Inching away

When Sally woke up this morning in her Reno home, she took two bites of ravioli, drank a glass of orange juice and threw up. On a full stomach, brushing her teeth makes her gag. She gets sick in the shower every morning. The 16-year-old now cringes in disgust at the sight of foods she once loved.

The most superficial of analysts would see symptoms of bulimia nervosa, an eating disorder that has the affected girl—only females develop the disorder—throwing up after eating. But eating disorders are often onion-skinned, with unhealthful behavior layered upon unhealthful behavior.

With appetite suppressants—booze and some little red pills—Sally’s dropped from a size 13 to a size 5 in less than a year. At 5-foot-8, she can sometimes shimmy into size-zero jeans, depending on the cut. Sally’s not sure if she has an eating problem, but lately she’s starting to get concerned.

“I know people call me drama queen all the time,” she says, as lounging teenagers pass around a bottle of Mad Dog in the other room. “It’s just me. I don’t purposely do it. It’s just who I am. Get over it. And if you don’t like me, then don’t talk to me.”

Peter, Sally’s dad and a 50-year-old professional, struggles to raise two teenage daughters. Both have had their tough times, but one is more difficult than the other.

“Lots of gray hair,” he says, drawing a sip from a pint of Sierra Nevada in a dark neighborhood bar.

He speed-dials Sally, “Hi. Just calling to see if you’re home. She wants to come over and interview you for the article. It’s about eating disorders.” There’s a long pause. “No, it won’t make you cry.”

He hangs up and sighs, “She’ll be home in 20 minutes.”

Peter lights up a cigarette. “She’s my problem child. My drama queen,” he says of Sally, who recently dropped out of high school and is scheduled for an alcoholism and substance-abuse evaluation in coming days.

He thinks Sally’s purging goes in phases, and he’s convinced she’s doing it—and everything else—for the attention. She eats everything in the house, he says. Perhaps that’s the binging that’s such a recognizable symptom of bulimia. Hiding the fact that there may even be a problem is another telling symptom.

For her part, Sally says the only real meal she gets is lunch with her mother once a week.

Sally thinks she may need help—but not yet.

“If it gets to the point where I’ve lost so much weight, and I’m so sick, I will for sure get help,” she says. “Right now, I know I need to go see someone, but I don’t think I’m to the weight where I’m going to get so sick that I’m not going to be able to start eating again.”

Peter, who has only recently gained custody of his daughters, is not big on psychology or psychiatry, and he considers Sally’s plight the byproduct of youth.

“She’s just a typical teenager: ‘Look at me!’ “ he says, waving his arms in the air. “When you’re a 16-year-old girl, everything’s terrible, everything’s good, everything’s bad.”

Food can bring people together or push them apart. Bulimia nervosa is one of the great family dividers because it often strikes individuals with few emotional coping mechanisms, who turn to binging as a way to soothe themselves. The purging isn’t far behind. It can result from complex family interactions, and it can start with something as simple as going on a diet.

“Before they realize it, it gets out of control,” says Cheryl Hug-English, medical director of the Student Health Center at University of Nevada, Reno. “They’re in a spiral.”

The life of a bulimic is shrouded in secrecy. Her bizarre behaviors aren’t centered only on the refrigerator and the bathroom. Impulsiveness and compulsiveness are common factors, and bulimia can lead to problems with drugs, alcohol and school.

The longer it goes on, the more difficult it is to break the cycle, says Hug-English.

“Often it becomes so much a part of them that they can’t stop. It’s a lot more complicated than saying, ‘Just quit it.’ “

Bulimia, and the behaviors wrapped up in the disorder, can be as confusing for families as for the individual suffering from it.

The disease can be devastating to loved ones, who can’t compel changes in a bulimic’s behavior, not even by forcing the sufferer to get counseling. The disorder may also go unrecognized because, unlike an anorexic, a spiraling bulimic often maintains a normal body weight, so she’s difficult to spot, says Hug-English.

While bulimia is an isolating disease, statistically Sally’s not alone. She has not been diagnosed with an eating disorder or a drug addiction, despite so many obvious warning signs. It is estimated that half the people who suffer from eating disorders do not seek treatment. Some studies have found that 8 to 10 million people are now suffering from anorexia nervosa, bulimia nervosa and binge eating. The net of these disorders is widening. Where it once was associated only with teenage girls, experts are now finding girls as young as 5- and 6-years-old with life-threatening cases.

“Bulimia is very common,” says Hug-English. “We’re only seeing the tip of the iceberg to what’s out there.”

Sally developed poor eating habits and became self-conscious about her body when she was quite young. She describes herself as being “really, really” heavy in sixth grade, even though her pediatrician at the time told her she was the perfect weight for her height.

“When I lived with my mom, she pretty much locked us in the basement,” says Sally, her blond hair pulled back in a pony tail. “We had our own kitchen and everything down there, so all me and my sister did was eat all day long.”

Her twin sister, Jane, stayed slim, the result of her own battles with an eating disorder, while Sally put on the pounds.

Sally tried to shed inches by taking the family dog for a run every night, sometimes for several hours. But the balance on the scale did not start to move left until the drugs came into play. Now, instead of being made fun of, people tell her she looks great.

“I’m not proud of it; I didn’t do it the natural way,” she says. “It really does suck. It sucks having to live in today’s world where you have to fit in with everyone—looks, what you wear, how your hair is. I used to not care. For some reason, I care quite a bit now.”

Fitting in has not come without cost or risk.

It takes eight Coricidin tablets to get messed up, Sally says. She now pops up to 36 at a time—enough to keep her strung out for two days.

The warning on the back of a Coricidin box reads, “Taking more than the recommended dose may cause liver damage.”

When Sally returns after one of her frequent two-day runners, her sister always lectures her.

“My sister tries to be supportive, but she’ll do it in a mean way,” Sally complains. “She just doesn’t know how to do it right. I try to stay away from the house because I get a lot of shit for everything I do with my life.”

Jane is not so sure the problem lies with the food.

“I see her eat all the time,” Jane says. “I don’t think she’d be throwing her food back up. She just drinks a lot, parties a lot.”

Sally’s teenaged hell is a lonely place few can enter. She’s been throwing up for about a year-and-a-half, but only in the last two weeks has she considered it might be becoming something bigger than she can manage on her own.

Two days ago, she confessed to two friends she thought she may have an eating disorder. She doesn’t know where the answer to all her problems begins, but it wasn’t Paxil, which she stopped taking recently, because she was scared she’d get hooked. She wants to seek help, but she also wants to be drug-free first.

“Last week, I didn’t eat for the whole week because I couldn’t keep anything down,” she says. “I don’t know, I’ve been doing a bit better for the last couple days and able to eat some stuff, but I have to wait until I’m like completely sober to do it.”

Editor’s note: To protect the privacy of the family, the names of family members have been changed.