"It started out as me just wanting to get better for the next track season," Ouillette says. "And then I wanted to lose weight, and lose more weight. I'd ignore my body when it'd say it was hungry."

When she finally went to the doctor, she weighed 98 pounds. And her mom, Robin, says Teri was confused, indecisive and would "cry at the drop of a hat."

Teri Ouillette is one of an estimated five million American men and women who may suffer from the psychiatric illnesses anorexia nervosa, bulimia nervosa and binge-eating disorders, according to the American Anorexia Bulimia Association.

During National Eating Disorders Awareness Week Feb. 25 through March 4, physicians and researchers at the University of Michigan Health System are encouraging everyone to learn and recognize the signs of eating disorders and make sure loved ones find the help they need to get better, including a new counseling program at the U-M.

"Eating disorders kill people," says David Rosen, M.D., M.P.H., director of the Teenage & Young Adult Health program and clinical associate professor of pediatrics and communicable diseases at the U-M Health System. "I think that in the public's view of mental health conditions, many people think depression kills more people because they commit suicide, or that schizophrenia kills people because people who are psychotic sometimes do very dangerous things.

"The reality is that eating disorders kill more people than all of the other mental health conditions combined."

Contrary to what some may think, Rosen says eating disorders are much more common now than they have been in the past. "We're not sure exactly why that is, whether or not we're just finding them better or whether they actually are increasing in frequency over what they have been in the past," he explains.

The two most common eating disorders are anorexia nervosa and bulimia nervosa.

Anorexia nervosa is marked by the desire for thinness that leads to voluntary starvation -- sufferers tend to believe they are overweight even though they may be very thin. Anorexia nervosa tends to afflict younger women. "The books say 14 years old, but we're seeing them at ages 10, 11, 12, 13, and then we see anorexia again start showing up at around age 18," Rosen says.

Bulimia nervosa, sometimes called the binge/purge syndrome, is a disorder in which a person eats convulsively and then eliminates the food by self-induced vomiting, laxatives, fasting or excessive exercise. Bulimia nervosa tends to afflict older teenagers around the ages of 17 and 18, Rosen says.

New research is showing that eating disorders may arise, at least in part, due to a person's genes. "Some people are actually predisposed to the development of eating disorders," Rosen says. "The pathway by which any one person develops an eating disorder is going to be unique. It's going to be based on genetic factors, family factors, personality factors. And then, of course, I don't want to exclude the role that society, culture and the media play in purporting a thin ideal that is unachievable, but that young women aspire towards."

Early signs and symptoms that someone has an eating disorder may include starting to count calories and fat grams or eliminating certain classes of food altogether, such as fat or carbohydrates. Later signs may include obvious weight loss, the need to go to the bathroom after every meal, a dramatic and obvious change in eating habits and choosing not to eat around others anymore.

"By the time patients are having symptoms, by the time they're complaining of dizziness, of hair loss, of dry skin or constipation, by the time somebody's menstrual periods are gone, that's already too late," Rosen says. "That's somebody whose body has already started to show the signs of severe malnutrition and who we wish we could have gotten to sooner."

If you're concerned you or someone you know may have an eating disorder, find professional help to sort things out, Rosen says. If you know for sure that someone has an eating disorder, seek out assistance because it is likely to progress. The longer the eating disorder is present, the harder it is to provide effective treatment, he adds.

Currently underway at the U-M Women's Identity Intervention Program is a research project designed to test a new type of counseling to decrease symptoms of anorexia nervosa or bulimia nervosa and to improve health and well being in women with these disorders. For more information about the study, call 1-800-742-2300, category 2200.

"Many of the folks who go on to develop eating disorders start out in pursuit of some health goal, whether it's weight reduction or a healthier diet," Rosen says. "What suggests an eating disorder is when those efforts start to be maladaptive, when those efforts start to make you feel worse instead of better, when those efforts get out of control, or when you feel like you've lost control over what's happening to you."

Teri Ouillette knows those feelings. She would do exercises every night before bed, "and I felt like I had to do it, and if I didn't, I'd feel really bad about myself. I was really stressed out all the time. I started not wanting to hang out with my friends. I felt really tired and I was really sore from running so much. I felt really weak and my head felt cloudy all the time."

She knew she had a problem when everyone else around her was eating and drinking and, for some reason, her body kept telling her she couldn't have it. "I started thinking it was unfair, and I wanted it, so that's kind of what made me think I had a problem."

Ouillette finally went to Rosen, who assured her that she did have an eating disorder. Help from Rosen as well as a therapist has given Ouillette her life back.

"I feel great now," she says. "I will eat anything. If my friends want to go out for pizza, I'll go out. I have a lot more friends now. I don't feel as withdrawn and I actually, I can pay attention to things now."

Rosen hopes that National Eating Disorders Awareness Week makes people realize that eating disorders are a real problem, that the problem often goes unrecognized, and that it doesn't get a lot of attention because people are ashamed of it.

"We really count on parents, on brothers and sisters, on friends, on boyfriends and girlfriends," Rosen says, "to help identify those who may be at risk and work towards, in a very loving way, getting them the help that they need to get better." - By Valerie Gliem

Facts about eating disorders:

· Experts say that they key issue in anorexia nervosa is not food, but is more directly related to the person's desire for attention or approval. People who develop the binge/purge pattern of bulimia tend to be perfectionists who strive to please others.

· Eating disorders go beyond the extremes of anorexia, bulimia and binge eating disorder. Dangerous fad diets are also widespread in this country, according to the American Anorexia Bulimia Association.

· Treatments for eating disorders may include medication, psychotherapy, nutritional counseling, group therapy or family therapy. In some cases, hospitalization may be recommended.

Related websites:

U-M Health Topics A to Z: Anorexia - What is it?

U-M Health Topics A to Z: Anorexia - How to treat it

U-M Health Topics A to Z: Bulimia - What is it?

U-M Health Topics A to Z: Bulimia - How to treat it

American Anorexia Bulimia Association, Inc.

Academy for Eating Disorders

National Association of Anorexia Nervosa and Associated Disorders

26-Feb-2001