The residents of RainRock Treatment Center sit down for lunch at a homey dining table with a view overlooking the McKenzie River east of Eugene, Oregon. The young women, dressed in sweatpants and slippers, chatter around the table as bouts of laughter occasionally erupt. The chef and staff set down a personally-portioned chicken club sandwich with a bowl of fruit in front of each resident.
At first glance, the clients at RainRock appear normal and healthy. But for each of these women, everyday is a struggle with a destructive eating disorder that can ruin their self-esteem, tear apart families, and even lead to death.
“It’s a disease of secrecy and shame,” said Dr. Tara Holstein, Clinical Director of RainRock Treatment Center.
Surrounded by lush forest on the east edge of Springfield, RainRock treats residential and outpatient clients to help them overcome an eating disorder, primarily anorexia or bulimia, which affects mostly women in their early 20s. Anorexia nervosa is a condition where patients starve themselves to look skinny. Bulimia nervosa is when a person binges on food and makes them self throw up to lose weight. These young women constantly fight the need to purge or starve themselves to attain an impossibly thin model-like figure.
“We live at a time when we are constantly bombarded with unhealthy images,” said Assistant Director of Development Jessica Silye at the National Eating Disorders Association.
Anorexia and bulimia affect between 7 and 10 million American women, and one million men, according to the National Association of Anorexia Nervosa. Close to half of the reported cases in women began between the ages of 16 and 20. The cost of treatment can reach more than $100,000 and only 50 percent of those affected report being cured of the disorder. Around 6 percent of serious cases of anorexia nervosa result in death due to malnutrition and starvation.
Some treatment centers mostly focus on the medical issues of a patient, said Holstein, and often overlook the mental and emotional needs of a client. “A lot of treatment facilities are so heavily medical and they don’t really treat the person, and there’s a lot that needs to be done on that level,” said Holstein.
At RainRock, one of the few residential treatment centers in Oregon, residents have meetings with psychologists, dieticians, and create peer support groups with the other residents. RainRock patients are served three meals and three snacks a day, and some follow a light exercise plan.
Clients at RainRock had significantly higher self-esteem ratings and showed less signs of starvation or purging after discharge, according to a 10-year follow up study by RainRock. The specialized treatment and high full-recovery rate means RainRock always has a long waiting list. Most clients end up staying for around 60 days.
High-profile celebrities have suffered from eating disorders and have helped make the public more aware of the condition. Actress Jane Fonda discussed her eating disorder in the late ‘70s, and singer Alanis Morissette had anorexia and bulimia during her teen years. Brazilian model Ana Carolina Reston died in 2006 at age 21 from complications with prolonged anorexia.
“Models in stores would not be able to bear children if they were brought to life as they do not have enough body fat. This horrible standard makes it harder for those prone to [eating disorders] to avoid it,” said Silye.
A constant focus on dieting is another social factor that drives some women to sacrifice food and their health to look skinny. University of Oregon student Jerica Pitts remembers the pressure she felt as a teenager before overcoming bulimia in high school.
“Those women in the magazines create this illusion of what you need to look like rather than what you can actually become or should be,” said Pitts. “Earlier in high school you are still going through a bunch of changes and I just wanted to fit in and look like everybody else.”
Certain activities or influences can trigger an eating disorder as well. Pitts gained weight at age nine after she quit swimming to focus on dance. It was around that time when she recalled several comments her dance teachers made about her weight.
“My teacher said that if I wanted to do well in dance I would have to lose weight, so that’s when I became more aware of it. I didn’t care about the health part of it, I just wanted to look good,” she said.
Pitts binged on food and then purged on a daily basis throughout high school. She received outpatient treatment for her disorder after several hospital visits for dehydration and malnutrition. The self-esteem issues that drove her to such extremes still affect her today.
“Since then I haven’t had a consistent eating disorder, but I still make myself throw up sometimes,” Pitts said.
Enabling comments from close friends and family about appropriate weight can influence someone with an eating disorder. Before she decided to become a psychologist, Holstein developed an eating disorder in her early teen years into her 20s. After receiving compliments on her figure from family and friends, Holstein maintained a strict exercise and diet plan throughout her college years. Constant compliments on her weight and petite frame fueled her obsession with remaining impossibly thin.
“In our culture part of becoming a woman is like becoming a dieter, so many of my friends and teachers made no comment about my eating habits,” said Holstein, who looked healthy and alert.
Eating disorders often coincide with or cause other mental conditions like depression or an obsessive-compulsive disorder.
“I basically ate carrots for dinner, and it just kept going. It was mainly restriction and over-exercising. I never missed a workout,” she said.
Experts and women affected by eating disorders blame different mental conditions as causes of the disorder.
“Most people who have an eating disorder have other mental conditions as well. It’s not always clear which of those disorders came first, sometimes the disordered eating itself takes a toll on brain functioning and then causes more depression and anxiety,” Holstein said.
University of Oregon student Micaela Sicroff watched her older cousin deal with anorexia when she in high school.
“It was hard to watch her struggle with her eating disorder, but I didn’t really understand it at first. I just knew that she had body image issues and was very much a perfectionist,” said Sicroff. “She finally got help during her senior year of high school and she found that her disorder was deeply rooted with depression.”
Obesity issues have been a popular topic in the media in recent years. While this phenomenon has caused many young girls to be unnecessarily worried about their weight, others still maintain healthy lifestyles and self-esteem levels.
“I have been very fortunate that I have never felt the urge to partake in drastic measures to change my appearance,” said Sicroff. “I love to eat and I love to exercise, and the older I get, the more I enjoy living a healthy life. I would never want to hurt my body.”
Many dieticians and doctors use the Body Mass Index scale to determine what weight range a healthy person should be in based on height. While one of the signs of anorexia is a BMI below 18, almost 60 million Americans have a BMI over 30, which is considered obese, according to the Centers for Disease Control and Prevention. The concept of an obesity epidemic has sparked constant debate about eating habits in American culture.
“If we lived in a culture where people didn’t talk about weight so much or how much you should eat, people would just naturally eat according to hunger and stop according to fullness. They wouldn’t monitor their weight in the same way that society tells us to,” Holstein said.
The majority of eating disorder cases reported are anorexia and bulimia. But psychologists and professionals are researching new types of related disorders, such as obsessive exercising, that may go unnoticed by most doctors and caregivers.
Education and research on eating disorders is a continuous process, Holstein said. Treatment centers around the country are still grappling to understand the complex psychological and social factors that cause many young women to develop dangerous eating disorders.
“We just need more awareness and better education of medical professionals,” Holstein said.
For more info or help with an eating disorder visit the National Association of Anorexia Nervosa and Associated Disorders website.