When Kids Can’t Concentrate: How Eating Disorders Impact Our Children’s Education

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When Kids Can't Concentrate: How Eating Disorders Affect Our Children's Education

House of Representatives Briefing: February 26, 2003

Stolen Years: Struggling with Anorexia Since Age 12
Asha Bornhorst, Eating Disorder Survivor
When Your Children Suffer from Eating Disorders: A Mother's Story
Mary Ellen Clausen, Ophelia’s Place
Men with Eating Disorders: Falling through the Cracks
Tommy Schrider, Actor
Myths and Facts about Eating Disorders: What we know from Research and Treatment
Anita Sinicrope Maier, Executive Director of the Pennsylvania Educational Network for Eating Disorders

Rep. Judy Biggert (R-IL)

Congresswoman Judy Biggert (R-IL) told over 55 activists that she and Ted Strickland (D-OH) had introduced an eating disorders bill (H.R. 873) into the House of Representatives. She addressed the group at the beginning of the EDC's Congressional Briefing, "When Kids Can’t Concentrate: How Eating Disorders Impact Our Children’s Education."

Also speaking at the briefing was survivor Asha Bornhorst, activist and mother Mary Ellen Clausen, actor Tommy Schrider, and Anita Sincrope Maier, a long-time activist and the executive director of the Pennsylvania Educational Network for Eating Disorders.

Above: Rep. Judy Biggert (R-IL) addresses a February congressional briefing in Washington. She introduced a new bill to prevent eating disorders, H.R. 873.

Stolen Years: Struggling with Anorexia Since Age 12
Asha Bornhorst, Eating Disorder Survivor

Nine years ago I looked in the mirror and was horrified at the image I saw staring back at me. I saw someone who was gaining weight and –in my mind- becoming fat. It was at this point I decided I needed to do something to change the disgusting image in the mirror. For the next nine years this image would be my worst and deadliest enemy. This was how my long journey with anorexia began.

I was twelve years old, entering junior high as a seventh grader and going through a lot of transitions. Until this point I had always been extremely active and very thin, so the weight gain I experienced in my junior high years came as a complete shock. Little did I know this weight gain was “normal.” I was just going through puberty. I was very involved in sports from the time I was little. I played soccer and had been in gymnastics since I was five. I also began running cross-country and track at a competitive level.

Our running coach was always talking to us about eating healthy and avoiding junk food. I knew girls on the team who restricted what they ate. I decided if skipping meals worked for them, it could work for me. So I gradually I lost weight but still I wasn’t happy with myself. I hadn’t achieved that “perfect image” and the more weight I lost the more I despised my body and myself. I remember my track coach saying something to my father about how I wasn’t eating but my father just blew it off and said that I ate at home so there was nothing to worry about. Since he didn’t see my self-starvation as a problem, then I didn’t have to see it as a problem.

My eighth grade year I was one of the top junior high runners on the cross-country team and of course I attributed this to the fact I wasn’t eating. This was also the year my parents separated. The circumstances of which, greatly contributed to my eating disorder. So it was an extremely difficult time for me and my eating disorder continued to get worse and worse. People saw this but thought it was from the stress at home and figured I would grow out of it.

In ninth grade I started purging. My performance in school and sports was rapidly declining and the more it declined the worse my eating disorder became. This was also the point people realized I had a serious problem. I passed out at a cross-country meet. At the hospital they discovered I was severely dehydrated and my electrolytes were way out of balance due to restricting and purging. My coach was very mad at me about this and said I needed to stop “this behavior” or stop running.

I ended up going in for an eating disorder assessment but since they said my eating disorder wasn’t bad, I ended up not going to treatment. I went the next two years without treatment and looking back now, I wish I had gotten treatment because it could have prevented the eating disorder from really getting out of control. I scared everyone but no one knew what to do. I wish they had known what to do because to me not eating and purging was just a normal part of my day, so I didn’t see it as a problem.

Meanwhile my performance in school was drastically declining because I wasn’t eating. I took an advanced placement test for my European History Class my sophomore year and I couldn’t stay awake or concentrate at all during the four-hour test. I ended up not doing well enough to get the college credits. This was just the first of many things I would not achieve because of my eating disorder. Then once I agreed to and went in for treatment, I was terrified about what was going to happen at school. I didn’t want to miss school and get behind.

