'Looking at me, you would never guess'

By Fiona Havers

"At first I would just eat and not plan to throw up afterwards, but then I would feel guilty about having eaten. Just the physical feeling of having food in my stomach would make me uncomfortable and I'd want to get rid of it.

"It evolved to the point that I would decide beforehand that I was going to throw up afterwards, and that's when I just started completely binging, because I knew it wasn't going to stay inside of me. For some reason it felt so therapeutic to eat, but afterwards there is an awful feeling of guilt."

Every night, Jill subjected herself to a ritual of binge and purge. Though her behavior may seem extreme, eating disorders--in Jill's case, bulimia--dominate the lives of a startling number of Yale women. College stress and societal pressure to possess the "ideal figure" make college women more vulnerable to bulimia, anorexia, and compulsive eating than almost any other group.

Redefining normal

Only a few reliable studies have been done, so numbers vary, but approximately one percent of college women are anorexic, and between five and nine percent are bulimic. But straight statistics can't tell the whole story: although many women might not meet all of the criteria for clinical anorexia or bulimia, some studies have shown that as many as a third of all college women engage in episodic bulimic behavior at one time or another. "Actual anorexics and bulimics are on the extreme end of the continuum, but everyone is on the continuum somewhere," Lisa Cohen, assistant clinical director of the Yale Center for Eating and Weight Disorders, said. "It is so widespread that people are unhappy with their bodies that it is basically accepted as normal."

That means hundreds of women at Yale have vomited or taken laxatives or diuretics to lose weight (as have some men: between five to 10 percent of people with eating disorders are male). While some fit the stereotype of the waif-thin anorexic, problems aren't always that obvious. "Five of the seven women in my suite last year have had an eating disorder at some point, but with none of them would you have been able to tell," Jennifer, a senior who has struggled with anorexia since her freshman year, said. "It is frighteningly common here."

Jill, a sophomore, said that she can think of at least nine close acquaintances at Yale who have had serious eating disorders. "The one thing that I've learned is that you never really know who has an eating disorder. If I went back now and told people in my high school that I had spent my time throwing up and was completely miserable, the vast majority would probably be shocked." Despite binging and purging for five years, Jill said that people probably didn't know about her problem. "I was never thin enough. And that's the scariest part about being bulimic: looking at me now and looking at me then, you never would have guessed that I had a serious eating disorder."

Though she was a varsity athlete in high school and at Yale, Jill used to skip breakfast and lunch and vomit after she ate dinner. Yet no one said a word--not even the seven people with whom she shared a bathroom last year. Despite all the effort Jill put into hiding her bulimia, she now says she wishes that someone had taken her "kicking and screaming" for professional help.

"At times I almost hoped someone would come in and have to force me to get help, because no one would ever say that it is an enjoyable way of living--to completely frame your whole day, your whole week, your whole life around what you're going to eat and how you're going to get rid of it after you've
eaten it."

`It's a fine line'

Experts suggest a non-confrontational approach towards helping suspected victims of eating disorders. "Talk to the friend and let them know that you are very concerned," Silliman Master and weight disorder specialist Kelly Brownell said. "Tell them you are willing

to be helpful if you can. There is not really too

much beyond that you can do. The person has to want to get help. If you think that it is a really serious medical problem, probably a confidential talk with the dean or the master would be a good idea."

Although Jill said that she wished someone had confronted her, it's hard for friends to know what to do. "It is a very fine line. It is hard to judge if you are going to intrude and alienate someone or if you are showing enough concern," she said. "But I definitely think that you are better off harping on them, rather than ignoring it."

Disregarding the problem can literally put a person's life in danger. Eating disorders have the highest mortality rate of any psychiatric disorder, and five to six percent of anorexics end up dying, usually from starvation or suicide. Lowered resistance to infection and permanent organ damage can also result, and the vomiting associated with bulimia can cause serious stomach, throat, and dental problems.

"I started to feel old. Nothing was fun any more, I was always tired, I had ulcers in my esophagus, my teeth would always hurt, my hair wasn't healthy--all the stereotypical things you hear about with bulimics," Jill said. Despite considering therapy "a million times," she never sought professional help, but last summer finally decided that she had to stop.

