For many Americans, Thanksgiving kicked off a holiday season marked by cheer, good will and a lot of eating. That's exactly what makes it such a difficult time for Thomas Hightower and his mom, Sandy Hightower.
Thomas, 16, is a recovering bulimic who struggled with his eating disorder for years before it almost killed him in February. He remembers Thanksgiving 2000, when he ate and ate because it seemed to please family members who saw it as a sign of recovery. They didn't know he'd go home and throw it all up.
Ms. Hightower is blunt in expressing her feelings on the holiday season.
"It's terrifying," she says.
Ashley, a 16-year-old Augusta-area girl who's a recovered bulimic, remembers what the holidays were like before she got help three years ago.
"This sounds really bad, but I think it's easier for bulimics, because they actually get to taste the food," said Ashley, who asked that her real name not be used. "Anorexics don't even get to taste it because they won't eat it in the first place."
Dealing with an eating disorder is an ongoing process, and that's why Thomas is starting a chapter of the national support group Anorexia Nervosa and Associated Disorders. It's particularly important to him because he wants people to know that eating disorders aren't just a problem for girls.
"Research shows that 95 percent of anorexics are female and 90 percent of bulimics are female," said Dr. Christian Lemmon, a clinical psychiatrist at Medical College of Georgia who specializes in eating disorders. "But those numbers are artificially inflated for females because males are less likely to report it."
Guys are less likely to seek medical or psychological treatment, Dr. Lemmon said. They also don't want to admit to having what's seen as a "girl's" problem.
For Thomas, it wasn't a girl's problem. It was a bullying problem. He was, he says straightforwardly, a fat child. He was teased, taunted and even physically assaulted in middle school. His parents talked to administrators, but nothing was done.
Thomas turned on his own body. He started simply, with a Tae Bo tape and a diet. As he dropped weight, those who had taunted him invited him to join their activities. Friends and family remarked on how good he looked, unwittingly encouraging his problem.
That emphasis on thinness is something society needs to change to help prevent eating disorders, Dr. Lemmon said. People need to focus on other things that promote self-confidence, such as school work and artistic ability. And teens need to have realistic expectations for themselves - many people with eating disorders expect themselves to be perfect, which just isn't possible. Thomas is very focused, his mother says wryly. He does everything exceptionally well - everything. She wishes she had seen when the new focus became an obsession. Thomas would binge on whatever he could find in the kitchen at night before throwing up. He spent days on the computer, trolling Web sites created by anorexics offering tips on losing weight to other anorexics. During the summer of 2000, he went to Rogers Memorial Hospital in Wisconsin and checked into one of the top programs in the country for eating disorders. It was the first time he had met other guys with eating disorders - some as young as 8. He managed a month back home before he relapsed. He watched his therapist detach from him so she wouldn't be as hurt if he died. His mother sat in her bedroom and cried at night. She'd come home and find him curled in the fetal position, weak from throwing up, but she'd be afraid to touch him because - at 6 feet tall and only 110 pounds - he looked so fragile, as if his bones could break through his skin. It took a stroke in February to put him on the path to recovery. He had gorged on fried food and desserts at a restaurant's all-you-can-eat bar. And he felt he had a lot of throwing up to do to make up for it. His mother safely in bed, he made an unusually large dose of Epsom salt and water. Unable to stop vomiting, he collapsed on the floor of the living room. He could barely move and watched his vision narrow to a pinpoint. Unable to call for help, he dragged himself to the nearby coffee table, where he managed to fumble out a decorative metal ball from a bowl. He banged on the coffee table with it to wake his mother so she could call an ambulance. The wood of the coffee table still has dents from the pounding. He runs his fingers over the irregular surface as he talks about that night. Thomas was in the pediatric intensive care unit for a week and a half. The effects of his illness will be with him for the rest of his life. He lost 25 percent of his vision and developed reflex sympathetic dystrophy syndrome, a condition characterized by burning pain in the limbs. Like concentration-camp survivors, he must reteach his body to process food properly, and his legs will swell after he eats as he retains fluid.
Craving self esteem
Nine months into recovery, Thomas says he is more hopeful and happy than he has ever been. He's being home-schooled, and he's joint-enrolled in classes at Augusta State University.
He's disappointed that he has missed some typical high school activities, such as band and proms, but the college classes have opened a new world, one where students work together to learn instead of competing for status and popularity.
"It's not about the eating; it's about what's under it," Thomas says of the disorders. "It's not about being fat or skinny; it's because there are underlying issues."
Those issues are self-esteem - or a lack of it, says Ashley, who developed bulimia after constantly being called fat by dance teachers and falling in love with her dance partner - who told her she was getting too heavy for him to lift so they'd have to stop dancing together.
Most people with eating disorders have other problems, including depression, Dr. Lemmon said. Both Thomas and Ashley said it's important to get professional help to overcome eating disorders.
