Thinspiration?

A decade ago, the Web wasn’t full of sites offering “thinspiration” and tips on weight loss and purging secrets for thousands of anorexics and bulimics.

Not only are there dozens of these “pro-ana” and “pro-mia” – for pro-anorexia and pro-bulimia – on the Web, these groups are springing up on social networking sites like My Space and Facebook.

According to a 2007 BBC News report, pro-ana and pro-mia sites, which promote anorexia and bulimia not as eating disorders but lifestyle choices, have been relatively anonymous. But on social networking sites, “users have real names and faces.”

A couple of the eating-disorder-as-lifestyle Facebook groups offer warnings by Facebook about the content of those groups. Fortunately, a group featured on the BBC news report, Pro Ana Nation, no longer exists on MySpace.

Sites like these are dangerous because people already suffering from eating disorders and others who may develop them can learn new weight loss methods.

The National Eating Disorders Association’s position is that, “these sites provide no useful information on treatment but instead encourage and falsely support those who, sadly, are ill but do not seek help.”

The Cost of Treatment

Though I hated being there at the time, I was lucky my mother’s insurance (she was a teacher, and had excellent medical coverage) covered my nearly year-long stay at St. Claire’s.

“You were very lucky,” said Carol Tracy, a psychologist who has treated only outpatients, about my long-term care as an inpatient. While outpatients usually are able to make the connection between their eating disorders and how they use that to cope with other issues, those that into outpatient treatment too soon because of insurance issues may need additional treatment they’re not getting.

Amanda’s mom Stella said her insurance picked up 80 percent of the combined three months’ hospitalization, and Stella, who wanted her last name omitted for this post, said she was liable for the other 20.

“I don't remember the amount of the bill for each hospital, but, as you can imagine 20 percent of a three month stay in the hospital was sizeable,” Stella wrote in an e-mail.

She remembers paying thousands of dollars to St. Claire’s but was able to negotiate through her insurance company payment for the Westchester hospital Amanda stayed at following St. Claire’s.

“Remembering the paperwork that I received, it seems that if you don't have insurance, you owe the hospital considerably more than if you do,” Stella wrote. She said the hospital charges a certain amount per day (say $100), and the insurance company could negotiate it down to $80, reducing the overall size of the bill by 20 percent, and reducing the bill that a parent or patient ultimately pays.

“If you have no insurance, there is no one who will negotiate a more reasonable price for you. In other words, the people least able to pay, the uninsured, have the highest liability,” Stella wrote.

An October 2007 edition of Newsweek features Dawn and Bart Beye, a New Jersey family suing their insurance company because their anorexic teen daughter would not be covered after three weeks of treatment.

In their class-action suit, filed against Horizon Blue Cross on behalf of the residents of New Jersey, New York and Pennsylvania, the Beyes argue their daughter and others suffering from eating disorders have illnesses that are “biologically based” and “should be covered under the laws of all three states,” Newsweek reported.

Not so, says the insurance company disagrees, arguing that anorexia is not a result of genes but rather the environment and should not be covered by state laws.

The National Eating Disorders Association estimates about 11 million people in the U.S. are affected by eating disorders, but “only 11 states have laws explicitly mandating that insurers cover their treatment. Thirty-four states require general mental health coverage, though insurance companies have a lot of leeway in how they define ‘mental disorders’ and some may not cover anorexia or bulimia,” according to the Newsweek article.

Bulimics v. Anorexics

I always checked to make sure Alana or other nurses and mental health workers supervising meals weren’t watching.

I at my chick peas and fruit (usually an apple or grapes) and drank my two four-ounce apple juices, but always tried to hide the butter in the chicken or pass along pieces of my wheat bread to Janine, a 13-year-old bulimic. There were times I hid pieces of bread and other “fear foods” – things that I found too scary to eat – in my clothes to give to Janine later.

The staff always monitored every meal, checking at the end to document how much you ate. If an inpatient ate “100 percent,” they got certain privileges like weekend passes or get their feeding tubes removed. Because I wasn’t gaining weight fast enough, I was placed on 4,600 calories (the calories I didn’t eat would come from the milky-looking fluid pumped into my nose tube). Naturally, I had to resort to tricks to eat as little as possible.

My nickname for Janine, who was my roommate for a brief period, was the "belligerent bulimic" because she always seemed angry and once threatened to pull the tube out of my nose. We didn’t have bathrooms in any of the rooms (they were in a common area with no doors in the stalls). There were no plastic bags in our rooms, and the only bottles allowed were shampoo and conditioner bottles. Still, Janine found ways to sneak food to binge and then found ways to make herself throw up. Our room frequently reeked of vomit.

