Actress Lohan's story sparks new interest in eating disorders

SACRAMENTO, Calif. -- Teen actress Lindsay Lohan is on the cover of this week's Vanity Fair with a bombshell interview in which she allegedly admits having bulimia, among other things.

The interview follows months of boney tabloid photos and rumors of rapid weight loss by the former redhead who starred in 2004's "Mean Girls" and "Confessions of a Teenage Drama Queen." Lohan denies the "confession" to Vanity Fair, but the cover story has landed bulimia back in the headlines.

Bulimia affects up to 4 percent of women. Men can be bulimic, too, as up to 20 percent of people with the disease are men, according to the National Eating Disorders Association. Bulimia remains deadly and difficult to detect, though new research shows there may be a genetic factor to eating disorders.

For decades, girls who look much like 19-year-old Lohan were the face of eating disorders. Affluent young white women were thought to struggle with bulimia, but that is changing.

The problem reaches beyond color and gender. In a 1999 survey of 6,504 adolescents, Asian, African American, Latino and Caucasian youths all reported attempting to lose weight at similar rates, according to NEDA.

And although eating disorders are directly related to a person's eating habits, experts say they actually have very little to do with food.

"It's not about eating," said Terry Sandbek, a psychologist with a Sacramento private practice. "It's about using the food to deal with anxiety and stress."

The tactic of using food to momentarily manage emotions, Sandbek says, is very effective, which is why it can be so dangerous. He likens it to alcohol or drugs, with which an addict becomes dependant on a substance in order to maintain daily function.

"The method they're using is so powerful, they'll give up everything for it," Sandbek said. "They know of no other way to help them."

Someone struggling with bulimia will consume large amounts of food in a short time and then compensate with self-induced vomiting, by taking laxatives or diuretics, fasting and/or compulsive exercise.

This cycle is often known as bingeing and purging, and can wreak havoc on the body. Electrolyte imbalances from dehydration can lead to irregular heartbeats and heart failure. Frequent vomiting can cause the esophagus to become inflamed and rupture, as well as stain and eat away at tooth enamel.

Without proper diagnosis and treatment, eating disorders can be deadly. They have one of the highest mortality rates of any mental illness. It is estimated that 6 percent of serious cases end in death, according to the National Association of Anorexia Nervosa and Associated Disorders.

"It's been really difficult for people to understand these diseases," said Annie Hayashi, director of communications at ANAD.

"If someone sees a person who is very, very thin -- almost skeletal -- they ask why the person doesn't just eat. But these are diseases that people can't control."

Timothy Walsh, professor of Pediatric Psychopharmacology at Columbia University and founder of the Eating Disorders Research Unit at the New York State Psychiatric Institute, said bulimia can be difficult to detect because bulimics often do not experience the drastic weight changes seen in some other eating disorders.

"(It) is something that can be kept hidden for a long time," Walsh said. "Especially in adolescence, which is a time ... when kids are spending more time away from their families."

Research has found that bulimia is not mutually exclusive with anorexia, an eating disorder marked by self-starvation and excessive weight loss. An April study published in the American Journal of Psychiatry found that 36 percent of anorexia patients developed bulimia over 15 years and 27 percent of bulimia patients developed anorexia.

The study also found that most of them crossed over in the first five years.

"Often, a person will be anorexic for a while, then they will discover bulimia and think they are cured of anorexia," said Sandbek.

Sandbek also said the most dangerous situation is when someone has both anorexia and bulimia at the same time, alternating between starving themselves and bingeing and purging.

"(By then), the body is so devoid of resources," he said.

Monica Goodpaster of Roseville, Calif., started restricting her food when she was 13. By the time she was 25, she had full-blown anorexia and had restricted her diet to small cups of white rice and diet hot cocoa. She also had a form of bulimia wherein she would use excessive exercise as her means of purging.

"I really started to go downhill," Goodpaster said. "I was having some real serious health problems."

Goodpaster said she knew that what she was doing to her body was hurting her. Yet it took an intervention from her husband and mother to convince Goodpaster to check into an eating-disorder facility in San Diego.

She was in denial and unable to face the problem by herself.

"It's food, for crying out loud. I thought, I can just pick this up and eat it," Goodpaster said.

Today, Goodpaster is 38 and no longer has daily issues with food. She does not have a scale in the house.

For Goodpaster, getting through treatment was especially hard because she had to face food every day.

"It's like telling an alcoholic that you can only have this drink, and you can only have it three times a day," she said. "I cried through the whole (first meal). It took me 45 minutes to eat a sandwich and an apple."

But what causes eating disorders? How could someone's self-image be so distorted, and why can't people like Goodpaster just eat a sandwich?

The answer is that there is no single answer. Doctors and psychologists say there are different causes.

"It's a complex problem (with) underpinnings we really don't understand," Walsh said.

Recent research shows that, along with stress, anxiety and social pressure, there may be a genetic component to eating disorders.

Numerous studies, including one published in the American Journal of Psychiatry in 2000, have found strong evidence linking eating disorders to genetics.

"Our whole culture is exposed to this pressure to be thin, but not everybody develops eating disorders," NEDA co-founder Sondra Kronberg. "If (someone) has a family history for mental illness, it would then put them at a higher risk."

Kronberg said that, much like addiction, there is not a single gene that makes anorexia or bulimia inevitable. But there probably are genes that make them much more likely in certain people, she said.

Teresita Romo of Sacramento was interested when she read about research linking eating disorders to genetics. Her daughter struggled with an eating disorder in her teen years.

Fifteen years ago, Romo said, much of the literature implied that parents were to blame.

"Anorexia has a lot of stigmas and misconceptions," said Romo.

"People think, 'Why don't their parents just force them to eat?"'

Although the research may help a mother or father better understand the causes, it will not change the turmoil parents go through when watching their child struggle with such a disease.

"I have never had something so immobilizing," she said. "You feel like you're in a dark tunnel and there's no one to help you."

Kronberg said there are deeply complex emotional, behavioral and psychological issues that contribute to an eating disorder, making it difficult to treat.

Still, eating disorders are treatable. The earlier the person gets help, the better.

"The longer it stays in place without the effective treatment, the less likely it is that the person is going to get better," she said.

Kronberg recommends that people seeking help make sure to see a doctor or therapist who specializes in eating disorders.

"Unfortunately, some people out there are treating it without levels of expertise to deal with it," she said.

And, Kronberg said, magazine articles such as the one in Vanity Fair can "undermine" treatment, making successful recovery even harder because they trivialize serious disorders such as bulimia.

"It doesn't accurately reflect the agony and turmoil the person goes through," Kronberg said. "And it says to the patients we're treating that there's something wrong with them because they aren't better in six weeks."

c.2006 The Sacramento Bee