movies, magazines, tv, other people, own experiences (trial & error so to say) etc...right? so yeah, clearly some of it is learned behaviour and maybe even consciously applied but the ed in itself doesn't just come from "learning" how to purge... there must be some other kind of predispositon, genetic or not. however, this is a good point and I have wondered b/f too, how did I come to do all of this? and the same w/ si?? would ed's develop if people had never heard of them? how do people think of these things and get themselves to the point where they're doing the behaviour??? It is really bizarre.

I would say though that someone who tried to purge or starve and can't do so, still has issues w/ eating... maybe the issues will "pass" but at the time being, there's some kind of problem. I have heard people say b/f that they couldn't "be" bulimic so they became anorexic and vice versa.....which kind of makes sense, but then again, aren't we saying that you can "choose" on some level? I don't get it.


Well, I guess that even though we are social beings and things are taught and learned, I think we forget how much we are all inherently the same. There are so many people in this world with ed's who get the same sorts of feelings from eating/not eating/purging etc. There are so many ways in which people practice self harm as ways of coping with their emotions. They could drink way too much, or engage in dangerous behaviour, take drugs, si, starve themselves or make themselves throw-up continuously. Living at a social level where food is abundant, one way of punishing yourself or causing self harm is to not allow yourself to eat or to try to get rid of what you eat. Just like why would someone continuously engage in dangerous behaviour when they have every opportunity to stay in a safe environment? Or, why would someone who isn't physically abused do it to themself? I just find all of these questions interesting, and even the experts who've been studying these things for years don't have any one answer.
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