The Self-Starvers

At 17, Susan looked alarmingly emaciated, with sunken eyes and fragile, sticklike arms and legs. Though she was 5 ft. 5 in. tall, she weighed only 70 lbs. and scorned all but the tiniest morsels of food. Amazingly, Susan believed herself to be too fat and maintained a frenzied level of physical exercise to help keep any weight off her scrawny frame.

Susan was a victim of anorexia nervosa, "the starvation disease" or "Twiggy syndrome," a rare and bizarre emotional disorder that has been occurring more frequently in the past few years. Of those affected, 80% are female, mostly in their early teens. Typically they are intelligent, ambitious, middle-and upper-class girls who are perfectionists and eager to please their mothers and fathers. Suddenly they start to diet and then simply stop eating, sometimes losing 50 lbs. or so in a few months. Some, like Susan, now 21, seek treatment and manage to get back to a normal weight. Others, with or without treatment, may start eating enough to survive, yet remain rail-thin and undernourished. Still, 5% to 15% of known victims of anorexia nervosa have starved to death despite treatment.

Researchers generally agree that the disease has purely psychological origins. Some therapists believe that young girls become anoretics out of fear of sexuality; by reducing their body weight to childlike proportions, they stall the process of becoming a woman. (Menstruation almost invariably ceases, or in the case of younger girls does not begin after such severe weight loss.) Other therapists see the disease as a symbolic "oral rebellion" against overcontrolling and troubled parents.

"There is a terrible fear of not being good enough, of not doing what is expected of them," says Dr. Hilde Bruch, professor of psychiatry at Baylor College of Medicine in Houston. "Anoretics want to reassure themselves that they are really in control. There is an obsession with slimness and achievement." Bruch believes that the incidence of anorexia will continue to increase as greater demands are made on women.

Some doctors hospitalize anoretic patients and take away privileges like watching television till they gain weight. But, says Bruch, "they lose it again as soon as they leave." She believes that psychiatric therapy is necessary.

Rite of Passage. Psychiatrist Salvador Minuchin at the Philadelphia Child Guidance Center finds that anoretics usually come from families that have conflicts but are "enmeshed" in togetherness. Minuchin's treatment is a mix of showmanship, ritual and behavioral techniques. Step one, oddly enough, is bringing the family together for lunch. The purpose is to replay a typical meal at home to see what happens. Like a director in a play, Minuchin may call the scene to a halt at the climax, perhaps just as the father is angrily and unsuccessfully trying to force his daughter to eat something. Minuchin then tells the girl: "You have won. You have humiliated your parents in front of the doctor."

Such melodrama tics, Minuchin believes, bring about a temporary exorcism of the anoretic's fear of open disagreement with her parents and become a rite of passage. The girl will eventually begin to eat, but the next problem is to keep her from slipping back to her old ways. Family therapy is then begun; parents and child get together with Minuchin for sessions in which they discuss their underlying pressures and conflicts.

Under a federal research grant, work with anoretics is under way at the University of Minnesota, the University of Iowa and the Illinois State Psychiatric Institute in Chicago. Says Dr. John Davis of the Illinois State team: "It's a life-threatening disorder, and it may be more common than we ever thought."

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