The muffled sounds of the mid-morning shuffle play out behind Erin Flannery, a third-year history major, as she sits cross-legged on a pillowed bench outside a campus cafe. She passes her drink between her hands, occasionally balancing it upon her knee. Flannery said that her sister, who struggled with anorexia nervosa, would go periods of time eating nothing, only chewing on gum and drinking excessive amounts of water.

A major factor in Flannery’s sister’s eating disorder was her experience in dance, and the expectations placed on many dancers to adhere to specific body type and aesthetic.

“In the dance world, especially in competitive dance, teachers are really interested in making you all look the same … and I think a lot of that correlates to weight,” Flannery said. “When you go on stage you wear the same makeup, the same hairstyle, the same hair clip … the same, the same, the same.”

Approximately 10 million women and 1 million men in the United States struggle with eating disorders like anorexia nervosa and bulimia nervosa, according to the National Eating Disorders Association. This does not include the number of individuals who suffer from binge-purging disorders, which can include things such as laxative abuse, as well as other forms of disordered eating.

A 2004 study published in the Clinical Journal of Sport Medicine concluded that eating disorders are more prevalent in elite athletes compared to the general population. It found that 20 percent of female elite athletes had an eating disorder, compared to 9 percent of the general female population. The numbers for male athletes were 8 percent versus 0.5 percent for the male population as a whole.

It is difficult to gauge the number of people who have eating disorders, however, not only because of the wide spectrum of disordered eating, but also because of the stigma attached to such illnesses. Many individuals do not seek out help, nor do many people recognize the development of an eating disorder or distorted body image. For some athletes, dieting, excessive exercise, and the desire to further push the physical self past its limits is not seen as a disorder, but as an undeniable part of the experience and lifestyle.

“We see a huge number of people … who have lost weight in such extreme ways through being more extreme in their exercise patterns and have really become medically unstable with super low heart rates, with bone loss, and a lot of medical complications,” Dr. Cynthia Kapphahn, medical director of the Comprehensive Eating Disorders Program at Lucile Packard Hospital said. “If anything, I think it’s worse [than in the past].”

Pressure for Perfection

For Joelle Maletis — a professional ballerina turned marriage and family therapist — the aesthetic of dance, and the pressure to surpass her own expectations of herself played heavily into her own struggle with eating disorders. Maletis struggled with anorexia nervosa and bulimia nervosa, as well as laxative abuse.

“[Perfectionism] became a huge force in everything I did,” Maletis said. “My strive for everything was to be the best — and it’s not that I wanted to be the best — but that was my role. Internally, I was numb. There was no feeling. This was a job and my job was to play a role … The standard was extremely high, and I didn’t know there was an option to not have those standards.”

Maletis, who retired from the professional world of ballet in 2007, said that her relationship with her body and with dance has been continually tumultuous. Maletis, a dancer since childhood, has not completely rid herself of body image issues.

“I would never want to go back to that place,” Maletis said. “I have no thoughts of it anymore. I have no desire to starve anymore. But is it still an issue? Yeah. Do I still have body dysmorphia … ? Yeah. Of course.”

Now that Maletis works as a therapist, she has become involved with working with people who struggle with eating disorders, including other athletes. Such work has allowed Maletis to better organize and make sense of her own history as well as the way she addresses the standards she lays out for herself.

“Because I understood [eating disorders], I could not just empathize but I could sympathize,” Maletis said. “It became a kind of rehab for me … I was really doing a lot of growth, looking at my own issues with perfectionism and control.”

In her work as a therapist, Maletis subcribes to a newer school of thought, which addresses eating disorders as an addiction. Whether disordered eating is related to addiction is disputed, but Maletis enters the debate from the perspective of someone who has dealt first hand with the issue.

“It is an addiction,” Maletis said. “You get addicted to starving yourself to death. The addictive piece came in for me with laxative abuse. Eventually you have to take more and more [laxatives], eventually you have to throw up more and more, eventually you have to not eat more and more to get the same results.”

Marsea Marcus, co-owner and therapist at Inner Solutions in Santa Cruz, which offers counseling services specializing in eating disorders said that “a lot of eating disorders start with someone innocently going on a diet” and that dieting “can be just like a gateway drug.”

Marcus, who like Maletis grappled with her own eating disorders, said that the way many individuals fall into an eating disorder is the allure of control.

“It’s sort of a high to lose weight,” Marcus said. “[It] makes you feel like you’re in control and that you’re doing something good or positive for yourself. You stop looking at things with a level mind.”

The Dancer Aesthetic

Among some athletes, there is disconnect between excellence and health. In order to improve the physical self and excel, the body has to be pushed to its limits. However, when performance is placed over health and disordered eating becomes an issue, the body cannot achieve athletes pushing themselves too far, exceeding their limitations, and sometimes leading to dire consequences.

