Health and well-being

Stick thin celebrities and models have long haunted real young girls and women. Despite health professionals efforts to contradict this ideal, Hollywood is still presenting this image. The new young teen stars of the remade TV hit "90210" has people up in arms about how skinny the girl starts are. And even though skinny models were recently banned from one European fashions how, the skinny frame still persists.

As these young women seem to waste away before our very eyes, becoming skinnier and bonier, at least they are being exposed for having an eating disorder.

Like other stick-thin celebrities - former Ally McBeal star Calista Flockhart, Men in Black II star Lara Flynn Boyle and even superstar singer Whitney Houston at one time - billionaire star Mary Kate Olsen’s struggle offers a valuable learning experience for millions of fans.

The lesson: Too Twiggy-like thin is not "in" — and can even be deadly.

The billionaire twin had even once checked into a rehab center in Utah weighing 86 pounds — dangerously low for her already tiny 5’2" frame.

Magazines have reported the young star’s condition as anorexia, but barely with enough detail about the condition - an education this column aims to remedy.

Drastic drops in weight - essentially starving - is an effort to control food intake, and y betrays deeper psychological issues.

It is too superficial - though true— to say that anorexics have an intense fear of getting fat. Looking in the mirror, they see a fat person - an assessment with which no reasonable person would agree. Striving to be skinner, they may exercise obsessively, refuse food, and even take laxatives. But there are multiple reasons for such an eating disorder.

Certainly the media, advertising and society deserves blame, pressuring adolescents to be thin. Especially vulnerable are young dancers, models, actresses and athletes.

The pressure to be perfect also makes young girls starve themselves. Deeper psychodynamics include a fear of growing up and resistance to becoming a fullgrown woman - explaining why young teens often suffer from this disorder when they begin to develop breasts, menstruate and mature. I have seen several young girls in hospital from 13 to 17 yeas old who dread turning 18. Starving themselves diminishes the signs of womanhood — by shrinking breasts and causing irregular or completely interrupted menstruation. "I hate those bumps on my chest," one young patient told me. "And I don’t want that disgusting blood every month." Digging deeper emotionally, some of these young women have conflicts over boys and sex. As one teen told me, "I hate boys coming on to me and looking at me like that." Others I have seen over the years became promiscuous and guilty about their sexual behavior.

Anorexics also have conflicts over mothering - either rejecting mothering and the mothering role, or desperately needing nurturance yet fearful of the dependence it implies. Some girls become attached to their father, but threatened when they mature sexually, so regress to looking like a little girl. Others come from enmeshed families, and become angry at parents or others who control them, and desperately seek autonomy - while paradoxically also unconsciously desiring to remain dependent. Rejecting food becomes a way of saying, "Leave me alone. I want to control my own life." The only way to do that is by controlling the food they do-or rather do not - eat.

Anorexics often suffer from low self-esteem. MaryKate has been reported to say self-deprecating things, comparing herself to her twin sister, and finding herself far less attractive. These dilemmas are poignant in a book, "The Golden Cage: The Enigma of Anorexia Nervosa" by Hilde Bruch. Drug-taking can also be a factor. For example, cocaine is an appetite suppressant that can lead to not eating and emaciation. While young females constitute the vast majority of anorexics, adolescent boys as well as women over 50 - and into their 80’s - can also develop this eating disorder.

According to a Gallup Poll, 20 percent of college-age women and 10 percent of adult women suffer from eating disorders. Recent studies also indicate that the preoccupation with weight begins at an even earlier age, with one report that 40 percent of third-grade girls and 75 percent of fifth-graders said they were dieting to lose weight. Family members have to be on guard for a young girl’s eating disorder - being prepared for the girl’s denial, resistance and anger. But they must insist on professional help, from a therapist who specializes in eating disorders or from an inpatient rehab clinic. Rich young women, like MK, have the added advantage of an individualized counselor assigned to monitor her behavior.

There are four basic criteria for the diagnosis of anorexia, according to the American Psychiatric Association’s Diagnostic Manual:

 Refusal to maintain body weight at or above a minimally normal weight for age and height - body weight less than 85% of the expected weight is considered minimal.
 Intense fear of gaining weight or becoming fat, despite being underweight.
 Grossly distorted selfperception and refusal to acknowledge weight loss.
 Missing at least three consecutive menstrual periods or menstrual periods occur only after administering a hormone.

