Parent writes in to say that vitamin C and niacinamide were very helpful in treating hyperactivity in her son with ADHD.

Natural Alternatives for ADHD

Gail from Canada writes:

"I hope you don't mind me e-mailing you about your son as I too had a son with the same problem. He is now 29 and doing very well. Here is what I did.

I was the president of the Association for Children with Learning Disabilities here in British Columbia and when my son was just starting school (in grade one) my family  doctor suggested that I put Darrin on Ritalin (which is the drug used here for hyperactive kids).   Instead, I went to every lecture through the Health and University system that I could and came to the conclusion that drugs didn't help. It broke my heart to see these kids (who were on the drugs) up on a stage trying to do the different tests that were put to them. So I looked for a different solution. It was through two learning assistant teachers that I found a solution:

1. I took Darrin off of all food colouring and of course sugar and this helped somewhat.
2. Then I took him to a  doctor in Victoria that specialized in hyperactive kids. This is where the breakthrough occurred.

Dr. Hoffer put Darrin on Vitamin C and Niacinamide (a form of B3). He started out on 500 mg - 3 times a day of each. And then we slowly increased the amount to 1000mg - 3 times a day of each. Before this took place, Darrin was not only hyperactive but also had a reading disability. I thought he could read but he was getting other kids to read to him and then he was memorizing the pages. Nothing wrong with the kids brain.

Well after taking the vitamins for a couple of weeks, he settled right down and to my surprise he started reading. By the time that all this took place, he was in grade four and a lot of damage had been done to his self-esteem. You know the old story of how they think they are dumb. Well, let me tell you, that Darrin completed grade one, two, three and half of grade four that year. We were all elated.

I remember back to when I was in school and there would be maybe 5 or 6 children with learning disabilities and now there are so many. You have to ask yourself - why? If they can't find anything physical i.e. ears - eyes - brain, then what is causing it? As one specialist from New York described it, it is like having measles on the brain and it needs scratching. And I found that the vitamins got rid of the itch.

If you would like more info from the doctor here, I could send his mailing address. But please try this with your son. These vitamins are non-toxic and will pass through the body - the body will only keep what it needs."

Editor's Note: We have recently been advised of some concerns regarding Vitamin C and adverse effects at high doses. We have taken some extracts about this from cspinet.org

"The current Daily Value is 60 mg, but some vitamin-C experts think that intakes should be at least 100 mg or, more likely, 200 mg.

If you eat the eight to ten servings of fruits and vegetables a day that we recommend, you should get at least 200 mg. So far there is no Upper Tolerable Intake Level (UL) for vitamin C. It should be 1,000 mg a day, some argue, because more than that may raise the risk of kidney stones."

Please remember, we do not endorse any treatments and strongly advise you to check with your doctor before using, stopping or changing treatment.

teenage sex

Are you trying to decide whether it's right for you to have sex? You're not alone. Many teenagers feel pressure to have sex from both their peers and the media; to "do what everyone else is doing." And this sometimes makes the choice a hard one.

Sometimes it might seem like everyone in school is talking about who's a virgin, who isn't, and who might be. For both girls and guys, the pressure can sometimes be intense.

But deciding whether it's right for you to have sex is one of the most important decisions you'll ever have to make. Each person must use his or her own judgment and decide if it's the right time - and the right person.

This means considering some very important factors - both physical ones, like the possibility of becoming pregnant or getting a sexually transmitted disease - and emotional factors, too. Though a person's body may feel ready for sex, sex also has very serious emotional consequences.

For many teens, moral factors are very important as well. Family attitudes, personal values, or religious beliefs provide them with an inner voice that guides them in resisting pressures to get sexually involved before the time is right.

Peer Pressure Problems and Movie Madness

Nobody wants to feel left out of things - it's natural to want to be liked and feel as if you're part of a group of friends. Unfortunately, some teens feel that they have to lose their virginity to keep up with their friends or to be accepted.

Nobody wants to feel left out of things - it's natural to want to be liked and feel as if you're part of a group of friends. Unfortunately, some teens feel that they have to lose their virginity to keep up with their friends or to be accepted.

It doesn't sound like it's all that complicated; maybe most of your friends have already had sex with their boyfriends or girlfriends and act like it isn't a big deal. But sex isn't something that's only physical; it's emotional, too. And because everyone's emotions are different, it's hard to rely on your friends' opinions to decide if it's the right time for you to have sex.

What matters to you is the most important thing, and your values may not match those of your friends. That's OK - it's what makes people unique. Having sex to impress someone or to make your friends happy or feel like you have something in common with them won't make you feel very good about yourself in the long run. True friends don't really care whether a person is a virgin - they will respect your decisions, no matter what.

Even if your friends are cool with your decision, it's easy to be misled by TV shows and movies into thinking that every teen in America is having sex. Writers and producers may make a show or movie plot exciting by showing teens being sexually active, but these teens are actors, not real people with real concerns. They don't have to worry about being ready for sex, how they will feel later on, or what might happen as a result. In other words, these TV and movie plots are stories, not real life. In real life, every teen can, and should, make his or her own decision.

When you're a teen, there can be a lot of pressure to have sex.

Boyfriend Blues or Girlfriend Gripes

Although some teens who are going out don't pressure each other about sex, the truth is that in many relationships, one person wants to have sex although the other one doesn't.

Again, what matters most differs from person to person. Maybe one person in a relationship is more curious and has stronger sexual feelings than the other. Or another person has religious reasons why he or she doesn't want to have sex and the other person doesn't share those beliefs.

Whatever the situation, it can place stress and strain on a relationship - you want to keep your boyfriend or girlfriend happy, but you don't want to compromise what you think is right.

As with almost every other major decision in life, you need to do what is right for you and not anyone else. If you think sex is a good idea because a boyfriend or girlfriend wants to begin a sexual relationship, think again.

Anyone who tries to pressure you into having sex by saying, "if you truly cared, you wouldn't say no," or "if you loved me, you'd show it by having sex" isn't really looking out for you and what matters most to you. They're looking to satisfy their own feelings and urges about sex.

If someone says that not having sex after doing other kinds of fooling around will cause him or her physical pain, that's also a sign that that person is thinking only of himself or herself. If you feel that you should have sex because you're afraid of losing that person, it may be a good time to end the relationship.

Sex should be an expression of love - not something a person feels that he or she must do. If a boyfriend or girlfriend truly loves you, he or she won't push or pressure you to do something you don't believe in or aren't ready for yet.

Feeling Curious

You might have a lot of new sexual feelings or thoughts. These feelings and thoughts are totally normal - it means that all of your hormones are working properly. But sometimes your curiosity or sexual feelings can make you feel like it's the right time to have sex, even though it may not be.

Though your body may have the ability to have sex and you may really want to satisfy your curiosity, it doesn't mean your mind is ready. Although some teens understand how sex can affect them emotionally, many don't - and this can lead to confusion and deeply hurt feelings later.