My teachers were very understanding when they found out I was going to be hospitalized. At this point none of them knew I was going into the hospital due to my eating disorder. They were willing to work with me and make accommodations. I was in the hospital for two weeks and then I went into the partial program, which was just during the day. After a week I had to go back inpatient. At this point my teachers found out I was in the hospital for eating disorders treatment. Some of my teachers were no longer supportive when they found this out. One teacher actually asked me “why I wasn’t better after spending all this time in the hospital.” A lot of people thought just being in the hospital for a while would cure it, which is not true. Another teacher told me I had to withdraw from his advanced placement class because I had missed so much school and was so far behind. This devastated me because I saw it as another way I had failed. My teachers didn’t know much about eating disorders so they didn’t know how to help or be supportive.

Not only did my eating disorder affect my academic performance but it also affected my relationships with my peers. I missed homecoming and my best friend’s birthday because I was in the hospital. My friends didn’t really know what to think and it was awkward when I told them I had an eating disorder. They would come visit me but would be uncomfortable because they had never dealt with someone with an eating disorder. They tried to be really supportive but by the time I ended up in the hospital the third time, they distanced themselves because they were scared and didn’t know how to help.

I spent most of my junior and senior years in and out of the hospital. I had been kicked out of inpatient the second time before I was ready because I ran out of insurance. They only allowed thirty days and it was $1500 per day, which we couldn’t afford to pay. I also ended up having to take a break from outpatient treatment because I was out of those benefits as well. Since I no longer was in treatment during such a critical time my eating disorder got extremely out of control. Finally in April I was put in the partial program for almost two months. At this point my school counselor told me I should consider postponing my graduation. This was a major blow to me and I decided there was no way I was going to postpone my graduation. I worked really hard to keep up with my classes and I was able to finish my junior year. I took the ACT and SAT tests to get into college and I ended up not scoring very well on them. Had I not been struggling with exhaustion, malnutrition and lack of concentration I know I would have done better.

College had been a dream of mine for as long as I could remember and I wasn’t going to let anything ruin that. I entered college doing really well. I continued to go back to my hometown to see my therapist every other week. However as the challenges of college life hit me, the symptoms of my eating disorder re-emerged. By the end of October I was in medical danger and had to be hospitalized on a medical floor. I then once again ended up in an inpatient program. I was there for a month and as a result was forced to withdraw from one class. My other professors said I could make up the work but not the class participation, which greatly affected my grades. I was not happy with myself at all. I was sick of the eating disorder taking everything away from me.

By the end of January I was in medical danger again. I was in the hospital for part of January term. I got mono soon after and was struggling so heavily with anorexia that I was unable to go to classes. I was told I needed to withdraw. My treatment team knew I was in danger and so I made the decision to go to residential treatment. I withdrew from school and was ready to go to residential treatment, however at this point my insurance company reneged their pre-authorization. I knew I needed to go into treatment or I was going to die. My treatment team knew this as well. I couldn’t afford the cost of treatment, especially since we already had thousands of dollars worth of bills for treatment my insurance company had said they would cover but hadn’t. So we fought the insurance company and finally they authorized thirty days. This was not enough time for me to get back to a stable weight and get control of my symptoms. So once again I was kicked out of treatment before I was ready due to lack of benefits.

Since I had to withdraw from school, I had to reapply. I had been told when I left there would be no problem getting back in. This was not true. In August I was denied admission because they didn’t think I was healthy enough to be on campus and they didn’t want someone with a serious eating disorder on their campus. They got reassurance from my treatment team that I was healthy but they wouldn’t budge. Finally I was able to get back in under the condition that I come up with a contract about how I was going to stay healthy and agree to stay in treatment. I had to meet with people from the school and they talked to my treatment team to see how I was doing throughout the year.