"Anorexics wanted to fade out, bulimics wanted to stand out," said Amanda, who was 12 when she was hospitalized and treated for anorexia.

At St. Claire’s, lines were clearly delineated between bulimics and anorexics. Sure, there were some “alliances” between the groups, and there were even patients who at one time or another suffered from anorexia or bulimia, but there was suspicion among the groups.

"Bulimics often feel like failed anorexics," said Carol Tracy, a psychologist who for 25 years worked with undergraduate and graduate students with eating disorders in an outpatient setting at Princeton University.

She said anorexics embody the "cultural ideal" because they are thin, whereas bulimics often feel "out of control because they can't stop eating."

Tracy said traditionally, anorexics start restricting food at a younger age, usually when they're teenagers whereas bulimics more often affects young college-aged women. She also said the goal of therapy is to get a person with disordered eating to get in touch with their emotions and issues behind why they don't eat, binge and purge or use laxatives and diet pills.

Tracy has also treated "bulimarexics" - patients who have tendencies to both restrict food, binge and purge or use laxatives and diet pills.

Eating disorders, Tracy said, are used as coping mechanisms. “Instead of saying ‘I need to break up with my boyfriend,’ the focus shifts to ‘I would feel better if I lost a few pounds.’”

Women of Color Suffer from Eating Disorders

Fair-skinned girls in their mid-teens walked past the nurses’ station as I was waiting to be admitted to the Eating Disorders Unit one brisk March morning.

Noticing their designer jeans and later learning they had parents who could afford European vacations and private tennis lessons, I felt out of place as the Cuban girl from the working class Union City.

My peers – fellow teen anorexics and bulimics in treatment at St. Claire’s Hospital - watched “Friends” and talked about boy bands. I read about Spanish-language soap-opera stars.

In the days before “cultural competence” and “diversity” were buzzwords, I’m sure the mostly-white patients initially were as fearful and suspicious of me as I was of them.

Going back to the first day when I was wheeled into the unit because I was too weak – by that point, I had “gained” weight, coming in at 79 pounds - Jasmine, the only other Latina there, smiled and walked toward the nurses’ station. She casually introduced herself to my parents, and then asked me: “I have a daughter about your age. How old are you?”

”Thirteen,” I answered.

”My daughter’s 12,” said Jasmine, a Puerto Rican woman who was in treatment for her binge- eating disorder.

“Carmen can sit with you,” my mother said before my parents had to leave. I knew my mother would be “relieved” leaving me in the hands of a mother and a Latina, someone who understood our culture.

Jasmine and I were lucky. For many Latinas and people of color, there is a stigma associated with getting treatment for mental health issues – eating disorders included.

“You go to the family with problems, or to a religious leader. You don’t go outside of family because you’ll shame the family,” said Annette Santiago-España, a psychologist and clinical team leader for the eating disorders team at Columbia’s Counseling & Psychological Services about the perception among some Latinas.

She said a reason there’s a misperception that white women primarily have eating disorders is that they were the only people that underwent research studies because they had more access to health care.

Santiago-España, who runs a women of color support group for undergrad and graduate students at Columbia where “eating issues sometimes come up,” said more women of color are becoming prone to eating disorders because of the impact of acculturation and body dissatisfaction – especially among Latina adolescents who grow up hearing from friends, family, schools and society that thin is ideal.

Yet “food is at the center of every celebration, every funeral, any occasion. … Food is a huge symbol for many communities of color,” she said.

For more information about people of color with eating disorders, visit http://www.pbs.org/wgbh/nova/thin/minorities.html. To watch me pitch Latina magazine’s Editor-in-Chief for a story about eating-disorder recovery, click here: http://www.mediabistro.com/articles/cache/a10037.asp

When Gum and Laxatives are Contraband: An Anorexic’s Story

My ex-boyfriend, a New Jersey Corrections officer, told me months ago about a raid at his jail. He and other fellow officers wore latex gloves and searched all crevices to confiscate cell phones, cigarettes, drugs, nude pictures of women or children and other contraband.

A decade ago, I was stashing a different kind of contraband: gum, chocolate-flavored laxatives, diuretics, diet pills, anti-depressants and salt packets. Though I’ve never been in jail, I felt imprisoned by the pink walls and watchful eyes of nurses and mental health workers at the now-defunct Eating Disorders Unit at St. Claire’s Hospital in Boonton , N.J.