But at the same time, don't beat yourself up or be too hard on yourself if you do have sex and then wish you hadn't. Having sexual feelings is normal and handling them can sometimes seem difficult, even if you planned otherwise. Just because you had sex once doesn't mean you have to continue or say yes later on, no matter what anyone tells you. Making mistakes is not only human, it's a major part of being a teen - and you can learn from mistakes.

Why Some Teens Wait to Have Sex

Some teens are waiting longer to have sex - they are thinking more carefully about what it means to lose their virginity and begin a sexual relationship.

For these teens, there are many reasons for abstinence (not having sex). Some don't want to worry about unplanned pregnancy and all its consequences. Others see abstinence as a way to protect themselves completely from sexually transmitted diseases (STDs). Some STDs (like AIDS) can literally make sex a life-or-death situation, and many teens take this very seriously.

Some teens don't have sex because their religion prohibits it or because they simply have a very strong belief system of their own. Other teens may recognize that they aren't ready emotionally and they want to wait until they're absolutely sure they can handle it.

When it comes to sex, there are two very important things to remember: one, that you are ultimately the person in charge of your own happiness and your own body; and two, you have a lot of time to wait until you're totally sure about it. If you decide to put off sex, it's OK - no matter what anyone says. Being a virgin is one of the things that proves you are in charge, and it shows that you are powerful enough to make your own decisions about your mind and body.

If you find yourself feeling confused about decisions related to sex, you may be able to talk to an adult (like a parent, doctor, older sibling, aunt, or uncle) for advice. Keep in mind, though, that everyone's opinion about sex is different. Even though another person may be able to share useful advice, in the end, the decision is up to you.

next: It's Okay to Say: No Way! to Teen Sex

sex therapy

What is sex therapy?

Sex Therapy is a professional and ethical treatment approach to problems of sexual function and expression. It reflects the recognition that sexuality is of legitimate concern to professionals and that it is the right of individuals to expert assistance with their sexual difficulties. Sex therapy, then, is the focusing of specialized clinical skills on helping men and women as individuals and/or as couples to deal more effectively with their sexual expression.

Why is sex therapy necessary?

Sex therapy is the result of relatively recent scientific attention to human sexual function and dysfunction. Out of the increased knowledge of the physiology and psychology of human sexual behavior has come a new professional appreciation for human sexual response. At a time in our society when sexuality is being more openly discussed, we are beginning to realize how uninformed many people really are about this important personal topic.

The importance of sexual function for individuals varies, of course, but for many it is closely tied in with their total concept of self identity. For these, problems in sexual function may lead to devaluation of self - "When I cannot feel good about my sexuality, how can I feel good about myself?" We are also in a time when marital and family units seem to be quite vulnerable. Concepts of these traditional relationships are being reevaluated, challenged and restructured. Alternatives to marriage are now being more openly tried and are becoming more widely accepted than at any other time in our history. Regardless of the structure of the intimate relationship shared, sexuality serves a valuable function for most couples. It becomes an expression of caring, not only for the partner, but for oneself. It can become a powerful bonding element in a relationship, which, in today's society, must withstand considerable demands on time, energy and commitment. Dissatisfaction with the sexual relationship and the loss of that shared intimacy, in many instances, may lead to negative feelings and attitudes which are destructive to the relationship. Many marriages end therefore, because of unresolved sexual differences and difficulties.

Who goes for sex therapy?

The sex therapist works with a wide variety of problems related to sexuality. People seek help with such problems with arousal (impotence and frigidity), as well as problems with orgasm (either inability to climax or the inability to control ejaculation). In addition to seeking medical evaluation and treatment, many people who experience painful intercourse also seek the assistance of a sex therapist. Couples often seek help when it becomes apparent that differences exist in their sexual desires or when they sense that their sexual relationship is not growing as they would wish. The need for additional information, more effective verbal/physical communication, and for sexual enrichment lead many couples to the sex therapist's office in their quest to enhance their intimate relationship.

The qualified sex therapist is also available to those wishing to resolve troublesome sexual inhibitions or change undesirable sexual habits. People with questions about their sexual identity or sexual preferences seek out the trained sex therapist for consultation. Parents consult the therapist about the sexual curiosity and experimentation of their children and seek insight into ways to foster the healthy development of their youngsters through effective sexual education in the home. Sex therapists also assist those experiencing sexual difficulties as a result of physical disabilities or as the consequence of illness, surgery, aging or alcohol abuse.

How does sex therapy differ from other therapies?

Sex therapy employs many of the same basic principles as the other therapeutic modalities, but is unique in that it is an approach developed specifically for the treatment of sexual problems. That is, sex therapy is a specialized form of treatment used with one aspect of the wide range of human problems. Herein lies its value and also its limitation! Sex therapy techniques, when applied by an unskilled counselor or therapist, might focus too readily on mechanical sexual behavior, to the exclusion of the total individual and the total relationship.

Are there limitations?

As with any therapy for personal or behavioral difficulties, sex therapy has its limitations. Although usually brief and effective with most sexual concerns, sex therapy does not offer a miracle cure for all interpersonal problems.

Success of treatment depends upon many factors, not the least of which are the nature of the problem, the motivation of the patient, the therapeutic goals and the therapist's skills. The motivated prospective patient and/or couple should choose a therapist carefully and establish realistic goals early in the counseling.

If you are not comfortable with your therapist or feel that the therapist has set unrealistic performance goals for you, discuss these concerns with him/her. All therapy depends upon trust and mutual respect, but this is particularly true when working with intimate issues of sexuality.

How do you know if a sex therapist is qualified?

One must realize that with any new field, a variety of definitions and expectations will exist for a time, and that a wide variety of people will claim expertise in accordance with their own definition of the field. The expectations presented here might be criticized by some as too rigid, but it is purposefully intended to present a fairly strict set of guidelines for selecting a sex therapist. Very few states license sex therapists, so the client must exercise caution and must choose wisely!

Five criteria need to be met in choosing a sex therapist. First of all, the therapist must have a sound knowledge of the anatomical and physiological bases of the sexual response. The sex therapist may, therefore, have a basic medical background or may come out of another non-medical profession but with post-graduate education in the biological aspects of human sexuality. A qualified non-medical sex therapist will usually work closely with physicians or may function as a non-physician in a medical clinic or university school of medicine.

Secondly, the qualified sex therapist must be skilled in providing counseling and psychotherapy, and most sex therapists will be found to have a sound background in psychology, psychiatry, psychiatric social work or psychiatric nursing. This background in the behavior sciences is essential to the understanding of the total individual and to the planning of an individualized treatment program. There are, however, some notable exceptions to the rule that a sex therapist should have a traditional mental health training background, in that there are also highly respected and well-trained sex therapists who began as clergy. These clergy, however, need to demonstrate specific post-graduate training in pastoral counseling or in equivalent psychiatric mental health areas.