I ended up getting back in for my sophomore year and I tried to keep things under control but was unable to and ended up in the hospital twice that year. I also entered residential treatment this past summer. Once again I was only allowed thirty days and had to leave before I had recovered fully. To this day I have been unable to finish a treatment program due to lack of coverage by my insurance company. If I had been able to finish a treatment program, some of these hospitalizations could have been prevented. Each time I went into residential treatment I was motivated to get better but at the same time it was a very scary process and I was always kicked out before I had time to get beyond the fear of getting better. ]

I came back to school this year and was hanging in there until October, when things got out of control. I was in medical danger and close to dying. I had been close to death before and had always just blown it off but this time was different. I will never forget looking into my boyfriend ’s eyes and seeing the fear and him telling me he was terrified he was going to lose me. I finally realized I was going to lose the best thing that ever happened to me if I didn’t get better and I did not want to lose him. I realized I couldn’t keep knocking on death’s door and still achieve the goals I had. I also realized I needed to do it for me, not for anyone else or just so I could get out of the hospital. John’s unconditional love and support have helped me realize that I can do this and it is a reminder of why I want to recover.

My struggle with anorexia goes much deeper than just trying to achieve the “perfect image.” It wasn’t just an adolescent phase or a temporary way to lose weight. It was something that controlled my life and stole my self-worth and confidence. It has prevented me from achieving my personal and academic goals. It has ruined relationships with my family and friends; left me isolated and nearly killed me. If you take anything away from my story take this: Eating disorders are serious diseases and need to be treated as such because they devastate lives as it has devastated mine. I am now only beginning the long hard process of fixing and reclaiming what it has devastated and taken away.

The road to get here has been long and hard but I know that had I given up and quit treatment, I would not be here to share my story. I owe a lot to my treatment team and all the other people in my life that never gave up on me. I think it’s important for people to realize that just because a person doesn’t get better the first time doesn’t mean they can’t. Recovery is a process, which takes time and a lot of hard work. The most important thing you can do for someone is never give up on him or her. The biggest things I’ve realized in the last nine years is that you have to keep getting back up after you fall down and until you truly want to give up your eating disorder for yourself, you won’t recover. People can try to keep you alive but they can’t make you get better. I am finally realizing this and deciding I want to get better for myself and move on with my life.

When Your Children Suffer from Eating Disorders: A Mother's Story
Mary Ellen Clausen

Where do I begin? After much prayer, consideration and my families support, I felt it important to share my story. If it can make a difference in just one person’s life, well, it will all be worth it.

My daughters have struggled for many years because of their eating disorders. I have spent many a night sitting by their bedside making sure they keep breathing. I live in fear of the phone ringing, a fear that sometimes is paralyzing. I live in crisis mode 24/7, always ready to face the next challenge. I minimize what I feel and maximize what they feel. Then, of course, there is the guilt and anger. I don’t go there very often because I can’t, you see. I must be ready at all times. If I start to process it all I am fearful that I won’t be available for the next crisis. That somehow if I go to the edge. I won’t come back. So for the time being my only feeling is numbness.

How and when did all of this begin? Some of the "how's" are obvious: we live in a society that is focused on appearances. Media dictate the ideals of perfection. Thin is in. It is socially acceptable to have an eating disorder. It has become the norm. We do not talk of education and prevention, we are just looking for the stories that offer the greatest shock value. The "when's" of this epidemic are difficult to pinpoint, and certainly vary widely. However, I’m not sure the "when's" or "how's" are even relevant at this point.

In my family this monster we call ED surfaced when my oldest daughter went off to college. What should have been an exciting time in all of our lives turned into something unthinkable. We thought we had prepared our daughter for college life. After graduating at the top of her class she received an excellent academic scholarship to a top university, she was accepted in the honors program with a strong desire to succeed in medicine. She completed only one year. She was diagnosed with anorexia/bulimia after her freshman year and unable to complete her education. We believed once she “conquered” her eating disorder she would return to school.