Other symptoms include:

* Overconcern with calorie intake, weight, and appearance
* Strange behavior around food: hiding food, refusing to eat in public, making food for others but not eating, eating only low calorie food like lettuce or popcorn
* Anxiety, depression, or obsessive-compulsive behaviors
* Bloating
* Weakness and shortness of breath
* Depression, irritability, sleep disorders, fatigue, disinterest in activities
* Brittle skin, feeling cold, fine body hairs, dental decay

The weight criteria of the American Psychological Association for anorexia nervosa is a BMI - body mass index - of 17.5 or below. Researchers in the psychology department at St. Mary’s University in San Antonio have found this BMI in three-quarters of models and celebrities, including Cameron Diaz and Diana Ross. Other celebrities who have battled anorexia include the Sopranos’ actress Jamie-Lynn DiScala, who wrote a book about it (2002’s Wise Girl) and became a spokeswoman for the National Eating Disorders Association. Other celebrities who have appeared pencil thin but denied an eating disorder include Friends’ star Courteney Cox, who was on the cover of People magazine illustrating a story on stars who were so skinny their health might be jeopardized, and Victoria "Posh Spice" Beckham, who told ABC’s YV show 20/20, "I was very obsessed. I mean, I could tell you the fat content and the calorie content in absolutely anything (but) I was never anorexic but I was probably very close to it." As for men, when actor Billy Bob Thornton (once married to Angelina Jolie) lost 59 pounds, he admitted to a newspaper that he "got anorexic" in a conscious bid to lose weight, and said, "Frankly, for a while there, I think I had a little mental problem… I got anorexic; of course I denied it to my girlfriend (then Laura Dern) and everyone else who said I had an eating disorder."

Emaciation from anorexia is not just unsightly; it can be deadly - a danger in up to 10 percent of cases. Body functions besides digestion cease to operate properly, leading to medical risks like dehydration, shrunken and brittle bones, low body temperature, irregular heartbeat, thyroid deficiency and permanent failure of normal growth. Harsh substances in some laxatives can be dangerous when absorbed in the body, and their continual use can disable bowel muscles’ function.

Anorexia claimed the life of singer Karen Carpenter who died from the eating disorder in 1983 at the age of 33.

Anorexia is particularly dangerous to pregnant women, who should gain between 25 and 35 pounds — that would be like telling a normal person to gain 100 pounds. Stopping eating can lead to miscarriage and premature births. Starving oneself from the eating disorder anorexia has to be distinguished from stuffing oneself as in the related eating disorder called bulimia — where the person eats large amounts of food like an entire quart of ice cream, or three hamburgers, or a whole pizza and then rejects the food, usually by throwing up.

I’ve known many women including celebrities with this binge and purge syndrome who are complimented for their svelte figure but consume large amounts of food in secret and then throw it up, exercise obsessively or overuse laxatives. Or they eat enormous amounts of food at a party and then quietly excuse themselves to the ladies’ room to stick their finger down their throat to throw up the food - often camouflaging the sound by running sink water. Both eating disorders are an effort to exert control not only over food but over life, and as a dysfunctional way to deal with emotional conflicts, fears, stress, and anger.

Stressful life events increase the risk of eating disorder - certainly MK has been reported to be under tremendous stress, keeping up with the Olsen sisters’ booming billionaire businesses. Proof is in the body biochemistry, as scientists have found anorexics to have abnormally high levels of cortisol linked to stress, as well as decreased neurotransmitters serotonin and norepinephrine linked to depression. Eating disorders also tend to run in families, with female relatives most often affected. The condition was first recognized over 300 years ago, but has increased in recent years because of the over-emphasis on appearance and thinness in our society.

Fortunately, help is possible. The treatment of anorexia requires careful medical management of health conditions, nutritional training and education about meals and eating. Therapy is also essential. This can be as an outpatient, but more effectively in a rehab center. Therapy includes psychotherapy, stress-reduction, rebuilding self-esteem, cognitive-behavioral counseling to change destructive thought patterns and habits, group therapy for support, and family therapy.

After any treatment, the environment to which you return matters. It should not include old haunts that trigger old habits and unwanted behavior, but should include positive influences. Any time such a celebrity role model goes through a psychological trauma, there is a silver lining in the dark cloud - in MK’s case, that millions of fans, especially young girls vulnerable to anorexia, can learn from their idol’s problem.

Fans apparently crowded chat rooms about MK and sent her letters. Such stars can be helpful to millions of young girls who are suffering emotionally from similar issues by sharing their problem and treatment. For support groups, hotline counseling, referrals and more information, contact organizations like the National Association of Anorexia Nervosa and Associated Disorders (ANAD) website.

Dr.Judy Kuriansky, Ph.D.
Professor, Clinical Psychology,
Columbia University Teacher’s
College, Fellow, American
Psychological Association
Radio Talk Show Host for 20
Years