The third criterion is that the sex therapist, having both biological and psychological sophistication, must be able to demonstrate extensive post-graduate training specifically within the areas of sexual function and dysfunction, sex counseling, and sex therapy. A weekend workshop or possession of a few sex therapy films does not meet this criterion, and the prospective client should feel free to ask for a list of specific training experiences in these specialized areas.

The fourth requirement to be met is that of having expertise in relationship counseling. That is, the sex therapist should also be a skilled marital, family and/or group therapist. In order to work effectively with sexual problems, the sex therapist must be able to work effectively with non-sexual relationships as well. Sexual behavior does not occur in a vacuum - it occurs within a relationship! The total relationship must, therefore, be accurately evaluated and treated.

The fifth requirement is the therapist's adherence to a strict code of ethics! Prospective clients have the right to request a copy of the therapist's ethical code before agreeing to any treatment.

How do you find a qualified sex therapist?

Most qualified sex therapists do not depend on ads in the newspaper, as most professionals have made themselves and their credentials known to other professionals in the community. If you need a sex therapist, you might begin by consulting your family physician, gynecologist or urologist. Ask for a referral to someone your doctor has used confidently in the past. In addition to this, you might be inclined to ask a trusted clergyman for a referral. As you begin to collect information about available resources, you might then wish to turn to the telephone directory Yellow Pages, looking under such headings as "Psychologist," "Social Workers," "Marriage and Family Counselors," and elsewhere. Remember, there is probably no legislative control of the title "Sex Therapist" in your state, so simply finding the title in the phone book does not document that individual's clinical skills! In all states, however, licensing laws control who can list as a "Psychologist" or as a "Physician." A small number of states now also restrict the listings of "Social Workers" and/or "Marriage Counselors."

When calling a professional, be sure to ask questions about qualifications, experience and fees! It is recommended that you call and ask, "Do you have a specialty?" rather than stating, "I have a sex problem - can you help?"

Perhaps the most useful referrals will come from other knowledgeable professionals within your community. However, it is also helpful to be able to discover which therapists belong to recognized national professional associations having high membership requirements and enforcing rigid codes of ethics. Specifically, The American Association for Marriage and Family Therapy (AAMFT) is a national professional association which credentials marriage and family therapists and which would provide a list of its clinical members in your geographical area. More specifically, The American Association of Sex Educators, Counselors and Therapists (AASECT) is the largest national group which certifies sex educators, sex counselors and sex therapists. You can learn the names and addresses of the certified professionals in your area by writing to this association. AASECT will also provide you with a copy of their Code of Ethics for Sex Therapists upon request. Addresses for AAMFT and AASECT are provided at the end of this page.

What can I expect in sex therapy?

Even qualified sex therapists may differ widely in their basic approaches to the treatment of sexual problems, but some generalizations can be made.

First of all, you can expect to be talking explicitly and in detail about sex. One cannot solve sexual problems by talking around them! Neither can one gain new sexual information unless clear, direct instruction is given!

Second, you might expect to be offered the opportunity to add to your knowledge by reading selected books and/or viewing clinical films designed specifically for use in sex therapy. You should not, however, do anything which you do not understand, and you must reserve for yourself the right to question the purpose of an assignment. It is your right to decline or postpone acting on the suggestions of your therapist, rather than allowing yourself to be pushed into behavior which might actually increase your discomfort. Every assignment, task, or experience presented by the therapist should fit into an understandable and acceptable treatment plan - and you have the right to question the procedures.

Third, you should expect sex therapists to be non-judgmental and to portray their own comfort in giving and receiving sexual information. While you might expect to be challenged and confronted on important issues, you should also expect to experience a respectful attitude toward those values which you do not which to change.

Fourth, unless your therapist is a licensed physician wishing to conduct a physical examination, you should not expect to be asked to disrobe in the presence of your therapist. Sexual contact between client and therapist is considered unethical and is destructive to the therapeutic relationship. Neither should you expect to be required to perform sexually with your partner in the presence of your therapist. Overt sexual activities just should not occur in your therapist's presence, even though the talk, material and the assignments must, by the nature of the problem, be specifically sexual and at times bluntly explicit.

Finally, you should feel that you are heard and adequately represented in your sexual therapy. That is, you should that you have been stereotyped as "female," as "gay," as "too old," or in any other way that interferes with your sense of unique identity within the therapeutic setting. You should feel that you are being treated as an individual, not as a category!

Sex therapy is a new, dynamic approach to very real human problems. It is based on the assumptions that sex is good, that relationships should be meaningful, and that interpersonal intimacy is a desirable goal. Sex therapy is by its nature a very sensitive treatment modality and by necessity must include respect for the client's values. It must be nonjudgmental and non-sexist, with recognition of the equal rights of man and woman to full expression and enjoyment of healthy sexual relationships.

For more info:

American Association for Marriage and Family Therapy (AAMFT)
1100 17^th Street, N.W., 10^th Floor
Washington DC 20036-4601
Phone: 202.452.0109

American Association of Sex Educators, Counselors & Therapists (AASECT)
P.O. Box 5488
Richmond, VA 23220-0488
Phone: 804.644.3288
E-Mail: assect@worldnet.att.net
Web Site: http://www.aasect.org

American Academy of Clinical Sexologists (AACS)
1929 18^th Street, N.W., Suite 1166
Washington DC 20009
Phone: 202.462.2122

next: Sexuality and Sex Therapy: Part 1 and 2

teenage sex

Love and sex are NOT the same thing. Love is an emotion or a feeling. There is no one definition of love because the word "love" can mean many different things to many different people. Sex, on the other hand, is a biological event. Even though there are different kinds of sex, most sexual acts have certain things in common. Sex may or may not include penetration.

"What's the difference between sex and love? I have four wives and five kids. I apparently don't know the difference."

- James Caan, actor

Differences Between Love and Sex

Love

• Love is a feeling (emotional).
• There is no exact "right" definition of love for everybody.
• Love involves feelings of romance and/or attraction.

Sex

• Sex is an event or act (physical).
• There are different kinds of sex but all kinds of sex have some things in common.
• Can happen between a male and a female, between two females, between two males, or by one's self (masturbation)

Abstinence

The word for not having sex is called abstinence. Some people, especially people who think it's not cool to wait to have sex, think that abstinence is a completely bad thing. Actually, there are some really good things about abstinence and some of them might apply to you.

• Abstinence, or not having oral, vaginal or anal sex, is the best way to protect yourself. It is possible to get an STD even without having intercourse (penetrative sex) through skin-to-skin contact (herpes and genital warts can be passed this way).

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  You also have to think about your own personal values and feelings. Your teenage years bring a lot of changes in how you feel about yourself, family, friends and potential love interests--even if you don't think about sex. No matter what your feelings on sex are, it may be smart to wait until something "feels right."