Months after her decision, Jill still struggles daily with bulimia. "Deep down I knew it was unhealthy, but once you start, it's a really hard thing to stop.... It's such a demoralizing cycle--I'd be proud of myself for not doing it for a few days, and then something would upset me and would trigger it, and I would be that much more disappointed in myself." Even now, when she gets stressed, the weak gag reflex that she developed after years of vomiting sometimes kicks in, and she consciously has to relax to avoid throwing up.

Most women--especially those at Yale--know their behavior is unhealthy. Jennifer, who became anorexic as a freshman, said, "It's a weird thing; I had read all of the books, knew all about it. I would go on rampages about how horrible the whole thing with eating disorders was. But you can't understand it until you've been through it.

"Looking back on it, I was a completely different person. I can only explain it by thinking that I had brainwashed myself into thinking that I was fat, that I needed to lose weight, that losing weight would make me happy, that I wasn't hungry."

By finals week of last year, Jennifer had resorted to staying in the library from 9 a.m. until 6 p.m. each day to avoid eating, filling herself up with Diet Coke and perhaps an apple. At dinner, she would eat salad and maybe bread, and then return to the library until closing time to avoid the temptation to eat.

"Once I started doing it, I fixated on everyone else's body," she recalled. "I would literally walk down the street and compare myself to every single woman I saw. It was definitely an issue for me...that a woman's body was always such a focus of adoration."

But it wasn't just that her body didn't match an impossibly strict standard. Shedding pounds became a way to cope with stress after she arrived at Yale. "I was very used to being successful in high school, and I came here and I felt that for everything I had done well, there were 100 people who did it 10 times better than me. I needed to feel like I was doing something right, and it was one area over which I had control. Not eating was a very conscious, very stereotypical control thing."

The college trap

Jennifer's "control thing" is part of a larger pattern found among college-age women. Studies that have shown that the extra stresses of university life put undergraduate women at an especially high risk for developing eating disorders. "People really feel they are judged on appearance when they first come to college and are meeting new people," Cohen of the Eating and Weight Disorder Center said. "Plus, it is a closed community, and there are more immediate comparisons. You suddenly have 2,000 women of approximately the same age who you are with around the clock."

And when the dreaded "Freshman 15" hits, a woman can feel like everything is out of control. Kelly, according to her roommate Jill, fell into this trap. After gaining 20 pounds her freshman year, she began starving herself last summer and has lost 35 pounds. Now weighing just 85 pounds, food still controls her life. She eats broccoli and salsa for dinner almost every night. If she has cereal, she measures it out in a cup. She highlights the dining hall menu when it comes out on Sunday. Although she shuns food for herself, Kelly has become obsessed with cooking. She buys cookbooks, she watches cooking videotapes, she bakes things and gives them to friends--but refuses to eat any of the food that she makes.

Peer evaluation

Food fixation, even when not taken to extremes, affects almost every college-age woman to some degree. "Weight can still become so central to a woman's life that their other achievements don't really mean anything unless they have the perfect body," Cohen said.

No one knows for sure whether eating disorders are a bigger problem at Yale and other high-pressure schools. Brownell said that no proper study has been conducted here, and said that every year he asks both the men and women in his undergraduate classes about this issue. "About half the people think that eating disorders would be less common here than at other colleges, because the women here are so accomplished and so intelligent that they evaluate themselves on more than just looks." According to Brownell, the other half--which always seems to include more women--say that Yalies, used to across-the-board success, often put more pressure on themselves to be perfect in every way.

Brownell stressed that there are established, validated, and effective treatments for eating disorders. Jill agreed, saying, "It could have been over so long ago if I had done something about it sooner....I was too embarrassed to do it myself. I was too confused, but really deep down inside I knew that there was a problem."

Admitting you need help is hard. Melanie, who came to Yale with anorexia and has gone through bouts of bulimia, is now seeing a therapist to help control her compulsive eating. "It's important not to wait to start treatment until it gets out of control. I know it's really hard to go see a therapist for the first time; I felt there was a huge stigma attached to going to talk to someone, but it has helped so much."

Jennifer, who went to a therapist at DUH and then spent an entire summer in intensive therapy, said, "It's a very long process to get better, and it won't happen overnight. I felt at times that I was never going to get better and I'm going to be like this for the rest of my life. It was horrible, but it was worth it because I'm much happier now than I ever was before. It takes a lot of effort and energy and time, but you can get better."

Students' names have been changed.