Kapphahn said that eating disorders can inflict serious damage on the heart. As with excessive weight loss, heart rate will slow down as a protective measure in order to conserve energy. In addition, eating disorders can cause health problems such as internal bleeding from purging, tearing of the esophagus from forced vomiting and dehydration from laxative abuse. For young female athletes in particular, over-exercise combined with disordered eating can cause loss of menstruation and bone mass.

“The more weight you lose in a shorter period of time, the more problems,” Kapphahn said. “[Dieting] is a fine line people walk. It’s easy to lose perspective and easy to fall into more disordered eating.”

Christine Hassel, who leads a support group for people with eating disorders, explains that with eating disorders comes a level of “adaptation.” As people with eating disorders give themselves less and less, they learn to survive on less and less, perpetuating a cycle.

“It’s an unsustainable mindset,” Hassel said, “You can’t keep depriving yourself and then pushing yourself to increase demands and [the] challenges of your sport.”

Erin Flannery and her sister were both dancers. Flannery gravitated towards tap and jazz dance styles, while her sister focused heavily on ballet. Flannery attributes her sister’s struggle with anorexia to the pressure for dancers to uphold a specific physical ideal. Ballet has become synonymous with a particular aesthetic, as lean, petite, leggy young women grace the stages of many classical ballet dance companies.

The prevalence of this aesthetic can be seen in contemporary visual art as well, such as in the photography of the Ballerina Project. The project, which started as a blog and now sells prints, captures the physical body of the ballerina — elegant and waif-like — contrasted with images of the urban cityscape. The photographs are visually pleasing, but the bodies presented characterize the “uniformity” that Flannery vehemently expresses distaste for the same “uniformity” that many dancers struggle to meet.

Flannery said that the pressure many dancers feel to meet and maintain a certain body type or a specific aesthetic and uniformity is a result of the physical expectations placed on the young women. The studio Flannery danced at in her hometown required that at a certain level, the girls only dance in a sports bra and shorts.

Although this is not something particular to Flannery’s studio, it’s a standard style of dress that allows both instructors and audience members to see the ways in which the dancer’s body is moving. Still, it results in pressure on the dancers to adhere to a certain body type.

“[The instructors] are all about making you really tiny,” Flannery said. “And ballet in general is about making you as toned as possible.”

UC Santa Cruz modern dance instructor Rena Cochlin said aesthetic adds pressure on young dancers to adhere to a certain body type.

“In dance, it’s very clear,” Cochlin said over the hum of classical music slipping in under the door from the ballet class outside. “It’s basically a performing art, and what you see are bodies which are sculpted, and in my opinion look undernourished, especially in ballet, and that became a style in ballet. It bothers me, because unfortunately, that is still the style. I don’t particularly feel you have to be skinny in order to look good.”

Joelle Maletis, a professional ballerina turned therapist, said it is important to stress that healthy and skinny are not interchangeable, and that it is possible to be a dancer or an athlete without over-stepping what is natural.

“You can be a dancer, and you can be thin, and you can be healthy and you have something that precludes being an athlete,” Maletis said.

Cochlin, who said that although in the style of modern dance, disordered eating is not as prevalent as in such areas as ballet, she is nonetheless aware of the pressure that many dancers feel when it comes to their relationship to their bodies and their ideas of consumption.

“Some of [the pressure] may be due to the fact they’re being demanded to keep… an unnatural weight,” Cochlin said. “So their bodies rebel… they’re toying with something that’s natural and making it much more difficult than it should be.”

What needs to change in dance is the aesthetic, Cochlin said. With that comes change in the perception of what equates a good or accomplished dancer.

A key factor in changing the perception of the body for competitive dancers — as well as performers in other more subjective forms of performance and athleticism such as figure skating — is changing the way in which the sport is evaluated, Cochlin said.

“What I care about is the overall feeling, if they’ve been able to present something that is artistic,” Cochlin said. “I don’t care if the [athlete’s] so-and-so turn is perfect. That way of looking at movement is invalid for me.”

Tricking the Scales

It is not just dancers who are affected by a desire to maintain a certain body type. Athletes from many other areas are plagued with issues to maintain certain weight goals, or even gain weight to add bulk.

One sport often linked to issues with body weight, binge-purging, and other disordered eating is Greco-Roman wrestling.

Coach John Corona, who works at Santa Cruz High School and the West Santa Cruz Wrestling Club, has been coaching since the early ’80s and has seen how eating disorders manifest in the sport. Corona said that over the past few years, the sport has taken proactive steps to help eliminate the prevalence of disordered eating among young wrestlers who have — in the past — turned to extreme forms of dieting in order to make desired weight classes.