Ways to Express Love Without Sex

There are millions of nonsexual ways to show someone you like them. You can show a person you care for them by spending time with them. Go to the movies. Or just hang out and talk. If you are with someone you really like, then anything can be fun. There are other ways to feel physically close without having sex. These ways include everything from kissing and hugging to touching and petting each other. Just remember that if you're not careful these activities can lead to sex. Plan beforehand just how far you want to go, and stick to your limits. It can be difficult to say NO and mean it when things get hot and heavy.

next: Does Having Sex Mean Falling in Love

Mary is a fictional character used to demonstrate how an intervention for bulimia nervosa works.

When we left Mary, she was in tears. She realized that she couldn't go on living the way she had been the past few months -- binge eating and vomiting, obsessing about food and her appearance, acting in ways that were harmful to her health.

Luckily for Mary, she wasn't the only one who had noticed that something was very wrong. Lisa, Mary's college roommate and closest friend, had been nursing suspicions for several months. Mary seemed different -- more withdrawn and secretive. She didn't know what was wrong, but she had a feeling that it might relate to food. She and Mary had always enjoyed going out to lunch together on Saturdays, but for the past few weeks, Mary had declined. She also noticed that Mary spent a great deal of time talking about food and what she ate.

With these vague concerns in mind, Lisa began reading up on eating disorders. What she discovered convinced her that Mary was suffering from bulimia.

Does Someone You Know Have Bulimia?

If you think someone you know may be suffering from bulimia, answer the following questions as honestly as you can.

First, think about her recent behavior in terms of food:

• Has she declined the offer to share a meal together more often than she accepts?
• When she does eat with you, does she avoid carbohydrates? Does she order only salads? Or nothing at all?
• Does she drink many glasses of water (to help the food come up more easily)?
• Does she disappear into the bathroom after eating and stay a long time?
• Does she flush the toilet more than once or twice?
• If she uses the bathroom at your house, does she run the water?

Think about her conversation:

• Does she talk about food all the time?
• Is she preoccupied with weight -- hers and others?

Think about her appearance:

• Was she recently slightly overweight -- just 5 - 10 pounds?
• Has she recently lost weight?
• Are her eyes bloodshot? Watery?
• Does she have sores on her knuckles from inducing vomiting?
• Is her voice hoarse?
• Does she constantly have cold-like symptoms, such as sneezing, coughing, sniffling?
• Does she have broken capillaries on her face?
• Is her face puffy?
• Do you notice small swellings in her cheeks, about the size of golf balls? (These are enlarged salivary glands.)

Think of your friend's general mood:

• Has she been avoiding social occasions?
• Does she seem especially secretive?
• Is she drinking more than she used to?
• Is she spending a lot of time at the gym, or compulsively exercising?
• Does she seem moody? Depressed?
• Is she habitually tired?
• Has she stopped doing many of the activities she used to enjoy?

If the answer to many of these questions is Yes, then your friend may well have bulimia.

How Can I Help?

Understandably, Lisa felt shocked, saddened, and confused. She desperately wanted to help Mary, but wasn't sure how.

Fortunately, there is a technique that helps bulimics confront their problem and seek much-needed help. It's called an INTERVENTION.

The Intervention Begins

The story below demonstrates how an intervention for bulimia nervosa works. You'll also find my comments and recommendations.

Mary's Story

Once Lisa was convinced that Mary had bulimia, she wanted to confront Mary about her condition, and thought that having an intervention would be the best way.

First, she called Mary's mother, Julia Finch. Julia began to cry the moment Lisa started explaining the purpose of her call. "I know you're right but I just can't believe it. My poor Mary. Where did I go wrong? I always tried to be the perfect mother"

Lisa was taken aback. Julia was talking about Mary as if she were a little girl, not a grown woman in her second year of college. "Julia," she said firmly, "let's not talk about whose fault it is. From everything I've read, it's not anyone's fault. Let's just figure out how we can help Mary. We all want her to get well, and I think having an intervention is our best hope."

Julia agreed, but Lisa could tell that Julia was still crying even as they planned the details of the intervention. Together, they decided to invite several key people in Mary's life to gather at Lisa's home on a Friday night. Lisa would invite Mary over on the pretext of having dinner together and going to a movie.

Mary showed up right on time. Her smile froze the minute she stepped into the living room and saw her parents, her sister Nikki and brother Bud, her friends, and Susan Bateson, the woman for whom she babysits. Confused, she turned to Lisa and asked, "What are they all doing here?"

Lisa walked over to Mary and tried to take her hand. "Mary, we're here because we're worried about your eating disorder.

"Eating disorder!" Mary said, her eyes widening in amazement. "I don't have an eating disorder! I don't know what you are talking about. I thought we were going to the movies" Her voice trailed off. She turned to look at all the people in the room as if she were seeing them for the first time. "What are you all doing here?" she asked, her voice rising in anger. "What's going on? Tell me, right now. What is going on?"

Crying, Julia rose and walked over to her daughter. "Mary," she began, trying to hug her daughter," We love you and want to help you."

But Mary didn't want her mother's hug. Pushing Julia aside, she walked right up to Lisa. "You lied to me," she yelled. "I thought you were my friend. What kind of a friend would do something like this? I hate you. I hate all of you."

"You've been lying to us for years now, Mary," Lisa said, her voice barely under control. "We can't stand by and watch you practically kill yourself with your bulimia."

"STOP IT!" Mary shrieked. She ran up the stairs and into the bathroom, slamming the door so hard the chandelier shook.

Lisa and Julia followed. Tentatively, they knocked on the door. "Go away!" Mary screamed. "I hate you. Just leave me alone."

The others in the living room sat in stony silence. Finally, Richard, Mary's father, stood up and began pacing. Angrily, Julia approached him and said, "For God's sake, will you please go up there and talk to her? She won't listen to me. Just once in your life, will you please get involved?"

Richard was on the verge of answering, but held his tongue. Exchanging an icy stare with his wife, he slowly walked toward the toward the closed bathroom door.

"Mary," he said softly, "please come out. We're not mad at you. We just want to help you."

No answer. Even more softly, as if his heart were breaking, he said, "Mary, we love you, and we just want to help you. I promise, I'm not mad."

He waited. Finally, the door opened a crack, and then Mary fell sobbing into her father's arms. "Oh Daddy, I'm so sorry," she cried. He just held her for what felt like hours. As her crying slowly subsided, she reached out to her mother as well. "Mommy, I'm sorry - for this, for everything. I'm sorry about what I'm doing to you. I try so hard, I try to be good, to be perfect"

Facts About Bulimia and Bulimics

Did you know:

1. Women who develop bulimia are more vulnerable to social pressures than their peers.
2. The average age of onset of bulimia nervosa is 18 - 19 years.
3. These years, when many women typically leave home to enter college or the work force, correspond to the times when many women are most dissatisfied with their bodies and diet most strenuously.
4. Most women who have the eating disorder are 10 - 47% heavier than their peers.
5. Binge eating usually starts during or after a period of restrictive dieting.
6. Purging behaviors (vomiting, overuse of enemas or laxatives, running 10 miles a day) usually begin about one year after bingeing.
7. Most women wait 6 - 7 years before seeking treatment for bulimia.

