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Eating Disorders on the Rise at Harvard

Bulimia, Anorexia Are Grounded in Need for Control, Search for Perfection

By Caralee E. Caplan, Contributing Reporter

Sobbing uncontrollably, Madeline A. Whalen '90-93 arrived at Harvard University Health Services (UHS), led by her ex-boyfriend. He was sure that something was terribly wrong.

During her two-week stay at UHS last year, Whalen found time to draw a picture of the view from her hospital window. Above the Lowell House tower, she added a strange and striking image: the body of a thin, naked woman floating in the sky.

Not long after the completion of the drawing, the doctors told Whalen that she suffers from a serious eating disorder.

Whalen is not alone. A 1982 study conducted by researchers at the Murray Institute found that about 8 percent of women Harvard students were bulimic and about 23 percent engaged in binge-eating behavior.

And according to Assistant Professor of Psychology Todd F. Heatherton, who is currently analyzing data for a 1992 follow-up study, the incidence of eating disorders on campus is on the rise.

For a growing number of Harvard women, Whalen's plight echoes their own struggle with abnormal eating behaviors.

The week before her admittance to UHS, Whalen and her boyfriend broke up, her thesis was due and her father called to say that her younger brother was missing. In addition, Whalen had to give up her dancing classes, the activity she most enjoyed, so that she could earn money to pay her rent.

"My coping mechanisms weren't working," Whalen says. "I had no one to talk to and all my support systems were pulled out from under my feet."

"If that week hadn't happened, I could have gotten really sick. I could have died," she says. "I'm lucky to have figured that out before I left Harvard."

Whalen says she lived two separate lives at Harvard: a successful and active student, on the one hand, and a person struggling with repressed pain, on the other.

"I had been physically abused by my father until I was 21," Whalen says. "I was going to Harvard and had a boyfriend and never told anyone what was going on when I was home."

Whalen says she never made a conscious decision to diet. In fact, she had always been thin and often told people that she wanted to gain weight, she says.

Whalen says she would stand in line for food but, because she was slowly losing her appetite, would throw half of it away before sitting down.

"It got to the point where I wasn't eating for a couple of days at a time," Whalen says. "I got down to 88 pounds...Sometimes, I'd stand up and feel dizzy and light-headed."

Starvation began to affect her cognition, Whalen says. She described the sensation of "de-realization."

"It feels like you're behind a glass wall and people don't relate directly to you," Whalen says. "I didn't feel good, but I was sort of proud of myself, because I was different."

The many and varied causes of eating disorders--ranging from the personal to the socio-cultural to the biological--are intensified for women in the college atmosphere, according to Heatherton.

Timothy M. Hall '94, co-director of Eating Concerns Hotline and Outreach (ECHO), says that perfectionists and people suffering under family pressure may be predisposed to eating disorders.

The perfectionist tendency provides one explanation for why eating disorders are so prevalent in highly competitive colleges, according to Sheila Riendl, co-supervisor of ECHO and leader of an eating concerns group for bulimic women at the Bureau of Study Counsel.

"Harvard and places like Harvard self-select for just the kind of person who is susceptible to an eating disorder," she says.

This desire for perfection extends to physical appearance, says Heatherton. Although men are not impervious to the diet mentality, society's "emphasis on physical appearance" is stronger for women than for men. Society's conception of the ideal female body is unrealistic, and college women undergoing natural physiological changes often feel trapped by their own biology, he says.

Riendl identifies the current idealization of an androgynous body type as a major source of eating disorders. "Women internalize an objectifying regard for themselves...and overvalue a very unwomanly shape," she says.

The incidence of eating disorders is particularly high among "athletes, dancers, gymnasts, weightlifters, wrestlers, swimmers, divers and people on crew," Hall says.

Students face stress from many sides, notably from themselves, the college environment and their families. When stress is high, some students may feel that the only aspect of their lives they can still control is their eating habits, says Hall.

One female student, who has recently overcome a combination of bulimia and anorexia, described an overpowering need for some control over her life.

"My life is out control," she says. "I have all this work. My boyfriend isn't here for me. What can I control? I can control what I put in my mouth."

And for people who are personally predisposed to abnormal eating, being at the mercy of the dining hall's menu and atmosphere can be extremely oppressive, say some students who suffer from eating disorders.

One student--who was anorexic in high school and became bulimic during her first year at Harvard--says, "The [Harvard] Union is probably the worst thing you can do to a freshman girl. There's all this high calorie food and you feel like everyone's watching you and it really makes eating an unpleasant experience."

Harvard's fattening food is not the only culprit, say other students. They say the college environment fosters an overwhelming group pressure to diet or to engage in abnormal eating behaviors.

"I end up eating out a lot instead of in the dining hall because I don't want people watching what I'm eating and I don't want want to notice what other people are eating, especially if they're trying to diet," says a student suffering from bulimia.

"The whole thing perpetuates itself," another woman says. "You're surrounded by girls and guys who are so concerned about dieting. It's almost a competitive thing among a lot of girls."

Ironically, the very attempt to achieve control over eating habits only plunges the victim deeper into the uncontrollable cycles of abnormal eating behavior.

