Julia, an 18-year-old from Arroyo Grande, got to know her friend ED during her sophomore year of high school.

She and her family had moved to Avila Beach from Arroyo Grande at the beginning of that school year, and she was becoming more and more isolated. On Valentine's Day, her boyfriend broke up with her. Julia took it hard because he was the only one she felt she could trust.

ED told her that if she could listen to him and trust him, she would be OK. He was reassuring, at first.

But ED became more and more demanding. Julia began starving herself to death in an effort to avoid the shame she felt when she didn't do what he said.

Julia was diagnosed with anorexia at the end of her sophomore year in May 2006. Her friend “ED,” or her eating disorder, was revealed to be a false friend. But it took her a while to separate herself from him.

She checked in to the Central Coast Intensive Outpatient Eating Disorder Program (commonly called IOP) in San Luis Obispo, and was given one week to stop losing weight, or she would have to go to Stanford Hospital. It was at the IOP that she learned “ED's” true nature.

“I didn't care if I lived or died,” Julia said. “It took too much energy to think about purposefully hurting myself.”

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Julia didn't have to go to Stanford at the end of the week, and began group therapy in San Luis Obispo, as well as sessions in Los Olivos, with registered dietitian Francie White.

White is the owner of the Central Coast IOP, and specializes in eating disorders.

Terry White, clinical director for the Central Coast IOP program and Francie's husband, said it takes a certain combination of factors to result in anorexia - a genetic predisposition in the individual, a perfectionistic, extrovert-focused culture, and traumatic or unhealthy circumstances or environment.

Holli Stewart, director of Dr. Holli Stewart and Associates Counseling and Psychotherapy and a specialist in eating disorders, said anorexia is encouraged by cultures that focus on an artificial body image. “It's certainly a societal thing, because we see it more in our culture than any other culture,” Stewart said.

Terry White said students in their first year of college have the highest statistical incidence of eating disorders. Stewart said she often sees cases starting in puberty.

“Puberty is a developmental age,” Stewart said. “Our brain is changing. Also, in our culture, youth are becoming aware of who they are (and) where they are in relation to others.”

Stewart said the causes tend to be multidimensional, and caused or aggravated by “the personality of the individual, the culture, the family, the friends, and how they interpret” the messages from those sources.

Francie White said anorexics tend to be introverts.

“As introverts, they don't feel seen, and anorexia can be a way of getting attended to,” Francie White said.

She blames a culture that is fragmented and competitive, and that “externalizes” life's problems by offering a solution outside the consumer in the form of a product.

“For the most part, there's sort of this standard that we're supposed to be happy, and if we're not, we take Prozac,” Francie White said. “The truth about life that the advertising doesn't allude to is it's a journey, and it involves great amounts of suffering or loss Š never mind the whole media setting a standard for weight that's impossible.”

According to Stewart, treatment for anorexia often involves addressing other issues such as other mental disorders and substance abuse. Anxiety and depression tend to be common in anorexics, so that SSRIs (selective serotonin reuptake inhibitors), a type of antidepressant, are sometimes prescribed by a psychiatrist.

Francie White said cognitive behavioral therapy is important to change erroneous core beliefs, such as “My worth is based on being thin,” and replacing them with beliefs such as “I have worth no matter what. I am a completely worthwhile, lovable human being.”

According to Francie White, a patient with anorexia needs a team composed of a physician, a psychotherapist, a registered dietitian, and sometimes a psychiatrist.

Nutrition therapy is necessary so the anorexia patient can be in good enough shape physically to go through therapy, Francie White said. The physician monitors the patient's physical condition and weight changes to make sure he or she is medically stable.

An Intensive Outpatient Program involves nine to 15 hours of therapy a week at the program's facilities. Outpatient care involves keeping the patient at home and working with the patient outside a facility. Inpatient care involves keeping a patient in a hospital or other institutional setting for 30 to 90 days.

Julia stayed at home with her parents while undergoing treatment. When her friends visited, they read magazines and watched movies. She wasn't allowed to do any strenuous physical activity.

She couldn't play tennis, her favorite sport, in the winter after she returned to school in the fall. But in her senior year, she got better and excelled in the sport.

Julia wants to go to Cal Poly and live in the dorms this fall. She's thinking of majoring in animal sciences, because she loves animals, or teaching, because she loves children.

She stopped going to church for a while, but has since regained her faith in God. She also has more faith in herself.

“Looking back, I'm kind of a better person,” Julia said. “I just have a way better sense of self.”

She learned that the people who love her would always be there for her, no matter what. And she's glad she's gone through anorexia and come out on the other side.

“I have total faith that it's going to work the way it's supposed to,” Julia said. “Looking back, it's like, why would you ever choose that other life?”

FYI:

Anorexia nervosa is a serious, potentially

life-threatening eating disorder characterized

by self-starvation and

excessive weight loss.

About 10 percent of patients with eating

disorders are male.

Nearly 10 million women and 1 million men in the United States suffer from an eating disorder.

Anorexia nervosa has the highest

premature mortality rate of any psychiatric disorder.

- Source: The

National Eating Disorders Association

Where to get help:

If you think someone you know has an eating

disorder, it's important to get professional help immediately.

The National Eating Disorders Association has an Information and Referral Help-line at (800) 931-2237. Information is also available at www.nationaleatingdisorders.org.

The Central Coast IOP can be reached at 688-5057, or by visiting www.centralcoastiop.com.

Dr. Holli Stewart and Associates Counseling and

Psychotherapy can be reached at 925-0898.

EDITOR'S NOTE:

“Julia's” name has been changed to protect her privacy.

Bettina Adragna can be reached at 739-2220 or at badragna@santa mariatimes.com.