Judith Recommends

"How Good Do We Have To Be?: A New Understanding of Guilt and Forgiveness" by Harold S. Kushner (Little Brown, 1997).

The author of "When Bad Things Happen to Good People" reflects on perfection, guilt and forgiveness. This book will help man people struggling with bulimia and the people who love them.

The Intervention Continues

When we left Mary, she was sitting on a sofa in Lisa's living room, surrounded by friends and family members who cared enough about her to stage an intervention. By ten o'clock, everyone had spoken, and looked completely exhausted.

Yet there was one more very important subject to discuss - getting Mary help. Mary's parents and Dr. Gilbert, a friend of the family, sat down next to Mary, who was still sniffling. Julia reached for Mary's hand and held it tight.

"Mary," Dr. Gilbert began, "we've all been doing some research on how to get you the best help possible. There's a wonderful residential treatment center that specializes in women's issues, especially eating disorders."

"You mean a hospital?" Mary said, dabbing her eyes. "I don't need a hospital."

"Let Dr. Gilbert finish," Richard said firmly.

"It doesn't really look like a hospital, Mary. It's a beautiful old estate, and it sounds like a good place for you. There are psychiatrists, social workers, and nutritionists, all specially trained to help people with eating disorders, and it's all under one roof. They can help you overcome your fear of food by eating with you. After meals, they'll sit with you so you can talk about how you're feeling and help you get used to the sensation of having food in your stomach. In the morning, they'll help you realize that you wake up looking the same as when you went to sleep. Many of them had had bulimia themselves, so they know what it takes to recover from bulimia. They know how it feels."

"But they'll make me eat too much, more than I should. I'll get fat!" Mary said, her voice rising in panic.

"I understand that you're worried about that," Dr. Gilbert said, "but one of the things you'll relearn is that on a normal diet you can eat three meals a day without getting fat. When you eat until you're comfortable and stop, you don't have to purge. And if you do gain a pound or two, they'll help you work through it until you feel OK."

"What I like best about the idea," Julia said, "is that you'll be with other young women like yourself, so you won't have to feel so alone anymore. And Dad and I will visit you for family therapy sessions. We're all in this together."

Mary looked at her father. "Dad, this is going to cost you a fortune. I can't ask you to do this for me. I feel too guilty."

"We're doing it, Mary. Whatever we have to pay, we're paying. You're our daughter, and we're not letting anything happen to you. No way. We love you."

"That's right," Julia said. Mary couldn't remember the last time her parents had agreed about anything.

"But what about work?" Mary cried. "Everyone will know. It's so humiliating. Please give me a chance to do this on my own. I'll do therapy, twice a week if you want, even three times. Just let me try by myself."

Her parents looked skeptical, but Mary felt Dr. Gilbert's sympathetic eyes on her. Finally, Dr. Gilbert said, "OK, Mary, you're an adult, so we'll treat you as one. You deserve a chance to try it your way, at least for six months. I can give you the name of a psychiatrist who works with women with eating disorders. Let's start there."

And she handed Mary the name and number of Dr. Melody Fine.

Judith's comments

Like Mary, many women with bulimia beg for a trial of outpatient therapy for bulimia before entering an eating disorders treatment center. Often, with enough support, they can break the binge-purge cycle. It isn't easy, and it takes great determination - almost like having a second job.

Dr. Gilbert sensed that Mary's desire to get well on her own was genuine and arose from within her. She also knew that getting involved in a power struggle with Mary wouldn't help since issues of control are central to Mary's illness.

In the end, Dr. Gilbert decided to support Mary's autonomy. Julia had also tried to support Mary, but she did it by talking to Mary as if she were a little girl. Dr. Gilbert treated Mary as a capable adult.

Did You Know?

According to James E. Mitchell, MD, and his research group at the University of Minnesota Medical School:

• Bingeing usually begins after a period of restrictive dieting.
• Purging behaviors (excessive exercising, use of laxatives, or vomiting) begin approximately one year after binge eating begins.
• The average length of time women spend bingeing ranges from 15 minutes to 8 hours, with an average duration of 75 minutes.
• People with bulimia binge an average of 11.7 times each week.
• During binges, people with bulimia consume an average of 3,415 calories, the total number ranging from 1200 to 5000.

Judith Recommends:

"My Name is Caroline," by Caroline Adams Miller (Gurze Publishing). It can be ordered on-line at www.gurze.com.

This is the inspirational yet realistic story of a high-achieving Harvard College student who appeared to have it all - and who suffered in secret from bulimia for years. It chronicles her eventual victory over her eating disorder. According to Kirkus Reviews, this is "An important, affirmative book for overeaters who've lost hope of a cure."

next: You Are Not Alone
~ all Beat Bulimia articles
~ eating disorders library
~ all articles on eating disorders

In trying to understand the causes of eating disorders, scientists have studied the personalities, genetics, environments, and biochemistry of people with these illnesses. As is often the case, the more that is learned, the more complex the roots of eating disorders appear.

Personalities

Most people with eating disorders share certain personality traits: low self-esteem, feelings of helplessness, and a fear of becoming fat. In anorexia, bulimia, and binge eating disorder, eating behaviors seem to develop as a way of handling stress and anxieties.

People with anorexia tend to be "too good to be true." They rarely disobey, keep their feelings to themselves, and tend to be perfectionists, good students, and excellent athletes.

Some researchers believe that people with anorexia restrict food -- particularly carbohydrates -- to gain a sense of control in some area of their lives. Having followed the wishes of others for the most part, they have not learned how to cope with the problems typical of adolescence, growing up, and becoming independent.

Controlling their weight appears to offer two advantages, at least initially: they can take control of their bodies and gain approval from others. However, it eventually becomes clear to other that they are out-of-control and dangerously thin.

People who develop bulimia and binge eating disorder typically consume huge amounts of food -- often junk food -- to reduce stress and relieve anxiety. With binge eating, however, comes guilt and depression. Purging can bring relief, but it is only temporary. Individuals with bulimia are also impulsive and more likely to engage in risky behavior such as abuse of alcohol and drugs.

Genetic and environmental factors

Eating disorders appear to run in families -- with female relatives most often affected. This finding suggests that genetic factors may predispose some people to eating disorders; however, other influences -- both behavioral and environmental -- may also play a role. One recent study found that mothers who are overly concerned about their daughters' weight and physical attractiveness may put the girls at increased risk of developing an eating disorder. In addition, girls with eating disorders often have father and brothers who are overly critical of their weight.

