Disappearing Act

By Christine Gorman

You've heard the gossip. You've seen the photos. All Hollywood is suddenly shocked to learn that Calista Flockhart, star of Fox's hit show Ally McBeal, is so thin. And we in the media are falling all over ourselves trying to figure out whether Flockhart has an eating disorder, especially now that she has denied it. Well, I'm not playing that game. If the entertainment industry really cared about sending the wrong message on body image, it wouldn't need so many size-2 celebrities in the first place.

But the fact remains that 2 million Americans--most of them women and girls--do suffer from eating disorders. In the most extreme cases they literally starve themselves to death. And those who survive are at greater risk of developing brittle bones, life-threatening infections, kidney damage and heart problems. Fortunately, doctors have learned a lot over the past decade about what causes eating disorders and how to treat them.

The numbers are staggering. Approximately 1 in 150 teenage girls in the U.S. falls prey to anorexia nervosa, broadly defined as the refusal to eat enough to maintain even a minimal body weight. Not so clear is how many more suffer from bulimia, in which they binge on food, eating perhaps two or three days' worth of meals in 30 minutes, then purge the excess by taking laxatives or inducing vomiting. Nor does age necessarily protect you. Anorexia has been diagnosed in girls as young as eight. Most deaths from the condition occur in women over 45.

Doctors used to think eating disorders were purely psychological. Now they realize there's some wayward biology as well. In a study published in the Archives of General Psychiatry this month, researchers found abnormal levels of serotonin, a neurotransmitter in the brain, in women who had been free of bulimia for at least a year. That may help explain why drugs like Prozac and Zoloft, which affect serotonin, have allowed a lot of bulimics to stop bingeing. Unfortunately, the pills don't work as well for anorexia. Nor do they offer a simple one-stop cure. Health-care workers must re-educate their patients in how to eat and think about food.

How can you tell if someone you love has an eating disorder? "Bulimics will often leave evidence around--laxatives on the dresser, vomitus in the toilet bowl--as if they want to get caught," says Tamara Pryor, director of an eating-disorders clinic at the University of Kansas in Wichita. Anorexics, by contrast, are more likely to go through long periods of denial.

You can pierce some of that denial by listening to how someone you are concerned about talks about her body. Does she moan about her fat behind even though she's rail thin? Is she hiding under baggy clothes? Has her energy level dropped so low that she's sleeping all the time? Doctors suspect anorexia when a woman weighs 15% below normal and hasn't menstruated for at least three months. But there are more subtle signs as well: the growth of baby-fine hair (as the shrinking body tries to keep warm), brittle nails, swollen joints. Bulimics may develop a chronic sore throat and dental problems (caused by frequent vomiting), bloating and other digestive complaints. Whatever you do, don't try to diagnose or treat an eating disorder on your own. There's just too much at stake.

For more on eating disorders, see time.com/personal You can e-mail Christine at gorman@time.com