ED however had something else in mind. The control ED had on her was bigger that anything we were prepared for. She cycled through treatment facilities with her insurance company making life decisions on her recovery. It is incomprehensible to imagine all that she has suffered. Her pain was bigger than life, and on several occasions, too many to count, she tried to end her pain. For just a moment close your eyes and imagine your daughter crying for you. You are unable to determine dream or reality. You awaken and somehow deep inside you know, reality, and yet your are unprepared for what you will find: your precious little girl curled up on the kitchen floor with a kitchen knife to her wrists. She tells you she doesn’t want to die, but she also doesn’t want to live. Imagine, if you will, driving through a snow storm all night to reach your destination and find your little girl on a ventilator unable to breath on her own. As we listened to the rhythm of the machine there was actually a sense of peace. I was by no means giving up. There were just moments she seemed free of pain. That I wished to hold on to, but those moments did not last long. Even in her unconscious state of mind she struggled to remove the thing that was keeping her alive.

Also imagine for just a moment, through all of this, your second daughter, your baby girl, succumbs to this disease, so rapidly and so severely that you just didn’t see it coming. How is that possible? Once again, I have failed. She is in crisis state. Her health is so medically compromised you know that she will die unless she receives treatment immediately. You spend all your waking moments searching for treatment facilities that will take her and you spend all your “attempting to sleep” moments by her bedside making sure she continues to breath.

As a family we have exhausted all financial resources to help our children, and will continue to do so. Emotionally and physically we are also exhausted, but we will never give up. My husband and my faith are my rocks that never budge. I thank God for that. And how grateful we are for the existence of the Eating Disorders Coalition and their aggressiveness in combating this disease. I have truly been privileged and blessed to meet so many amazing families with incredible courage and strength, some of whom have suffered tragedies beyond comprehension. And yet they are here today, with love, support, and a desire to make a difference. They are an inspiration.

How are my daughters now?....They have yet been unable to complete their education. My youngest daughter is back in treatment, she has totally relapsed and unable to complete her freshman year of college. There was a time that would have saddened me. Now, however, I am so grateful that she is even alive. And my oldest daughter is here with me today. There is not a day that goes by that she does not suffer the ramifications of this disease. At 23 years of age, she is in constant pain. And yet she works aggressively on her goal of one day being able to complete her education, which is no longer a given but something she will have to fight and work very hard for.

Our lives have been changed forever. My heart hurts from the inside out and there is an emptiness in my soul that I can not fill. However, through God’s grace I have never lost hope. I believe we have choices to make. We can choose to concentrate on the pain of this brokenness or we can allow the pain to drive the passion to make a difference. I believe the choice is obvious. Our voices will be heard today. Together we CAN make a difference.

So I urge you to take this mother's story to heart. We need policies that recognize eating disorders as a serious public health threat. We need resources for education, prevention, and treatment. We have run out of time. This is a matter of life or death. Urge your member of congress to address eating disorders now.

I stand before you here today to give voice to the, until now, untold scores of men both young and old across this country who have suffered or continue to suffer from disordered eating. A silent group, we have starved, binged and purged ourselves in the shadows, humiliated by our inability to eat and enjoy food like normal, healthy, red-blooded American men are expected to. Restricting food, zealous calorie counting, throwing up meals and self-inflicted emaciation were reserved for insecure young women bent on attaining self-worth through supermodel slimness: a decidedly female problem that preyed on the weak and unfortunate “other”. Anorexia and bulimia were certainly foreign to me, until I woke up three years ago and realized they were eating me alive.

Never in my wildest dreams could I ever have conceived of the debilitating insanity, the soul-crushing despair that my eating disorder wreaked upon me. And it was not as if I had been immune to adversity before. As an adolescent, I was painfully shy and struggled with frequent bouts of low self-esteem and depression. I had a difficult time making friends and was unable to concentrate in school, so I turned to drugs and alcohol for a sense of well-being and security. It worked for awhile: my social life skyrocketed and I experienced my first taste of self-possession. Eventually, however, getting wasted became the top priority in my life, which I began to notice was slipping quietly through my fingers. So, when I was eighteen, I entered rehab for twenty-eight days, started to confront some of my demons, and have, I am grateful to say, remained sober for the last twelve years. Thanks in large part to my sobriety, I went on to college, made the Dean’s list three years in a row, graduated Cum Laude and went on to receive an MFA in acting at New York University’s Tisch School of the Arts, one of the most competitive programs in the country. But I tell you these things not to brag or boast. No. I tell you because I want you to know that I have been through rough waters and made it back to shore. I do not enjoy nor do I make a habit of playing the victim. Nothing, however, could have prepared me for the turmoil that lay ahead.

