Coping With Eating Problems at Harvard

Annette had anorexia nervosa in high school. At one point she weighed 97 pounds. She remembers that she couldn't admit that she had a problem, that she would look in the mirror and see herself as fat, even after losing 30 pounds. Her mother finally forced her to see a doctor.

After a year and a half of therapy she was back to her normal weight. At Harvard, she stopped going to therapy, but she still worries about eating and her weight. Sometimes she plays with her food without eating; other times she indulges in sweets and then is depressed for days because she went off her diet.

In the spring of her freshman year at Harvard, Jenny realized that she had gained 10 pounds over the winter and decided that she needed to go on a diet. She shed the 10 pounds without much effort, but with the summer ahead and the prospect of seeing her old high school friends, she became convinced that she needed to lose even more weight.

But instead of dieting more she began eating more, especially late at night when she was studying. Finally one night she tried throwing up and felt she had resolved the two pressures working on her--wanting to eat, yet afraid to gain weight. Jenny found herself eating more and more food and then vomitting.

When Jenny visited the dentist for her checkup, he asked her if she threw up often; the acid had been affecting her tooth enamel. Her dentist scared her, but when she tried cutting back on her binging and purging, she found it almost impossible.

Jenny is not a Harvard student, but she is typical of the many women at Harvard who have bulimia, says Ellen Porter Honnet, assistant dean of the college for co-education. Annette is a real student. And people, men and women, like them are a growing population at Harvard. Bulimia and anorexia have not struck Cambridge in epidemic proportions, but the eating disorders on campus can't be ignored either.

Anorexia has been recognized since the Middle Ages, while bulimia, Jenny's problem, has only been recognized for a decade. Anorexics have an intense preoccupation with dieting and lose at least 25 percent of their original body weight but still see themselves as fat. Bulimics are more difficult to diagnose because they binge and then purge, not greatly affecting body weight. The most difficult type of eating disorder to diagnose is the irregular eating habit. Large numbers of students pursue very unhealthy eating patterns, going on crash diets, eating unbalanced meals, binging on sweets.

These problems affect predominantly female Harvard students, but many men also suffer with eating problems. People who have a disorder can suffer severely; it can psychologically and physically control their lives, drawing them into a cycle which is difficult to escape.

Coping Strategy Gone Awry

"Anorexia and bulimia are not diseases. If labeled as such people think they can take pills or something to get rid of it. I call it a 'coping strategy gone awry.' It's a combination of the psychological and the physical," says Honnet, who is also an assistant psychologist at University Health Services dealing with eating disorders.

"Bulimia is much more common than anorexia, but it is very difficult to get reliable statistics," according to Dr. Margaret S. McKenna '70, a psychiatrist at UHS. In medical literature, many surveys of college age women have yielded a wide range of results: from 2 to 25 percent of the female college age population have eating disorders McKenna says.

According to a 1982 and 1983 Radcliffe survey that stringently defined bulimia as binging once a week, between 4 and 8 percent of the 400 women and less than 1 percent of the 200 men surveyed at Harvard and another Boston area college could be classified as having bulimia, says Norma C. Ware, assistant dean of Radcliffe.

"The results of our survey corresponded to the results of surveys [that used comparable definitions of bulimia] done in other parts of the country on other college campuses," Ware says.

"Our conclusion is that bulimia has increased, but it is not nearly as prevalent as has been widely believed. At the same time, there are many individuals who have bulimic-like syndromes that don't fit all the stringent requirements of the operational definition," Ware says. "The same would be true for anorexia," she added.

Honnet says that the number of students coming to Harvard who either have eating disorders or develop them is increasing. "The incidence at Harvard parallels incidences in the population as a whole," she says. Indeed recent studies found that 75 percent of the fourth grade girls in a San Francisco school were dieting. Other studies indicate that even if the number of people with outright disorders is not increasing dramatically, the number of people on diets who weigh a normal amount is large and growing.

Ware's study reveals a profile of bulimics: "Bulimics were more depressed, felt higher levels of stress, weighed more, were more perfectionistic, were likely to eat in response to stress, dieted more frequently, saw themselves as less self-accepting, thought thinness was more important, and were more ashamed of their eating habits than individuals with normal eating patterns," she says.

The women and men with anorexia and bulimia are on physical roller coster rides. The physical repercussions can be deadly at times, though for bulimics the prognosis is usually brighter. Anorexics at various stages can experience a cessation of menstruation, insomnia, hypothermia, fatigue and depression. Bulimics suffer dehydration, internal bleeding, enlargement of salivary glands and severe loss of potassium which can lead to heart or kidney failure, says Honnet.

Many individuals with eating disorders divide foods into "good" and "bad" categories. "If they've eaten one bad food, they might feel they've ruined the day; they might as well eat more; it won't matter. It's a painful cycle to be in. Women feel compelled. It's a kind of veil coming down over them. They feel like they can't break the cycle," says Honnet.

Sociocultural Explanation

Women comprise between 90 to 95 percent of all people with eating disorders, according to experts. A sociocultural view explaining the increase looks at the increasing importance placed on the body for finding social acceptance, according to Honnet.

"Our environment creates a real crazy attitude in demanding people to be thin and exercise a lot, be successful and perfect, all as a package deal. There's also the suggestion that we can still eat what we want [and maintain this image]. There's no woman who isn't affected [in some way by this pressure]," says Honnet.