An emphasis on weight and physical appearance in our culture makes that the focus of many self-esteem and depression problems. About 1 percent of teen-agers are anorexic; as many as 5 percent are bulimic. The rate can be even higher in certain groups that emphasize physical appearance or high achievement, causing additional stress and anxiety.
"That's what I heard every day: 'You're fat, you're fat.' 'I can't pick you up,"' Ashley says.
Her response was to stop eating. She allowed herself a can of V-8 juice a day. Anything else was thrown up.
You lose perspective on what you really look like, she says. While her ribs were sticking out, she watched a 20/20 news segment on anorexia and told herself she didn't look anything like those girls - and believed it.
"You always see yourself the way you did that first time you looked in the mirror," she says. "You don't get past that initial reaction of 'Ugh, I'm fat."'
You don't realize you've become so skinny you're not attractive anymore, she says.
When she started throwing up her meals, she was 5 feet 2 inches tall and weighed 120 pounds. When she started recovery, three years ago, she was 5 feet 6 inches tall and still weighed 120 pounds. She has grown another 2 inches, but doctors tell her that, despite being from a tall family, she won't reach the 6-foot height she could have achieved because she starved herself of essential nutrients while she was growing.
She's also more susceptible to osteoporosis because of calcium loss, and most of her internal organs are more susceptible to failure. She chopped off her long, curly hair because it started breaking off - handfuls would come off when she brushed it. She bound her feet, jamming them into shoes that were too small so they wouldn't grow - they're still disproportionately small.
"I wanted everything to be small," she says. "Smaller was better."
One side-effect many anorexics see as an advantage of their disorder is that it slows and delays physical maturity and growth, Dr. Lemmon said. One part of the diagnosis of anorexia is that a girl's menstrual cycle stops - or never starts. Dr. Lemmon has one patient in her mid-20s who has never had a period.
It's a way of dealing with fears of maturity and growing responsibility, and a way of making them feel like they're in control in a world that's changing so much for them, he said.
If Ashley could tell anorexics and bulimics one thing, it would be that what you do to your body isn't worth it.
Ashley wasn't able to stave off adolescence completely. Even as her ribs showed through her skin, her body managed to develop and mature. She remembers a woman who spoke to her at the last dance competition sheattended, telling her how pretty she was - because of the same adult curves she was trying to kill.
"She told me how beautiful I was - that I was the most beautiful dancer she'd seen because I had womanly curves that other dancers didn't have," Ashley remembers.
Three hours later, Ashley injured her knee. A trip to the hospital exposed her secret when X-rays showed a calcium deficiency in her bones. Her dance career was over - and she was shoved onto the road to recovery by parents, doctors and teachers. At school, she had to eat in front of teachers. She wasn't allowed to go to the bathroom after meals, to prevent her from throwing up.
Just as important in her recovery as the professional help was the memory of the person who complimented her at the dance competition.
"I really needed to hear that," Ashley says. "I needed someone to tell me that I was beautiful. No one except my parents had ever said that to me before. It was the only time I ever felt I was beautiful, and I felt so good about myself."
ANOREXIA INFORMATIONTo be diagnosed with anorexia, patients must:
Refuse to maintain a normal body weight for their age and height
Lose or never develop a menstrual cycle
Have an intense fear of gaining weight or becoming fat, even though they're underweight
Have a distorted body image
To be diagnosed as bulimic, patients must:
Have recurrent episodes of binge eating and purging behavior (vomiting, laxatives, fasting periods, excessive exercise)
Binge eating is different from overeating because it's done rapidly, often when the person isn't hungry.
(Source: Dr. Christian Lemmon, Medical College of Georgia)
FOR MORE INFORMATION
To learn more about the area chapter of Anorexia Nervosa and Associated Disorders, call Thomas Hightower at 860-5430 or send e-mail to email@example.com.
Eating Disorders Awareness and Prevention Hotline: (800) 931-2237
Medical College of Georgia: 721-0211
National Association of Anorexia Nervosa and Associated Disorders: http://www.anad.org
Anorexia Nervosa and Related Eating Disorders: http://www.anred.com/
Harvard Eating Disorders Center (including information for friends, parents and teachers on how to help someone with an eating disorder): http://www.hedc.org/
Be careful in searching the Internet for information: There are "pro-anorexia" sites that discourage efforts at recovery.
The sites talk about "Ana" - more friendly sounding than "anorexia" and a code name not as easily recognized by those outside the pro-anorexia movement - as a friend and an ally. They offer tips on how to eat less, questionable information on how to burn calories faster and tricks to hide eating disorders from friends and family.
After recent media attention, Yahoo! and many other search engines have refused to list the sites, and many site providers pulled down pro-anorexia Web pages as a violation of terms of service. But pro-anorexia Web pages, Internet clubs and e-mail lists still exist. Those trying to help someone with an eating disorder should be aware of them.
Reach Alisa DeMao at (706) 823-3223 or firstname.lastname@example.org