Ironically, anorexia first reared its ugly head in the midst of a very fruitful period in my life. I was a year out of undergrad, apprenticing at a major regional theatre, where I had the good fortune of being cast in three large roles in three main stage productions with three important directors. I wasn’t prepared for, nor did I feel I was deserving of, that kind of success. Unfortunately, I was my own greatest skeptic, and nothing I did could live up to the enormous expectations I had heaped on top of myself. My body, unable to withstand the emotional stress I kept bottled up inside it, shut down. It just stopped. I was, quite literally, blocked, unable to relieve myself. Thus, everything I ate, every morsel that crossed the threshold of my lips, made me feel bloated and heavy. Suddenly, there was this cold, hard stone in my stomach that was dragging me down. Food became anathema to me, and that discomfort soon turned into a full-fledged obsession.

My blood boiled with rage at my body, which I felt had betrayed me. Distrust of food soon mushroomed into an unreasonable fear and loathing. Moreover, because I felt fat, I started to see myself as fat. I maniacally watched what I ate and reveled in what I didn’t with I passion I had never know. My first thought upon waking, my final thought before bed and all of my thoughts in the hours between revolved around denying myself food. At this point, I was in my second year of graduate training, slogging through very physical sixteen hours days at one-hundred and twenty pounds. Health complications like anemia and the beginnings of osteoporosis set in. My red and white blood cell counts spiraled. Ten minute walks home turned into two-hour tours of food shops, gazing trancelike at all of the goodies I forbade myself to eat. I tossed and turned through sleepless nights, dizzy with terror as to how I would ever survive the coming day.

No one seemed to now what to do. I saw countless doctors and homeopaths for the magical solution. Gastric emptying studies and endoscopies yielded nothing except recommendations to add a high fiber cereal to my breakfast. My teachers and classmates were obviously concerned, yet were at a loss as to how to help. The possibility that a man in their midst had anorexia was alien to them. It was not something they could comprehend, let alone discuss. My parents and my girlfriend, whom I put through the emotional wringer, were worried sick, and it was they who first broached the idea that I may, in fact, be suffering from an eating disorder. But I was deaf to their pleas and simply drifted further away, cut off from everyone and thing around me.

A tumultuous, unbearably lonely year later, my therapist at the time forced me to fae the reality that I was anorexic, and needed to do something about it before the damage was irreparable. I went to an inpatient hospital program during the Christmas break of my third year at NYU, but left after two weeks, determined to complete my Masters. While I did gain some weight back during treatment (though not nearly enough), I hadn’t solidified myself against those seductive, deadly voices that lure the sick back into the anorexic abyss. Soon, I was restricting again, more heavily than before. This was followed by wild bouts of binging, a new development, that flung me into an utter panic. My only retaliation was further restriction, which led to further binging, and, inevitably, I began to purge. I was now enmeshed in a ruthless cycle that dominated every aspect of my withering life. My first acting job out of NYU was at a summer theatre in the Berkshire mountains playing Albert Einstein in a show about his life: a dream job. But my disease nearly took it away from me. Hours before opening night, I parked my car in a desolate patch of woods, a daily ritual, and proceeded to binge and then purge - in a very unsafe manner. Regardless, I went on that night and it was all I could do to keep from vomiting all over the stage.

Several weeks later, my parents came to see the show. Before I went to meet them at their hotel, I, you guessed it, binged and purged. On the drive over - and I remember this clear as day (even the shirt I was wearing) - I announced to myself out loud that I could not live like this anymore, and that if I was unable to get better would kill myself. And I meant it. When I arrived at their room, I broke down, told them everything and begged them for help. They stayed in that hotel or another week, putting their lives on hold at a moments notice, until the show closed, so I wouldn’t have to suffer alone. They just may have saved my life.

