Jeff Wurm calls them his "dark years." From 2001 to 2006, the Sacramento Air National Guardsman struggled with bulimia, a dangerous condition of self- induced vomiting that calmed his growing feelings of fear, anger and anxiety.
"I was having trouble dealing with my emotions," said Wurm, 52, who started dabbling in restrictive behavior in the mid-1990s. "If I had any negative feelings, I used my eating disorder to deal with that.
"I was getting deeper and deeper into my disorder. It was comforting me, but at the same time, it was killing me."
On a good day, he took in 1,000 calories, far below the amount needed to maintain or gain weight. After years of starvation and withdrawing socially, he eventually got help with the encouragement of his wife and co-workers.
"I lost those years, and I can't get them back," Wurm recalled. "A lot of that time is unclear to me. I lost so much weight that I'm not sure how I survived."
To Jennifer Lombardi, Wurm's addictive behavior is familiar ground. Herself a recovered anorexic, she is now executive director of the Sacramento-based Summit Eating Disorders and Outreach Program, where Wurm sought help.
The distraught faces on the other side of Lombardi's desk are getting more diverse. They're getting younger, they're getting older, they include more men, and they cross all socioeconomic and cultural boundaries. And there are simply more of them.
The rise in traffic to Summit's program is bittersweet. It means the health care community is doing its job of educating the public and getting more people in for help. But it also means the beginning of a scary and heart-wrenching process for families, especially when the patients are as young as 7 years old.
"When someone that young comes in, it's devastating," Lombardi said. "It breaks my heart."
Despite a national awakening to eating disorders following singer Karen Carpenter's death in 1983, eating disorders still have the highest death rate of any mental illness, with 10 percent of those diagnosed dying of the condition â" often from cardiac arrest or suicide.
Lynn Grefe, president and chief executive officer of the National Eating Disorders Clinic, said from 24 million to 30 million people in the nation have eating disorders of some kind. She said that to truly attack the problem health care professionals need more training to spot the symptoms.
"We don't know how many people die, because of heart failure or suicide, from undiagnosed or untreated eating disorders," Grefe said.
Summit, Northern California's only medically supervised outpatient clinic, offers treatment for eating disorders, including anorexia nervosa, bulimia and binge eating. Since its founding in 2000, the clinic's patient volume has grown to 50 to 60 patients on any given day, with patients coming from as far as Fresno and the Oregon border.
In the past 18 months, Summit opened satellite offices in Roseville and Fresno, and the patient load doubled.
While some of the surge is due to increased awareness about eating disorders, Lombardi thinks the cultural obsession with diet and exercise is creating a tripwire for restrictive behaviors.
In the past few years, breakthrough research has highlighted the biological processes at the root of eating disorders, shaping therapy and allowing patients to get insurance coverage for treatment, Lombardi said.
"Karen Carpenter certainly elevated these illnesses onto everyone's radar, but we know of instances of eating disorders dating to the 1300s, when nuns would restrict diet in devotion to God," Lombardi said.
The disorders are slowly becoming understood as medical conditions rather than simply emotional troubles or lifestyle choice.
"What we understand now is that there are certain factors that people are born with that put them at greater risk for developing eating disorders," she said. "We used to blame family or environment, but we're finding there's a predisposition toward anxiety and depression that leads to restrictive behaviors."
Personality traits and temperament also play a role, including conflict and harm avoidance, or a higher aversion to change or stress, and perfectionism, Lombardi said.
"The typical sufferer is high-achieving, likes to excel and make people happy," she said. "They use compulsive exercise or restricting eating to give them relief. It makes them feel less anxious and blots out the conflict."
Since contemporary culture rewards weight loss and shapely bodies, the dieting or exercise often starts small and snowballs, becoming a pattern of behavior, she said. Environmental stressors, such as relationship troubles, trauma or loss, or cultural pressure to be thin, add fuel to the fire.
Lombardi said dieting and exercise are similar to substance or alcohol abuse in the ways they affect the brain. The empty feeling in their stomachs and the release of exercise actually feel good to them.
Summit now has patients ranging from 7 to 67 years old.
"Most people imagine teenage girls, white and from upper-income households, but we're seeing a more diverse population," Lombardi said.
Lombardi is seeing more referrals from physicians, which means more health care professionals are seeing danger signs and asking more questions. But she's also seeing more patients at younger ages.
"We're admitting more middle school students," Lombardi said. "We've admitted more from that age in the last year than in the last three years combined. We're definitely seeing a trend toward younger children struggling."
She said the main precursor behavior for the youngsters is dieting.
"The tripwire is dieting, and when we look at what kids are being exposed to, there's no doubt they are being exposed to dieting behaviors at an earlier age, either through media or family," Lombardi said.
Grefe said younger people nationwide are developing eating disorders. She knows of 8-year-olds who are hospitalized and on feeding tubes. Older people are also being diagnosed more often, probably because of a lack of an earlier diagnosis or a relapse.
She said the next eating disorder that will be recognized by the health care community is binge eating, in which people secretly eat large amounts of food, but don't purge.
"We are getting this condition confused with the obesity situation," Grefe said. "This is a mental disorder. It's about how they feel about themselves, not about the food."
Summit first gets a patient medically stable, then unpacks the biological and psychological roots of the disease. Through therapy, the patients learn to decrease restrictive behaviors and cope with stress in a different way.
The clinic, which boasts a 65 percent to 70 percent graduation rate, offers an intensive outpatient program with individual, group and family therapy for nine hours a week. For more medically compromised patients, Summit has a "partial hospitalization" program of five days a week, 11 hours a day, under supervision of doctors and dietitians. They eat meals at the clinic, many times with family members, where they all learn healthy eating behaviors.
Some families from out of the area stay in nearby housing arranged for by Summit while their children get treatment.
Five warning signs of an eating disorder
1. Dramatic weight loss in a short amount of time
2. Change in behavior around food
3. Dramatic increase in exercise, despite illness or injury
4. Change of mood, including social withdrawal
5. Obsession or fascination with dieting or exercise, including rituals around weight loss
Source: Summit Eating Disorder and Outreach Program (www.sedop.org)
Glossary of disorders
Anorexia nervosa â" A serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.
Bulimia nervosa â" A serious, potentially life-threatening disorder characterized by a cycle of bingeing and compensatory behaviors, such as self-induced vomiting or laxatives.
Binge eating disorder â" Recurrent binge eating without the regular use of compensatory measures to counter the bingeing.
Source: National Eating Disorders Association (www.nationaleatingdisorders.org)
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