Women have been more vulnerable to the disorder because they have been judged by men on how they look since time immemorial, says Honnet. "Now society has gotten even more intense. In the 1960s, there were a lot of plump women in miniskirts, and they managed to feel fine. Over time, as models became more culturally significant, they became icons. We all know their names. Increasingly, movie stars and models embody what women should look like. In the 1950s, women could be curvy and look like Marilyn Monroe. Now there's Jane Fonda [with a fit, muscular-looking body]," says Honnet.

"There are definitely society pressures," says Julie M. Mihelich '86, co-director of Eating Problems Outreach (EPO). "There's a dislike of femininity, with the roundness associated with it. If you're really slim, you are denying the notion of femininity," she says.

According to Mihelich, since 1950 the body weight of women between ages 20 and 30 has been increasing, yet the ideals for women have been decreasing. "Women are biologically heavier, but [are under pressure] to become slimmer," she says.

Women's self-esteem gets wrapped up in body shape. "There's an equation: if I don't have a nice body, I'm not worth anything. This seems to be a pervasive attitude. Many charming, attractive, lovely young women come in thinking they're `gross,'" says McKenna.

The key issue is self-perception, says McKenna. "Plenty of people may tell them they look great, but they don't believe it." she says. "And these are extremely successful people.

It is difficult to classify who is most vulnerable to an eating disorder, says McKenna. "One type of person who is commonly described as a stereotype is the controlled perfectionist, the highly successful and driven individual," she says.

While only 5 percent of all individuals with eating disorders are men, Honnet believes men are starting to become more vulnerable. "In the 1980s, men's magazines increasingly focus on looks--GQ and Esquire both have clothing spreads. There's more focus on men's weight," she says.

The most vulnerable are those who find themselves on crash diets, says Honnet. "Male athletes, especially wrestlers and rowers, can develop bad habits. Both use drastic measures to get down to unrealistic weights."

Jennifer C. Keeler '86 studied men and women on the lightweight and heavyweight crew teams as well as the basketball team for her senior thesis for the Psychology Department. While she found that men on both teams were more concerned about weight than normal, they did not have an excessive or dangerous preoccupation with weight. "In general, athletes tend to be pretty healthy," she says, though she adds she did find some individuals who had problems. "It's more of an individual thing or predisposition than something that is caused by a sport that has a weight restriction," she says.

The coaches of the crew teams try to watch their rowers and catch any students who may be having nutrition problems, says Harry Parker, the men's heavyweight crew coach. "Certainly when some of the lighweights have to lose weight, they think about it a lot. But I haven't seen anybody exhibit what I would consider dangerous levels." Parker says the coaches try to counsel their rowers about good nutrition and eating patterns. The counseling "has been very effective in recent years," he says.

Crew teams have an obvious reason for concern about weight. Lightweight rowers have to weigh in at a certain level or they don't row in that boat. But for many other people, weight concerns develop for less discernable, psychological reasons.

Eating disorders may begin when people feel a need to gain control over their lives, according to EPO's Mihelich. "In college they enter a new situation. At home you are controlled by your parents. At school, there are more issues over which you have direct control--how much you eat, study, if you stay out late or not," she says.

Women tend to focus on their body as a way of gaining autonomy, says Mihelich. "It may be a way of breaking off from one's parents. The person may think 'only I control what I eat, you have nothing to do with what I put in my mouth.' It becomes a coping mechanism," she says.

Stopping the Cycle

Attempts to cure bulimics and anorexics take different routes because of the difference in attitude about their behavior, according to McKenna. While bulimics tend to feel guilty about their behavior, anorexics don't see it as abnormal.

"Bulimics think: 'I can't believe I'm doing this--it's so gross.' They say to themselves: 'Once the circumstances change, I'll stop. Once I finish this paper, once the semester's over, when I'm done with my thesis.' And then they realize they cannot stop. By the time bulimics come in for help, they may have been bulimic for four years. They come in and say 'make this stop' or 'cure me,"' says McKenna.

But McKenna emphasizes that a therapist cannot do it for them. "They have to realize what purpose it [binging] serves. Because when they start out, it serves a purpose," says McKenna. "A person has to be ready to work with a therapist," she adds.

For anorexics, their quest for control over their bodies is the central issue of their lives, says McKenna. "They don't see it [their not eating] as a problem, but as a solution."

"Anorexics' cognitive functioning is affected. They can no longer tell what they really look like. There are 80 pound women in the hospital who are angry when they are force-fed; they think people are forcing them to get fat," says Honnet.

Anorexics characteristically have a distorted perception of their body size according to experts. "Anorexics I've talked with--they weigh half of what I weigh, and they can't tell who is fatter," says Sheila Reindl, a counselor at the Bureau of Study Counsel and co-director of an EPO group.

"A true anorexic won't call us [EPO]," says Mihelich. "Characteristic of the disorder is a vehement denial of thinness. Their perception is skewed. They really see themselves as big when they are so painfully small. It has to do with the hypothalmus gland in the brain which is affected by starvation," says Mihelich.

In many cases, anorexics and bulimics may need medical attention to overcome the effects of their problems. Therapy also helps them overcome the disorders. Honnet, who is a co-leader of a group of bulimic women, said that her group talks about alternate strategies for coping with stress.

Anorexics, on the other hand, are the victims of very isolating problems and do not often reach out for help. "Anorexics tend to become more and more withdrawn," says Rosalind J. Carter '86, an EPO counselor.

Anorexics tend to control their emotions in group therapy. Honnet warns that the deeper the anorexic or bulimic gets enmeshed in her problem, the harder it is to get out. "The price is much too high."