I immediately went into another hospital program where my parents kept me for twenty-nine days, a full two-and-a-half weeks after my insurance ran out. Others I met there were not as lucky, forced out long before they had come to grips with their illness. These were women - and, yes, men - young and old who were, almost unanimously, tremendously bright, tremendously sensitive, tremendously generous and tremendously sick. Most came from dysfunctional families. A disproportionately high percentage had suffered violent physical and/or sexual abuse. Whatever our backgrounds, we all shared a significant pain and sadness that had manifested itself in an irrational terror of eating. Even though I was often, as a man, in the minority, I saw myself in each one of their hollowed faces. All of us were striving toward this twisted idea of physical perfection thrust upon us by the outside world in order to fill the gnawing emptiness we felt inside. Some are in recovery today, most not. Some are dead. Because of my parents’ love and support, both emotional and, importantly, financial, I was able to stay in treatment, gain back the lost weight (some thirty-five pounds of it) and build a solid foundation which has thus far sustained my recovery. I am lucky. I am blessed. I left with a chance.

I now look forward to the future. My girlfriend and I have worked and continue to work, slowly and often painfully, through the aftermath of those years - in fact, we are getting married this summer. I have a career, albeit in its infancy, as an actor and anticipate the challenges and mysteries that lie ahead. But, as I said, I am lucky. There are countless others whose stories do not turn out for the better. I ask you, please, to do what you can to increase awareness of eating disorders in this country, among women and men. Increased awareness, open and frank discussions about the nature and scope of these diseases and proactive support from parents, teachers, counselors and peers will help us recognize those who are falling through the cracks, and more importantly, catch the before they fall. With your help, we can make this worthy goal an even worthier reality. Thank you.

Myths and Facts about Eating Disorders: What we know from Research and Treatment
Anita Sinicrope Maier, MSW, Executive Director of the Pennsylvania Educational Network for Eating Disorders

Good afternoon. My mission today is to notify you that our most precious natural resource is in danger. No, I am not talking about water or oil, trees or coal, or any of our other natural resources that get so much press, attention and concern in order to preserve. I am talking about the resource that cannot be substituted by any other substance, the resource that if it is not “saved” will result in a dim future for America. I am talking about our best and brightest young girls and boys, women and men—in other words—the cream of the crop—who are vulnerable because of biological, psychological, cultural and genetic predispositions and influences to develop eating disorders. These vulnerable youth may experience emotional pain that is so severe that it seems impossible to face and express. Their eating disorder serves as a maladaptive coping mechanism as it anesthetizes and distracts from the real problems they are experiencing. Moreover, it appears to be, at first, the avenue to a better self-esteem.

But, eating disorders are cunning. They are seductive. They are a total paradox—because just as that young person believes that this “magic formula” is the path to gaining control in their lives, to becoming more beautiful or handsome, to being better accepted by their peers and loved ones, and to actually feel better about themselves—they soon discover that the exact opposite prevails. As the behaviors progress from dieting to extreme restricting or sporadic bingeing and purging to protracted rituals and daily obsessions, there seems to be no turning back. Their social acceptance becomes meaningless as they withdraw further and further into isolation and alienation and the self-hatred and loathing that they feel increases rather than decreases. The illness invades their every hour—both day and night. Control is now in the hands of the illness and life is often perceived as not worth living.

Eating disorders are not a fad, passing fancy, dieting gone wild or an illness someone will outgrow. Nor are they really about food and body image. They are multi-faceted, potentially life threatening illnesses with biological, psychological, genetic and sociological components. Most, but not all, begin with dieting---even though the person may not really need to lose weight.

In anorexia, eating becomes more and more restrictive and weight loss is 15% or more of normal body weight. Even when emaciated, the person with anorexia may continue to see herself as overweight. When dieting and/or restricting leads to feelings of extreme hunger and deprivation, someone with bulimia may begin a cycle of secretive bingeing followed by purging through self-induced vomiting, the use of laxatives, diuretics, diet pills or excessive exercise. The majority of people suffering with bulimia are of normal body size. Binge eating disorder is characterized by eating large quantities of food that may be interspersed with periods of dieting, fasting and restrictive eating. People with BED are represented by all types of body sizes from normal to obese. It is not terribly unusual for someone to move from one behavior to another in the progression of the illness.