Although most victims of anorexia and bulimia are adolescent and young adult women, these illnesses can also strike men and older women. Anorexia and bulimia are found most often in Caucasians, but these illnesses also affect African Americans and other racial ethnic groups. People pursuing professions or activities that emphasize thinness -- like modeling, dancing, gymnastics, wrestling, and long-distance running -- are more susceptible to the problem. In contrast to other eating disorders, one-third to one-fourth of all patients with binge eating disorder are men. Preliminary studies also show that the condition occurs equally among African Americans and Caucasians.

Biochemistry

In an attempt to understand eating disorders, scientists have studied the biochemical on the neuroendocrine system -- a combination of the central nervous and hormonal systems. Through complex but carefully balanced feedback mechanisms, the neuroendocrine system regulates sexual function, physical growth and development, appetite and digestion, sleep, heart and kidney function, emotions, thinking, and memory--in other words, multiple functions of the mind and body. Many of these regulatory mechanisms are seriously disturbed in people with eating disorders.

In the central nervous system -- particularly the brain -- key chemical messengers known as neurotransmitters control hormone production. Scientists have found that the neurotransmitters serotonin and norepinephrine function abnormally in people affected by depression. Recently, researchers funded by NIMH have learned that these neurotransmitters are also decreased in acutely ill anorexia and bulimia patients and long-term recovered anorexia patients. Because many people with eating disorders also appear to suffer from depression, some scientists believe that there may be a link between these two disorders. In fact, new research has suggested that some patients with anorexia may respond well to the antidepressant medication fluoxetine which affects serotonin function in the body.

People with either anorexia or certain forms of depression also tend to have higher than normal levels of cortisol, a brain hormone released in response to stress. Scientists have been able to show that the excess levels of cortisol in both anorexia and depression are caused by a problem that occurs in or near a region of the brain called the hypothalamus.

In addition to connections between depression and eating disorders, scientists have found biochemical similarities between people with eating disorders and obsessive-compulsive disorder (OCD). Just as serotonin levels are known to be abnormal in people with depression and eating disorders, they are also abnormal in patients with OCD.

Recently, NIMH researchers have found that many patients with bulimia have obsessive-compulsive behavior as severe as that seen in patients actually diagnosed with OCD. Conversely, patients with OCD frequently have abnormal eating behaviors.

The hormone vasopressin is another brain chemical found to be abnormal in people with eating disorders and OCD. NIMH researchers have shown that levels of this hormone are elevated in patients with OCD, anorexia, and bulimia. Normally released in response to physical and possibly emotional stress, vasopressin may contribute to the obsessive behavior seen in some patients with eating disorders.

NIMH-supported investigators are also exploring the role of other brain chemicals in eating behavior. Many are conducting studies in animals to shed some light on human disorders. For example, scientists have found that levels of neuropeptide Y and peptide YY, recently shown to be elevated in patients with anorexia and bulimia, stimulate eating behavior in laboratory animals. Other investigators have found that cholecystokinin (CCK), a hormone known to be low in some women with bulimia, causes laboratory animals to feel full and stop eating. This finding may possibly explain why women with bulimia do not feel satisfied after eating and continue to binge.

Written by Lee Hoffman, Office of Scientific Information (OSI), National Institute of Mental Health (NIMH).

next: Impact of Obesity and Dieting
~ eating disorders library
~ all articles on eating disorders

Helping Your Friend

Please note: For ease in reading, we have used "she" and "her" in the description below even though eating disorders exist in men, women, girls, and boys. This advice is suitable for a child of either gender.

If your friend doesn't admit to having a problem and/or doesn't want help, the best way to approach her is to help her see that she needs assistance. However, you'll need to prepare yourself well since approaching a friend with an eating disorder can be tricky.

Remember that her eating disorder is a desperate way of trying to cope with underlying problems. Even though you can see her disorder as unhealthy and unproductive, your friend may view her eating habits as a lifeline. That is why it is common for someone with an eating disorder to get upset or mad if you try to help her. She may fear that you are going to take away her only coping mechanism. She may deny the problem, be furious that you discovered her secret, or feel threatened by your caring. When you raise your concerns, give your friend time and space to think and respond.

Before approaching your friend, find out about resources for help in your community so that you can offer her a strategy to connect with that help.

You might first seek advice from someone else, like a counselor at school, or perhaps read more about eating disorders. Choose a cozy, safe, and private place to talk. Plan ahead for enough time to talk without being interrupted.

Begin by telling your friend how much you care about her. Next, gently offer some specific observations about her emotional well-being or lack thereof. For example: "You seem unhappy / preoccupied / anxious / fidgety / distant / jumpy / angry, and I'm worried about you." Speak from your heart, using "I" statements. Do not name other people who are also worried about her. That can feel like an overwhelming gang-up.

Then give your friend a few observations about her behavior to explain why you think she might have an eating disorder. For example: "I see you skip meals / I watch you run to the bathroom / I hear you talk all the time about being afraid of being fat, what you ate, how much you're going to exercise, etc."

If she gets upset or mad, stay calm. Do not get angry or panic. Do not get into a "Yes, you do / No, I don't" power struggle. Remind her that friends tell friends when they are worried about them.

If she insists that she doesn't have a problem, or that she can stop on her own, you can say something like, "You know how it is with alcoholism and denial. The addiction makes it so hard to see you have a serious problem and that you need help. I'm worried you're trapped in a similar kind of situation. Even though I hear what you're saying, I think you're really struggling and you need help stopping. I believe in you and I know you deserve to get help and get better."

Give your friend information about who can help her. Offer to go with her. It may take more than one approach before she will agree to get help. If she refuses to get help, tell her that you are not going to bug her, but that you are also not going to stop being concerned either. For example: "Even if I can't convince you get help now, I can't stop caring." This gives you a foot in the door without being too threatening.

Stay calm and avoid sounding as if your mission is to rescue or cure her. Eating disorders are serious physical and psychological problems, but they are usually not emergencies. However, if your friend is fainting, suicidal, or otherwise in serious danger, get professional help immediately. These words may help: "I don't care if you're mad at me. Friends don't let friends suffer in danger and isolation."

If your friend is getting help for her eating disorder, stay connected to her the same way you would with any friend. Call her, invite her to do things, hang out, and ask her for advice about your life.

When talking with her about herself, it is usually best to focus on daily life events, on her feelings about herself and her life, and on your concern about her. Do not focus on her eating disorder. Her eating disorder is a sign that other issues are troubling her and a way of trying to deal with those issues. Moreover, most people with eating disorders feel embarrassed about them and feel safer in friendships in which friends do not try to get involved in the details of the disorder.

Avoid all comments - even compliments - about looks, weight, food intake, or clothes. This includes hers, yours, and other people's. Avoid giving her advice on how she could change her behavior. Do not ask a lot of questions about her recovery. Remember that recovery takes time.

next: Helping Parents Deal with Eating Disorders
~ eating disorders library
~ all articles on eating disorders

teenage sex

It's especially important to remember that pregnancy isn't the only thing you should be thinking about. Sexually transmitted diseases (STDs) pose a serious risk to anyone having unprotected sexual intercourse, oral sex, anal sex, and in some cases, skin-to-skin contact with an infected area. (FYI - an infected area may not always be noticeable.) It is important to remember that although all methods of contraception provide protection against pregnancy, they don't always protect against STDs.

