Eating disorders know no gender

Published 2:00 pm Saturday, February 26, 2005

Therapists will discuss the issue with students at schools next week.

Gabriel Chrisman was starving to death when he finally checked into a California treatment center last summer, weighing only 119 pounds.

His heart rate had plunged to a dangerously low 30 beats per minute, and his temperature and blood pressure were well below normal. He was so sick he could no longer work.

During his two-month stay, he was one of three people from Bainbridge Island admitted to California’s Rader Center for treatment of a life-threatening eating disorder.

“That should tell you something,” said Chrisman, now 156 pounds and back to work at the B.I. Cycle Shop, where his boss, fellow employees and customers supported his recovery. “Out of 30 people (in treatment), 10 percent of us were from Bainbridge Island, at a center that draws from the whole country.”

What he discovered is that eating disorders are a serious, and all too common problem on Bainbridge Island. It’s a concern that therapists, doctors and educators on the island all share.

“Across the board, I see more kids who are obsessive about restrictive eating, a lot more children with disease,” said Dr. Jillian Worth, a family practitioner at Virginia Mason Winslow Clinic. “It begins with weight loss, and it becomes an obsession.”

The disorder usually strikes girls in adolescence, but some youths on the island say they began engaging in dangerous behavior as early as third grade, throwing up after every meal. National statistics show that after puberty, 5-10 percent of girls and women suffer from eating disorders, although as Chrisman demonstrates, men are not immune.

An estimated 1 million men in the United States suffer from the illness, according to the National Eating Disorders Association.

“The pressure here to be the best, at all costs, to get straight As, to be the cutest and the sexiest, to be the best at sports,” are elements of island culture that contribute to various forms of disordered eating, said Bainbridge therapist Janie Burke, an eating disorder specialist, who works closely with Worth.

“It’s usually not about eating at all,” Burke said. It is, she said, about control – and a confluence of issues that include a lack of coping skills, distorted and often unrealistic ideals of beauty and athleticism, and unresolved emotional issues.

Secrecy and denial of the problem are common as well, and many abnormal eating behaviors remain hidden from view, she said. Then, when parents suspect something is wrong, they often don’t know how to approach the problem, thinking it might just be a phase, Burke said.

But denial of the problem – by the sufferer and his or her family members – can be devastating if not deadly, statistics show. Health problems stemming from the disorder include heart damage, anemia, eye problems, ulcers, skin disorders, electrolyte imbalances, infertility, tooth decay and ulceration of the esophagus from vomiting.

Victims also suffer from high rates of suicide and alcoholism, according to the American Psychiatric Association.

“It is as destructive as cancer, but people often don’t see that,” Burke said. “I tell them, ‘you would get treatment if you had cancer, wouldn’t you?’”

That’s something parents and students need to know. Burke and several parent volunteers will be at Woodward and Bainbridge High schools during the noon hour next week, distributing information about eating disorders and answering questions. Feb. 27-March 5 is National Eating Disorders Awareness week.

While eating disorder pamphlets are regularly made available to high school students, any boost in awareness is helpful, said BHS Principal Brent Peterson.

Eating disorders “are a reality in our community and we find ourselves working with them on an ongoing basis,” Peterson said. “While we characterize ourselves as a small community with a lot of support, that doesn’t make us immune. In communities like ours, there is a lot of pressure to succeed and do well academically and socially, and that increases the likelihood of eating disorders and other challenges for our kids.”

How it starts

Dieting or pushing oneself physically can begin innocently enough, but can quickly spiral out of control and become dangerously habitual, with excessive weight loss and/or bingeing and purging food, Burke said.

“What I have found, is that a lot of patients feel isolated, and the eating disorder becomes their friend,” Burke said. “This friend has a voice, which applauds them when they don’t eat, and chastises them when they do. It is the most destructive voice they hear. The voice is a cheerleader, and it becomes a behavior.”

Eighteen-year-old Kristen Kelly of Bainbridge Island knows that voice well. But back when her mother Susan tried to get help for the teen, she screamed at her and denied she had a problem. Once, when a Seattle physician confronted Kelly, she screamed at her, too, ran out of the office and wandered the streets for several hours.

“I was terrified of someone taking it away from me,” said Kelly, who had developed food problems in third grade, and was throwing up her meals by the fifth grade.

This was an ominous sign of where the illness would take her.

Kelly spent her high school years in and out of health facilities and treatment centers, becoming so ill in her freshman year that she had to be hospitalized for weeks with a feeding tube in her nose. She was so weak she couldn’t lift her arms. And yet, to keep her from feeling proud of her weight loss, the doctors had to hide the numbers on the scale when they weighed her.

“I fought it. I swore up and down I did not have a problem,” Kelly said, even though her mother took the extreme step of moving with her to San Diego for treatment, only to have it fail. They tried a program in Long Beach, Calif., with no progress. They moved back to Bainbridge, and employed a team with a doctor, a therapist, a psychiatrist and a nutritionist.

Kelly couldn’t go to school. She did not get better.

“I was born on Bainbridge, and I feel like I died there,” she says now. “Something I learned is that you are only as sick as your secrets, and there are a lot of secrets on Bainbridge. A lot of appearances – ‘everything is fine.’

“Well, everything is not fine. That’s a big part of it.”

Finally, her parents had her whisked off to a wilderness camp, and she spent her senior year at a mental health facility in Montana, where she came to see the depth of her problem.

“I started to get at the core of the emotional stuff,” she said, noting that she couldn’t control her eating disorder when she hadn’t addressed what was eating at her emotionally.

“I didn’t know how to cope with anything,” she said, noting that starving, and bingeing and purging, substituted for emotional release.

“It takes a lot of work and a ton of effort to be comfortable with who you are,” said Kelly, now a psychology student at Eckerd College in Florida. “I have to go out there and be active and appreciate the things my body can do for me, and treat it as if it were sacred. It is the only body I have.”

Still, she struggles.

“I know a part of my head is still sick,” Kelly said. “Sometimes I eat and feel guilty if am I full. I have to tell my self that the fullness will go away, that food is good for me. I have to convince myself to eat.”

Chrisman also struggles to eat and to keep his weight up. As he looks back at his eating disorder, he can see now how bizarre it was, even foolish. He once rode his bike 145 miles, pulling a camping trailer, eating only a can of tuna. On the way home, near the Agate Passage Bridge, he couldn’t go on. Unable to stand, he had to call his brother to pick him up.

Chrisman, 26, started losing weight during his parents’ divorce, and started excessive cycling to deal with stress. This was a distraction, he sees now, that kept him from dealing with the issue at hand.

“It seems silly now, but it seemed very powerful at the time,” he said. “Getting out of (the disorder) means facing reality. You are saying you can survive without food, but you can’t, and whatever you are trying to avoid has to be faced.”

Worth said therapy to address eating orders can take three to six years, which is why she is working harder than ever on prevention in her practice.

“Healthy eating needs to be couched very carefully, and not just in terms of what people in the family eat and how much they weigh,” she said, adding, “eating disorders often begin at home.”

Instead of emphasizing a child’s looks or weight, parents can encourage health for the whole family, through walks and bike rides. Instead of remarking on a child’s body or physical appearance, parents should praise the things their children do well, such as being a kind brother or sister, a thoughtful friend, or encouraging their painting or violin playing, for example.

“The best thing I can do,” Worth said, “is emphasize how beautiful they are inside.”