Clinical manuals characterize anorexia nervosa as "a phobic avoidance of food" in the presence of a loss of about 15 percent of one's body weight. Bulimia, on the other hand, is associated with the cycle of uncontrolled eating ("binging") and subsequent ridding of the body of unwanted food ("purging").

And self-gagging and vomiting are not the only means of purging, the bulimarexic student says. Ipecac, a drug used to induce vomiting, and laxatives are frequently used, resulting in serious chemical imbalances and heart problems, she says.

"Laxatives are so dangerous. They don't even rid your body of food...they rid your body of everything it needs to stay alive, like electrolytes. It gives a very temporary feeling of being skinny, because you're really just dehydrated," she says. "And after using [ipecac] for so long, it really poisons your body."

"Controlling means complete lack of control," the same student says. "With bulimia, when you try to control, you basically set yourself up for a binge. And with anorexia you're not in control of anything either...You can't think clearly because you're at such a low weight."

While the bulimic cycle often begins with extreme dieting, a subtler form of the purge, the cycle may also be driven by the binge due to the interplay between "the effort to seek control and the effort to seek some comfort," says Riendl.

"For people with eating disorders, it is the combination of the desire to seek some sense of control and the over-reliance on food that is a set-up for a binge-starve cycle that can lead to a binge-purge cycle," she says.

Aside from the physical aspect of the cycle, a variety of psychological cycles perpetuate the problems. In some eating disorders, perfectionism breeds perfectionism, according to Hall.

"When you starve yourself, you begin to think in very concrete black and white terms which only encourage perfectionist tendencies," Hall says. "Then you can't deal with anything that might be perceived as failure."

The feeling of being thrust suddenly into independence can be traumatic, especially for college students. One student says that being sick allowed her to continue to rely on her parents.

"It's that idea of staying like a little kid. Being sick was a way for my parents to take care of me still," she says. "And my parents really fed into that. It became a way of not dealing with social situations."

After a while, the eating disorder became a part of her identity, the woman says. "It was expected of me and I felt obligated to stay in that role," she says.

Hall says the physical and psychological cycles are both unhealthy and difficult to break.

The slight rise in eating disorders at Harvard may be explained by the overwhelming diet mentality of our time, Heatherton says.

"The number of women trying to diet increased, so the number of women that fail also increased," he says.

And bulimia appears to be more common than anorexia nowadays, Heatherton says. He attributes the rise in bulimia cases to the difficulty of sustaining the extreme dieting habits of anorexia.

Bulimia is more prevalent than anorexia on college campuses simply because anorexia occurs more commonly at high school age, Hall says.

The increase in eating disorder cases can also be attributed to the "superwoman" syndrome, says Heatherton. Women are facing "increased pressures to fulfill multiple roles," he says.

Not only has the number of cases of eating disorders risen, but the possible forms eating disorders can assume have increased, says Heatherton.

Sub-clinical eating disorders such as compulsive exercise have become especially common, he says.

ECHO, the Bureau of Study Counsel and UHS are all available to help students with eating concerns.

ECHO, the student-staffed organization founded in 1984, receives about three to four calls per week on a variety of issues: from "grumbling about the food in the dining halls" to actual eating disorders, Hall says.

"ECHO tries to look at eating concerns as a spectrum," Hall says. "We primarily provide a place where people can talk about issues with people who have had some training."

But Hall emphasized the fact that ECHO may refer students to the Bureau of Study Counsel or to UHS for more serious treatment.

"It is a coordinated effort," he says.

The Bureau of Study Counsel offers an eating concerns group for bulimic women and a workshop--titled "What Should I Do? A Workshop for Friends, Lovers and Roommates of People with Eating Disorders"--once each semester.

Riendl, who along with Suzanne Repetto supervises ECHO and provides individual counselling and UHS referrals, says that the Bureau may be more accessible than UHS to some students.

"For some students, it is easier to seek help in the service of their learning...rather than turn to a more medical model," she says.

For students who seek more professional help, UHS provides extensive medical assistance, according to Nadja B. Gould of the UHS Mental Health Service.

"Our staff is interdisciplinary," Gould says. "There are psychiatrists, psychologists, nutritionists, and social workers."

"We provide comprehensive evaluation of anyone with an eating disorder or anyone with concerns about eating," she says. "The person does not have to be a bulimic or anorexic."

One woman, who says she needed "a far more intense dose of help" than ECHO could provide, praised UHS.

"I've been amazed at how good they have been with dealing with this," she says. "I was never a huge fan of UHS before and they have been fantastic."

Whalen agreed, saying "the people at UHS were really helpful. All the nurses were really nice. And they knew what I needed."

One recovered bulimic, however, complained of the absence of actual eating disorder specialists at UHS, and declared the Bureau "the least helpful place."

She also called for Harvard to institute programs to increase awareness of eating disorders. The woman says first-years are the most susceptible.

"I was sharing a bathroom with my proctor and was throwing up about five times a day," she says. "I know she could hear me, but obviously could not have given a damn."

"I think Harvard has a problem admitting that anybody here has problems," she added.

But if there is one message which all recovered bulimics and anorexics seem to want to convey, it is the need to end the reign of silence and denial.

"No matter how many food plans a doctor gives you," another woman says, "it won't help until you decide you want help."

Another woman echoed the sentiment, saying "I really hope that more people can help themselves. I think people should know that it's not an acceptable thing to be going on."

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