“Decades ago you’d see a student make weight and that was the goal,” Corona said. “That’s why in the last 10 years we’ve worked hard to get rid of that.”

Corona called eating disorders among athletes an “epidemic” and explained his own philosophy of addressing weight in a sport that categorizes itself by weight.

“We’re really… doing a disadvantage to the athlete by demanding [that they] lose excessive weight,” Corona said. “We are not a win-at-all-costs program… All these trophies and medals go into a shoebox in the end, and it’s what you do that you take with you.”

Although she is apprehensive to say that the prevalence of disordered eating in athletes has lessened, Dr. Cynthia Kapphahn, from Lucile Packard Hospital at Stanford, said she recognizes that there are some moves to make changes in the ways weight and body image are addressed.

“I do think there’s more and more coaches who realize that it’s important for athletes to eat normally,” Kapphahn said. “I think there’s at least a lot more discussion and awareness of the issues and coaches that are striving to be encouraging of their athletes to be at a normal weight.”

Nonetheless, not all coaches share Corona’s philosophy and instead turn a blind eye to the extreme lengths some athletes go to lose weight.

Anthony Salazar*, a sophomore in high school is a member of his school’s varsity wrestling team. He said that he and many of his peers will skip meals, take laxatives, run excessively, and even frequent saunas in order to shed a few extra pounds and make a desired weight class.

Although Salazar said he does not think it is normal to skip meals, it is something he feels like he has to do to make weight and that he does not have a choice in the matter. Salazar estimates he skips meals about three times a week.

“I don’t eat the day before [a match],” Salazar said. “I’ll eat breakfast, and that’s pretty much it. You’re hungry, but not to the point you can’t walk, but after the match you just want food.”

Salazar said that some wrestlers will “chew gum and spit to lose weight, [because] spitting gets rid of saliva and moisture.”

He admitted with hesitation that the coaches were not aware of the lengths some of the wrestlers were taking, including not drinking water before weigh-ins.

Salazar has taken laxatives, but he said he “would not take them again if he had to.” He said that he does not think of the consequences of his actions, or whether “it’s good for him or not.”

Kapphahn, who has worked with athletes coping with eating disorders, explained that eating disorders can manifest without the conscious recognition of the athlete.

“People who are athletes are oftentimes are just expecting really high things for themselves, and they’re expecting perfection even in their eating,” Kapphahn said. “They just lose track of when that becomes something that’s not healthy for them anymore.”

Weighty Consequences

Inside the Campbell office of the Eating Disorder Resource Center (EDRC), afternoon sunlight floods through large windows, the smell of coffee filtering through the air. Kenneth McCraney’s hands shake slightly as he talks. His speech warbles and is barely a whisper. His movements are lethargic and compact. His story of relapses into anorexia, and his daily struggle to overcome what has become a behavioral pattern for him unravels.

“Once I got like this, I couldn’t break the pattern. I was stuck,” McCraney said. “When I go to eat something, I have panic attacks.”

Age is imprinted on the face of McCraney, who at 61 continues to deal with the effects of his battle with disordered eating. McCraney has grappled with his personal demons throughout the years — from drug abuse to alcoholism. And as his body continues to deteriorate, he has become completely blind in one eye. Anorexia has been present throughout his life, and has led to the demise of personal relationships.

It is a black stain, a dark cloud that looms over his day to day.

With McCraney sits EDRC founder Janice Bremis, and Lisa*, who has anorexia and volunteers at the EDRC, both of whom have battled with anorexia. Bremis, tall and sinewy, leans forward as she discusses how she hopes to bring awareness, reach sufferers, and offer aid.

In contrast to Bremis’ openness sits Lisa, who speaks directly, her slightly raspy voice is sharp and her language clear and realistic. She explains the ways in which control has affected her relationship with her body and with consumption.

“You get down on yourself [when you eat], you get angry at yourself, and you feel out of control,” Lisa said. “It’s very perpetuating. Once the ball starts rolling, you can’t just stop. It’s really easy to get back into it. I struggle with it every day.”

It is this perpetuating factor that drives people like Bremis to offer help and services to others struggling with disordered eating.

“We’re all older, we’re all matured, but when I was young, I would have been scared [to get help],” Bremis said.

But it is important that those struggling with any form of disordered eating or body dysmorphia seek out help. As Bremis explains, “this isn’t just a phase or a fad,” and it is not an issue someone should address alone.

Lisa, whose life continues to be marked by anorexia, reflects on the long-term effects her disordered eating has had.

“You’d rather die. If you had to choose between dying and being thin, you’d die,” Lisa said. “You know when you’re younger, you have dreams and aspirations, [but] you’re not going to meet any of them. All you’re going to do is survive. You’re not going to thrive at all [when you live] with an eating disorder.”

~~~~~~u

*Names have been changed.