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Becoming 'the Best Anorexic Ever'

Battle With Food

'It Becomes a Friend' continued...

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."

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