Treatment is long—between 5-7 years--and the outcome depends on the quality and quantity of specialized treatment, the social support received and the sufferer’s belief that they can recover. Early and aggressive intervention provides the best prognosis for recovery.

If you will refer to the fact sheet that we have provided, you will see that the lifetime prevalence rate is: 7 million women and 1 million men suffer from eating disorders.

The prevalence among adolescents is: 0.5% suffer with anorexia and 2-3% with bulimia. If, however, we recognize dieting as the strongest predictor and entrée into an eating disorder, we can see what the future may hold in the following data.

Anorexia nervosa has the highest death rate of any mental illness—upwards to 20% over time. The true numbers may be illusive because of the secretiveness and shame of the illness and because death is often attributed to suicide, heart or kidney failure instead. The precursors of dehydration, electrolyte imbalances, gastrointestinal disturbances, heart arrhythmias, amenorrhea, osteopenia and osteoporosis—just to mention a few—may have gone completely undetected as the suffer ignored or dissociated from the symptoms. Depression, anxiety and other emotional disturbances are exacerbated by the behaviors and friends and family may begin to view the sufferer as a stranger.

School functioning is profoundly affected although it may at first go unrecognized. Let’s face it. These are often our brightest, highest achieving students who even under stressful and disturbing circumstances can study a little harder to maintain their grades. But as time progresses, concentration becomes impaired, memory disturbed and judgment and decision-making seem like impossible tasks. The simplest decisions such as choosing clothes or a movie may cause tremendous distress. Sleep disturbances—either not being able to sleep at all, frequent awakening or sleeping too much—make it so difficult to get up in the morning and actually get to school that absenteeism becomes a problem. Some may have trouble sitting in their chairs because their tailbone now sticks out and the lack of “padding” from too low body fat and muscle atrophy causes pain. This also causes them to feel cold all the time and the simple act of climbing stairs may cause exhaustion.

Perhaps the most heartbreaking thing to witness in anorexia is that when weight loss and emaciation becomes so severe, fellow students shun and avoid the sufferer. They become as one of my clients describes a “freak” in the eyes of their peers. Sadly, many must also endure teasing and name-calling. Not only are their bodies suffering the effects of starvation but their brains as well. Under these circumstances, it is not rational that we expect them to be able to go to school.

Schools must become more educated on the complexity, causes and treatment of eating disorders and more involved in the process of how to adjust the educational process so these very bright students do not fall to the wayside educationally. Traditional schooling may not be possible in the most acute stages and re-entry to the system must be done with compassion and understanding of the extreme emotional and physical conditions the child has experienced. This can best be done with a team of people including guidance counselors, teachers, school nurses, administration, parents and the child’s therapist. In my own professional experience, this approach has been most effective in helping the child to return to normalcy in the school setting.

I have watched this process first hand for over 20 years now. First as a parent with my own child, then as a professional with my clients and those who attend the support groups that I facilitate. I have not, however, become desensitized over the years to the fear, sadness and profound disruption of life that occurs not only in the eating disordered individual but in their family and friends as well. Watching your child or loved one literally deteriorate before your very eyes as you feel impotent to stop the process is a hell one can’t truly comprehend unless you have experienced it.

But we can have empathy. We can develop an understanding and we can do something to try and intervene in a timely and more aggressive manner. Families often cannot get help because they do not have enough mental health insurance coverage to get the treatment that these illnesses require. Treatment, especially in the past 15 years, has been progressively and severely compromised because of the lack of reimbursement even though we can potentially provide better treatment now due to the continued research of the efficacy of treatment modalities. We also need more education to provide awareness for earlier and appropriate intervention and prevention and more research dollars in order to discover better ways to conquer these devastating illnesses. Comprehensive and aggressive treatment is the only thing that makes sense. The rewards will not only be better health for our precious children but, in the long run, less cost for the treatment of related and chronic illness. We need mental health parity now.

I want to end this talk on a positive note to give hope and inspiration to those who are still suffering. Today I am blessed to have a healthy daughter who is a family practice physician and three beautiful granddaughters who light up my life. When my daughter recovered from her very complex illness at age 15, she said she wanted to become a doctor unlike the ones that she had seen. We need to let her and others like her dedicated to saving our children do their jobs now.