As a Cuban American where I grew up believing food is love, my parents were baffled by my weight loss. At 13, and 5’3,” I had gone from a healthy 105 pounds to a bony 60 pounds in eight months, carefully hiding my skeletal frame in baggy clothing. My parents bribed me to eat my favorites: rice and black beans and caramel custard, but I refused. When my curly brown hair started falling in chucks and two of my molars broke off, they rushed me to gastroenterologists, pediatricians and even oncologists: they’d sooner believe I had cancer than an “eating disorder.” Finally realizing I was anorexic, they took me to a hospital that specialized in eating disorder treatment.

Once at the hospital, I was scared of gaining weight and losing the false sense of control starving had given me. Though I knew how to cut calories and exercise for hours at a time, I learned how to hide my Prozac or give it away, how to barter for gum and salt packets, and how to appear as if I’ve gained or maintained a certain weight from different patients at the hospital.

During my first week at the Eating Disorders Unit in March 1997, my roommate Christine told me that chewing cinnamon gum burned more calories and that I should sit next to the bulimics and sneak them some of my food under the table. Christine had long reddish brown hair and pale skin, and looked more like she was 13 than 17. She had been in and out of hospitals for the past four years.

Since our meals were supervised, patients weren’t allowed to have any food in our rooms. We also weren’t allowed to have plastic bags for fear bulimics would throw up and hide the vomit in their rooms. But when some of the “healthier” patients were given privileges like day-long “passes” to leave the hospital, some would stash gum and laxatives in their socks, bra, or other articles of clothing to bring back to the in-patients. Other times, outpatients would bring the contraband: carefully hiding it in unsearched crevices in their backpacks or shoes. Some of us would get creative during dinner time, snatching the salt, pepper and sugar packets that were brought to us with our food trays.

I usually traded gum for salt packets, so I could retain weight for the following morning’s “weigh in.” During my second stay as an inpatient at that hospital in July 1997, I had become adept at the bartering business. Though alliances between anorexics and bulimics were rare, Lisa, a 33-year-old bulimic with rotted teeth, called a meeting with all 11 inpatients to exchange contraband and war stories.

“Does anyone have Klonopin? I’m really jittery and need a fix,” said Lisa, who boasted her bulimia started on September 27, 1981, the first time she struck her fingers down her throat.

“I have one,” said another patient who was prescribed the panic disorder medication.

I spit out my Prozac from under my tongue and placed it under an air vent.

“Who has gum? I have salt packets and a diet pill, if anyone wants,” I said.

Patty, a 25-year-old exercise-obsessed bulimic/anorexic was pacing around the room. The youngest, Amanda, 12, stayed quiet.

She told me know she only bartered her anti-anxiety medication when she left St. Claire's for Cornell University Medical Hospital, where patients with eating disorders were locked away with people with schizophrenia and those who chose treatment over jail.

"At St. Claire's it was just a game. I wouldn't eat because I didn't like the staff there. It was like my rebellion," said Amanda, now 22.

Throughout Amanda's stay at St. Claire's, she would not eat or drink, getting her nourishment only from the feeding tube - a think plastic tube that goes from your nose to your stomach. I also had “the tube” – that like intravenous provided nutrients from whatever calories we didn’t eat. After the pills and foodstuffs were exchanged, some of us quickly left Lisa’s room. If the nurses or mental health workers suspected a swap, they could put us on “lock down,” asking us to stay in a common area as they put latex gloves and searched every room.

When I began cutting down on cookies and other fattening sweets, I never suspected ending up in a hospital, feeling like a criminal in my early teens. I spent most of 1997 - including my favorite holidays, Easter, my birthday in May, July 4th, Thanksgiving Christmas and New Year’s. Every time I would be discharged, I would go back. The other patients and I would joke about that, since I would only go home for two-week intervals and that was my “vacation.”

My turning point came at 17, when after years of inpatient and outpatient therapy, I grew tired of the revolving door between my house and the hospital. When I was determined to get healthier, I no longer hid food and over exercised. I also took my medication as prescribed. After meeting men and women who’ve quit law school, jeopardized their relationships, had miscarriages and lost jobs, I knew life was more than about counting calories and bartering with bulimics.

“Wow, I never thought of gum as contraband,” said a wide-eyed, Ted, the corrections officer.

“Yes,” I said half jokingly, “I guess you could say you’re dating a former criminal.”