Many STDs have no symptoms, so you can't tell if you have one just by looking. The only way to know for sure whether you have an STD is to get tested. That means you can't tell if a partner has an STD, unless your partner also gets tested. If you have never been tested for STDs, you may want to ask your health care provider about testing and screening for chlamydia, gonorrhea, syphilis, and trichomoniasis.

The Centers for Disease Control and Prevention (CDC) recommends that all sexually active teens be screened for chlamydia annually, even if symptoms are not present. Ladies, also remember that although pap smears can screen for any cervical abnormalities, including abnormalities linked to the human papilloma virus (HPV), pap smears are NOT a test for STDs. In other words, there are different tests for each STD.

To get tested for STDs, you can go to a health care provider or to a family planning or STD clinic that provides low cost (sometimes even free) and confidential STD testing and treatment. To find a clinic near you, call the CDC's National STD Hotline at 1-800-227-8922 or Planned Parenthood's national hotline at 1-800-230-PLAN

Here are the most common STDs:

Chlamydia

• What it is: A bacterial infection of the genital area.
• How many get it: About 3 million cases each year.
• Signs: There are no symptoms in most women and many men who have it. Others may experience abnormal vaginal bleeding (not your period), unusual discharge or pain during urination within one to three weeks of having sex with an infected partner.

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• How it's spread: Through unprotected vaginal, oral, or anal intercourse.
• Treatment: Oral antibiotics cure the infection; both partners must be treated at the same time to prevent passing the infection back and forth, and both partners need to abstain from unprotected intercourse until the infection is gone.
• Possible consequences: Pelvic inflammatory disease (PID) in women, tubal (ectopic) pregnancy, infertility, and increased risk of HIV infection.

Genital Herpes

• What it is: A viral infection of the genital area (and sometimes around the mouth).
• How to get it: About 1 million new cases each year; an estimated 45 million cases already exist.
• Signs: There are two kinds of herpes. Herpes 1 causes cold sores and fever blisters on the mouth but can be spread to the genitals; Herpes 2 is usually on the genitals but it can be spread to the mouth. Nearly two-thirds of people who are infected with herpes don't even realize it. An outbreak can cause red bumps that turn into painful blisters or sores on the vagina, penis, buttocks, thighs, or elsewhere. During the first attack, it can also lead to flu-like symptoms, including fever, headaches, and swollen glands. Symptoms usually appear within two weeks of infection but can take longer in some cases. The first outbreak is usually more severe than later recurrences.
• How it's spread: By touching an infected area or having unprotected vaginal, oral, or anal intercourse. Warning: some people may be contagious even when they don't have symptoms.
• Treatment: There is no cure. An antiviral drug can help the pain and itching and also reduce the frequency of recurrent outbreaks.
• Possible consequences: Recurrent sores (the virus lives in the nerve roots and keeps coming back), as well as increased risk of HIV infection. Transmission of herpes to newborns is rare. Most mothers with a history of herpes have normal vaginal deliveries. However, an infant who gets herpes can become very ill, so some precautions are advisable.

Gonorrhea

• What it is: A bacterial infection of the genital area.
• How many get it: Approximately 650,000 new cases a year; teens have higher rates of gonorrhea than do sexually active men and women aged 20-44.
• Signs: Most women and many men who get it have no symptoms. For those who do get symptoms, it can cause a burning sensation while urinating, green or yellowish vaginal or penile discharge, and for women, abnormal vaginal bleeding or pelvic pain. Symptoms can appear 2 to 10 days after infection.
• How it's spread: Through unprotected vaginal, oral, or anal sex.
• Treatment: Oral antibiotics. Both partners need to be treated at the same time to prevent passing the infection back and forth  and both partners need to abstain from intercourse until the infection is gone.
• Possible consequences: PID, tubal (ectopic) pregnancy, sterility, increased risk of HIV infection. The infection can spread into the uterus and fallopian tubes. It can also cause complications during pregnancy (including stillbirth) or infant blindness or meningitis (from an infected mom during delivery).

Hepatitis B Virus

• What it is: A viral infection primarily affecting the liver.
• How many get it: About 77,000 new cases a year through sexual transmission; about 750,000 people are already infected with Hepatitis B as a result of sexual transmission.
• Signs: Many people don't have any symptoms. Others may experience severe fatigue, achiness, nausea and vomiting, loss of appetite, darkening of urine, or abdominal tenderness, usually within one to six months of exposure. Yellowing of the skin and whites of the eyes (called jaundice), and darkening of the urine can occur later.

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• How it's spread: Through unprotected vaginal, oral, and anal sex. It can also be transmitted through sharing contaminated needles, or through any behavior in which a person's mucus membranes are exposed to an infected person's blood, semen, vaginal secretions, or saliva. (Don't worry... the chance of getting Hepatitis B through kissing is slim, unless your partner likes to bite!).
• Treatment: Most cases clear up within one to two months without treatment, during which complete abstinence from alcohol is recommended until liver function returns to normal. Some people are contagious for the rest of their lives. A three-dose vaccine is now available to prevent this STD.
• Possible consequences: Chronic, persistent inflammation of the liver and later cirrhosis or cancer of the liver; plus, if you're pregnant, your baby must be immunized at birth.

Human Papillomavirus (HPV)

• What it is: A viral infection with more than 100 different types, primarily affecting the genital area, both the outer and inner surfaces.
• How many get it: An estimated 5.5 million new cases each year; at least 20 million people already have it.
• Signs: Soft, itchy warts in and around the genitals (vagina, penis, testicles, and anus) may appear two weeks to three months after exposure. Many people, however, have no symptoms but may still be contagious.
• How it's spread: Through unprotected vaginal, oral, or anal intercourse, or by touching or rubbing an infected area (infected areas may not always be noticeable).
• Treatment: There is no cure. Warts can be removed through medication or surgery. Even with such treatments, the virus stays in the body and can cause future outbreaks.
• Possible consequences: Increased risk of genital cancer for men and women. Some virus types cause the most common form of cervical cancer in women.

