Part one in a series of two

“Once it gets to the point that you legitimately have an eating disorder, you don’t have a life. It takes everything from you.”

—-Janelle Leatherwood ’10

Eating disorders, and body image in general, are difficult things to talk about. No one wants to ask their recently slimmed-down friend if they are anorexic–conversely, no one wants to admit that they have a problem. In our sheltered bubble at Stanford, it’s easy to think that we live in an idyllic place where these “issues” don’t exist.

EATING DISORDER CARE TEAM

“Issues with body image and eating disorders are very much alive at Stanford,” said Dr. Naomi Brown, a psychologist with Counseling and Psychological Services (CAPS). “There is so much pressure and competition built in. And because of the climate, students can exercise all the time.”

Dr. Brown is in her 12th year at Stanford and serves as the psychologist on the three-member eating disorder care team at Vaden along with physician Dr. Robyn Tepper and nutrionist Vivian Crisman. They work in collaboration with the rest of the staff at Vaden to diagnose and help students who suffer from eating disorders.

“About 35-40 percent of the students I see each year are students with eating disorders or disordered eating,” Crisman said. “Just a handful of students leave each year. The vast majority are just those that struggle through.”

Disordered eating is a subclinical level of eating disorder, and can refer to a variety of unusual eating behaviors. Disordered eating can include an obsession with exercising or with avoiding high calorie foods. It can also include stress eating or covert binge eating.

“It is not unusual for students to come to me first,” Crisman said. “I am the least scary person to come to. From there, we discuss if they would be open to speaking to Dr. Brown.”

“I’m the go-to psychologist for students with disordered eating, eating disorders or body image issues,” Dr. Brown said. “Vaden doesn’t turn away anyone; we at least provide evaluation and assessment. But we are primarily a brief therapy outlet as opposed to long-term. We have to refer out most cases.”

But the team is working against structural issues, with the understaffed team unable to deal with the growing demand for their services.

“We don’t have enough resources at Vaden,” Dr. Brown said. “We need more eating disorder specialists. We need more nutrition hours. And we do not have the resources to do outreach because we are too busy in clinic, and so we have to depend on student groups.”

“We try to do the best we can with the resources we have,” nutritionist Vivian Crisman said. “It is a challenge with a half-time nutritionist position to serve 15,000 plus students, to do individual counseling and campus outreach.”

The limited resources available mean that it can sometimes take a student multiple weeks to get an appointment with Crisman, who is unable to take on more than a few regular patients. Dr. Brown faces the same problem.

To expand its outreach, the eating disorder care team works with each student to come up with the best individual course of treatment. For some students, this means referring them to an off-campus doctor for outpatient treatment. For others, this means checking in to an in-patient treatment facility. In the most extreme cases, the doctors are able to put a medical hold on the student’s academic standing, forcing them to take time away from school to get better.

DORM STAFF

The eating disorder care team at Vaden is not the only campus support group that has to refer eating disorder patients elsewhere. Former Bridge counselor Yasmine Hamdouche ’10 called The Bridge Peer Counseling Center a “referral organization.”

“In terms of eating disorders, the Bridge would just refer people right to CAPS,” Hamdouche said. “They don’t offer real advice, they just talk people through and listen. They do not want people to call back, they are not a consistent support organization.”

The Bridge is not the only student support group to refer affected students to Vaden. Peer Health Educators (PHEs) and Resident Assistants (RAs) are also instructed to refer their eating disorder cases to more experienced counselors.

“The big thing is refer, refer, refer,” said Sandra Yen ’10. “Refer to the nutritionist, refer to CAPS.”

Yen is currently serving as a PHE in east Flo Mo, and last year worked as an RA in Cardenal. Through her staff training, she has learned to recognize the symptoms of potentially unhealthy behavior. Fortunately she has not had to deal with too many students with eating disorders or body image issues in her time on staff.

“Nothing has gone overboard,” Yen said, “but there are just things that I have been trained to pay attention to. If someone is maybe working out too much, I’ll make a note of it.”

Yen also had some issues with students being concerned about gaining the “freshman 15,” but that is nothing compared to the experiences of a former RA in an all-freshman dorm, who asked to remain anonymous for this article.

“I probably had conversations with a dozen or so cases in my two years on staff,” the RA said. “At least three students went home. The University keeps this really hush-hush. RAs are instructed not to say anything to anyone because of confidentiality.”

