Nov. 12, 2001 -- Wendy, 22, has struggled with anorexia for more than a decade but has no immediate desire to recover from the condition that could one day kill her. Though she says she wouldn't wish the eating disorder on anyone, Wendy adds that "for myself and many others, there's a need to hold onto it."
"I didn't choose to have an eating disorder when I was 10 years old, but after 12 years of this, it is all I know and it is what I'm used to," Wendy wrote in a letter to WebMD. "I have been in outpatient therapy for six years, and have been hospitalized for organ failure. I know what I am doing. ... No, I don't plan on staying this way for the rest of my life, but for now, it is what I'm choosing. And it is what many others are choosing."
Wendy was one of several young women who wrote to WebMD recently in defense of pro-anorexia Internet sites and chat rooms. Many of the web sites have since been shut down by servers like Yahoo! in the wake of a flood of news stories and complaints from groups fighting eating disorders.
"I know you're probably jumping for joy," CZ wrote WebMD. "You and thousands of other reporters have taken down the enemy. Do you have no empathy? Now I have no support. It wasn't just about starving, achieving our goals, and so on. We gave support."
'It Becomes a Friend'
Both Wendy and CZ said the intent of the pro-anorexia sites is not to promote eating disorders in hopes of recruiting converts. Their comments suggest that they consider the Internet "clubs" they frequent to be exclusive sororities where they can express their feelings without being judged. Australian researcher Megan Warin says a sense of community and belonging is strong among anorexics and helps explain why treating the condition is so difficult.
Warin spent more than three years talking to anorexics in an effort to learn more about the day-to-day social effects of the disease. She says one of her most surprising findings is that anorexics frequently view their eating disorders as "empowering" rather than seeing them as debilitating psychiatric illnesses.
"The people I talked to described the early phases of anorexia as being quite seductive," says Warin. "People often don't want to give up their eating disorders. They enter into a relationship with anorexia and it becomes a way of coping. Many sufferers personify it, and even give it a name. It becomes a friend, the enemy in disguise, an abusive lover, someone they can rely on."
Figures suggest that approximately 8 million people in the U.S. have eating disorders like anorexia nervosa and bulimia, and 7 million of them are women. The overwhelming majority of sufferers develop the disorders in their teens and early 20s.
Eating disorders expert Michael P. Levine, PhD, professor of psychiatry at Kenyon College in Ohio, agrees the sense of identify that often accompanies anorexia frequently complicates treatment. He recalled a poignant interview many years ago with a 19-year-old struggling to recover from the disorder.
"She had never had a menstrual period, she had very few friends, and she spent a lot of time in therapy or alone," he says. "With tears in her eyes, she told me that she struggled every day with anxieties about food. She said she wanted to recover, but it was hard. And she looked me in the eye and said, 'At least when I was anorexic, I was somebody.'"
'The Best Anorexic Ever'
National Eating Disorder Association spokeswoman Holly Hoff says perfectionism and competitiveness are common traits in young women who develop eating disorders.
"There is often a strong, strong drive to be perfect, and even with the eating disorder they want to be perfect," she says. "That is why group treatment settings can be problematic. They may hear things that other people are doing and they may think they are not going as far as they could."
Vivian Hanson Meehan, president of the National Association of Anorexia Nervosa and Associated Disorders, agrees.
"Often what happens when you see anorexics in a group is that they start to compete with each other," she says. "They are vying to be the best anorexic ever. But the best anorexics are dead."
Hoff says there is currently no clearly superior strategy for treating eating disorders but medical professionals know far more about them than they did even a few years ago. She recommends a team approach to treatment, integrating psychological therapy with medical treatment aimed at restoring physical health.
"A big issue in treatment right now is whether it is necessary to get a sufferer's weight up before working on the psychological issues," she says. "Research suggests that some anorexics can be so physically depleted that they need to be returned to some baseline level of physical health before analysis can be effective. It speaks to the power of this illness that some people are so ill that they can't understand that they need care."
There is a far better chance for recovery, Hoff says, when the illness is identified and treatment is begun early. Friends and family members can have a big impact here, because sufferers rarely acknowledge they have a problem until it can no longer be denied.
"Many sufferers lose their grasp on reality and begin to think that what they are doing is normal," she says. "That is why it is so important that family and friends keep driving home the point that it is not normal. What we hear from people in recovery is that even though they may resist those messages, they are always somewhere in the back of their minds. The messages are there when they start to feel less and less in control and more and more weak."
Recovery from eating disorders is often a long road, she adds, and most people are not able to do it without professional help.
"We often hear from sufferers who have gone to a counselor, but it wasn't the right match and they are ready to give up," she says. "We encourage them to try someone else. Finding someone they trust and can work with is almost more essential than the specific method of treatment."