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Published May 05, 2012, 11:30 PM

InDepth | Eating disorders aren’t about food; they’re about fear, control and stress

Ashley Morgan’s 11-year battle with anorexia and bulimia began as a coping mechanism after a breakup. “It didn’t sprout from wanting to be skinny,” the 28-year-old says.

By: Meredith Holt, INFORUM

Ashley Morgan’s 11-year battle with anorexia and bulimia began as a coping mechanism after a breakup.

“It didn’t sprout from wanting to be skinny,” the 28-year-old says.

There’s no one “reason” for an eating disorder.

Nadine Hillesheim, psychologist and counselor with The Village Family Service Center in Fargo, lists genetic disposition, an unhealthy home environment, external stressors, change or a “diet gone bad” as potential eating disorder triggers.

As many as 24 million Americans suffer from an eating disorder, according to The Renfrew Center Foundation.

Though widespread, eating disorders are complex, sometimes misunderstood mental illnesses that often start in young girls.

A couple years ago, eating disorder specialist Tricia Cook Myers would have said her youngest patients were 11 or 12.

Now, the psychologist with Sanford Eating Disorders & Weight Management Center in Fargo sees kids as young as 9 coming in for treatment.


Most teenagers are unhappy with their bodies, and most Americans have been on a diet, says Stephen Wonderlich, director of clinical research at the Neuropsychiatric Research Institute in Fargo.

So when does being dissatisfied with your body or restricting what you eat become a disorder?

“It’s not just the behavior – it’s the frequency and intensity of the behavior,” Wonderlich says.

The current diagnostic criteria for eating disorders are narrow.

According to the National Association of Anorexia Nervosa and Associated Disorders, more than half are classified as “eating disorder not otherwise specified.”

The mental health professionals interviewed for this story all said a preoccupation with food, weight and body image becomes a disorder when it starts to affect an individual’s quality of life.

Hillesheim starts by asking new patients how much of their lives are consumed with eating or body-image issues.

“If someone says 95 percent, I’d call that an eating disorder,” she says.

People with eating disorders report both a need for control and a lack of control, Hillesheim says.

Morgan, who grew up in Breckenridge, Minn., and attended Minnesota State University Moorhead, agrees and says her disorder took over her life.

Morgan, who now lives in Plymouth, Minn., withdrew from her friends, became secretive and avoided situations where she knew food or alcohol would be present.

All her mental energy went toward her eating disorder. “It became all-consuming. It controlled everything,” she says.


Years later, one of Morgan’s college roommates told her, “We all knew, but nobody said anything.”

So when do you intervene? When do you seek help? Most agree the sooner, the better.

“Earlier intervention is more effective,” Cook Myers says.

Many individuals with eating disorders go years without getting help, or they never get help.

According to the International Journal of Eating Disorders, only one in 10 men and women with eating disorders receive treatment.

There’s no one single-most effective form of eating disorder treatment, either.

Sanford Eating Disorders & Weight Management Center staff recommend a comprehensive team approach, family involvement, and in some cases, medication.

Wonderlich says successful treatment requires learning long-term management skills and coping strategies.

“Getting people to make meaningful changes in their lives – that’s the key to eating disorder treatment,” he says.

When asked whether she wished someone had approached her about her eating disorder, Morgan says, “Absolutely.”