This RA in particular felt that Stanford’s response to students suffering from eating disorders was inadequate.

“Stanford is a recipe for disaster,” the RA said. “You have a bunch of overachievers living in one place. You have lots of sunshine and lots of opportunity to look pretty. It is not in Stanford’s interest to help because they are not a long-term care facility, because they don’t have the resources.”

The lack of resources is a recurring problem within the eating disorder community. PHEs, RAs and Bridge counselors are instructed to refer students to Vaden, where the limited resources force the doctors to refer patients to expensive, off-campus doctors. All of these hurdles make the process of getting care very difficult for students looking for help.

“It often takes two to three weeks to see the nutritionist,” Crisman said. “That could present a barrier to getting students in when they are ready.”

TRUE STORY

Janelle Leatherwood ‘10

Janelle Leatherwood’s personal battle with eating disorders started after her freshman year of high school.

“I was not ever comfortable in my own skin,” Leatherwood said. “I had thought most of my childhood that I was overweight. Then I got sick at the beginning of sophomore year, and I got out of eating for like a week. I was elated that I didn’t have to eat. It was the best feeling in the world, like I was a new person.”

Leatherwood lost about eight pounds right away, and decided to become a vegetarian to give her an excuse to avoid eating most of the food her family ate. She also began to follow the Atkins diet, giving up carbohydrates.

“I always had an excuse for why I wasn’t eating something,” Leatherwood said. “My rules became a lot more strict as time went on.”

In the beginning, she would have two cups of coffee for breakfast, an apple or two sugar-free Redbulls for lunch, a peanut butter and jelly sandwich as a snack throughout the day and the smallest dinner possible. Then she began to plan to eat only in front of people, to minimize her meals. She would take breakfast from home and not eat it, and came up with excuses to get out of dinner.

“Subway for lunch would be my one meal every day,” Leatherwood said. “Then I started to get really weak and really sick, and I was still doing two sports. By winter, I started to look frightening. But I felt euphoric. I would lay in bed starving, so I would get up and exercise for hours.”

Leatherwood ended up losing about 30 pounds, and finally felt comfortable with her weight. However, Leatherwood developed a stomach ulcer from the dehydration and stress on her stomach and had to go to the hospital, where they told her she would need to be constantly eating to help her stomach heal.

“I had developed dizziness and heart palpitations,” Leatherwood said. “So many things were wrong with my body, but I felt great mentally. But I started eating because I couldn’t get away with not.”

That’s when the throwing-up started.

“I didn’t know how to eat like a normal person,” Leatherwood said. “Every time I ate I felt like I was going crazy. But once I’d eaten anything I’d be like ‘screw it,’ and I’d eat a lot and then throw it up.”

It began infrequently, but eventually progressed to the point where every time Leatherwood ate, she threw up. She would plan her day out so that she would be able to leave to throw up after each meal, and minimize her meals.

“It became so integrated into my life,” Leatherwood said. “That was just how I controlled my emotions. If I was disappointed, I ate something and threw it up. I couldn’t let people know I wasn’t perfect. The most I ever threw up in a day was probably ten to twelve times. By senior year, I was throwing up usually at least twice a day. I knew which foods were easier to throw up.”

Leatherwood was also exercising daily and reading about eating disorders. That’s when she got into Stanford. She knew that things had to change.

“I just had to make myself better enough to go to Stanford,” Leatherwood said. “High school was easy; I had the free time. My every waking thought was about food, exercise and calories. I couldn’t do things beside that. I didn’t want to be that person in college. I thought it was my chance for a fresh start.”

Leatherwood would force herself to eat, and then distract herself from the urge to throw up by going for walks or reading. Each day that she went without purging, she would put a sticker on her calendar. Eventually, she was eating three meals a day, and keeping them down.

“It’s a decision every day to eat and not throw up,” Leatherwood said. “I have a relapse every once in awhile, but it’s very rare. But sometimes I can’t think about anything else, and I want to go on with my life, so I make myself throw up.”

Now, Leatherwood studies eating disorders and does research on eating disorder patients for a clinic. She has also worked with student groups on campus focused on helping Stanford students with body image issues.

“I am much better for the effort that I make everyday to be better,” Leatherwood said. “Part of my getting better is letting people know.”

Check out Part 2 in “TRUE LIFE: I have an eating disorder” in tomorrow’s issue of The Daily.