HIV

• What it is: The human immunodeficiency virus (HIV), the cause of AIDS.
• How many get it: An estimated 40,000 Americans are infected with HIV each year, most of whom were infected sexually, and an estimated 800,000 - 900,000 people in the U.S. are living with HIV/AIDS.
• Signs: Many people who have HIV don't even know it because symptoms may not appear for 10 years or longer. Others experience unexplained weight loss, flu-like symptoms, diarrhea, fatigue, persistent fevers, night sweats, headaches, mental disorders, or severe or recurring vaginal yeast infections.
• How it's spread: Through body fluids such as blood, semen, vaginal fluids and breast milk - in other words, during vaginal, oral or anal intercourse; by sharing contaminated needles; or via pregnancy or breast-feeding. During vaginal intercourse, the risks of becoming infected are higher for women than for men, because HIV is more easily transmitted from man to woman.
• Treatment: There is no cure and AIDS is considered fatal. Several new antiviral medications can slow progression of the infection and delay the onset of AIDS symptoms. Early treatment can make a big difference.
• Possible consequences: It is the deadliest STD of all and can weaken the body's ability to fight disease, making someone with HIV vulnerable to certain cancers and infections such as pneumonia. Babies born to HIV-positive mothers may become infected with HIV if the mother is not receiving treatment, but treatment can reduce that rate significantly.

Syphilis

• What it is: An infection caused by small organisms, which can spread throughout the body.
• How many get it: About 70,000 new cases each year.
• Signs: In the first phase, sores (chancre) may appear on the genitals or mouth several weeks to three months after exposure, lasting for one to five weeks. Often, however, there are no noticeable symptoms. In the second stage, up to 10 weeks after the initial sore has disappeared, a variety of symptoms can appear, including a rash (often on the palms of the hands, soles of the feet, or genital area).
• How it's spread: Through unprotected vaginal, oral, or anal sex and also through kissing if there is a lesion on the mouth.
• Treatment: Antibiotic treatment can cure the disease if it's caught early, but medication can't undo damage the disease has already done. Both partners must be treated at the same time.
• Possible consequences: Increased risk of HIV infection. If syphilis is left untreated, the symptoms will disappear, but the germ will remain within the body and progress into the third stage, which may seriously damage the brain, heart, and nervous system, and possibly cause death. It can also seriously harm a developing fetus during pregnancy.

Trichomoniasis ("Trich")

• What it is: A parasitic infection of the genital area.
• How many get it: As many as 5 million new cases each year.
• Signs: Often there are no symptoms, especially in men. Some women note a frothy, smelly, yellowish-green vaginal discharge, and/or genital area discomfort, usually within 4 days to one month after exposure to the parasite. Men may notice a discharge from the penis.
• How it's spread: Through unprotected vaginal intercourse.
• Treatment: Antibiotics can cure the infection. Both partners need to be treated at the same time to prevent passing the infection back and forth and both partners need to abstain from intercourse until the infection is gone.
• Possible consequences: Increased risk of HIV infection; can cause complications during pregnancy. Also, it's common for this infection to happen again and again.

HealthyPlace.com: Sexually Transmitted Diseases: What's Your Risk:.

Emergency

Think you may have a sexually transmitted disease? Arrange a medical visit immediately, or call the Planned Parenthood Hotline at 1-800-230-PLAN for a referral to a confidential, low-cost clinic. Other hotlines for more information: the National STD Hotline, 1-800-227-8922; the National HPV and Cervical Cancer Prevention Hotline, 1-877-HPV-5868; or the National Herpes Hotline, 1-919-361-8488.

Worried that you may be HIV-positive, or that you may have been exposed to the virus? Get tested for HIV. Remember that tests are either "anonymous" or "confidential" and there are different kinds of tests. If you need help finding a place to be tested, or you have questions, call the CDC's National AIDS Hotline at 1-800-342-AIDS, or the National Teenage AIDS Hotline at 1-800-440-TEEN.

next: Sexual Orientation: "Am I Gay (Lesbian) because I think about it?"

Student tells story of anorexia and bulimia struggle, success

Sherri Barber/The Coloradoan

In Control: Jenna Radovich, 20, runs on the track at Colorado State University's Recreation Center. Radovich, who is a junior at CSU, suffered from anorexia and bulimia starting at the age of 17. She has had the disorder under control for two years

She was encouraged by an American culture that experts say admires excess and pushes extremes, but the behavior that was gaining Jenna Radovich's admiration was taking her from happy to miserable, from a women's size 6 to children's clothes, and from healthy to obsessed with food and exercise.

"I started losing weight and someone mentioned it," said Radovich, a 20-year-old junior at Colorado State University. "To me that meant that, before, I hadn't been presentable or something."

As her eating disorder progressed, people Radovich knew asked her, "How'd you do it?" and told her they wished they could look like that. They told her she must be so happy.

Overexercising and throwing up, however, was not making her happy.

"The only time I would cry is when I was over the toilet," said Radovich, who two years ago recognized she had an eating disorder and sought help from counselors, family and friends.

It was the summer before her senior year at Pomona High School and Radovich, a centerfielder, was excited about the fall softball season; she wanted her last year of softball to be her best.

That same summer, her dentist removed her wisdom teeth and for five days, Radovich couldn't eat solid foods. She said she lost weight and gained attention.

"I didn't notice anything until people said stuff, and then I kind of liked it," Radovich said. "That definitely kept the cycle going."

During her junior year of high school, Radovich started measuring her meals - literally, with measuring cups - after reading a fitness magazine article about Americans and their misconceptions about portions.

"I never had more than a cup of anything," Radovich said

Soon, however, she had cut that to a half-cup. Friends kidded her that Fitness magazine was her Bible.

Her mother, Mille, had suspected that her daughter might have body image problems, but the food measurement was the "biggest giveaway."

"I knew we had crossed that line," Mille said.

Still, Radovich's grades improved. Her social life was good. On the outside she didn't seem to be suffering. Her friends were concerned, but Radovich said she tricked them simply by eating ice cream.

To maintain energy for softball, Radovich "had to eat." She started exercising excessively to combat eating, something physicians call exercise bulimia.

Radovich would drive home after school, then run about three miles back to softball practice. After three hours of practice, she would run another one to three miles.

"I was basically starving my body ... using exercise," Radovich said. "Because I was an athlete, it was looked at in a good way."

But she was getting light-headed in class in the mornings and once passed out when she stood up. Doctors tested her for diabetes but didn't notice she had dropped 20 pounds.

During her senior year of high school, she wrote a 27-page research paper for an English class about exercise addiction. Still, it would be another year until she recognized the symptoms of an eating disorder that was ruining her life.

The youngest of three girls, Radovich grew up trying to keep up with her older sisters.

"She skipped over childhood toys and went straight to Barbies because they were into those sorts of things," Mille Radovich said.

"Of all my daughters, I never thought it would be her," Mille said.

Women have long been pressured to stay thin, said Dr. Jane Higgins, staff physician at Hartshorn Health Center at CSU for more than 17 years.

"I think it's always been normalized," Higgins said. "How many magazines don't have articles about losing weight?"

Fast facts

• Out of millions of Americans diagnosed with eating disorders annually, 90 percent are adolescent and young women
• Eating disorders have doubled since the 1960s and are increasing in younger age groups, as young as 7 years
• 40-60 percent of high school girls diet

Source: Journal of the American Academy of Child and Adolescent Psychiatry

The No. 1 wish of girls 11-17 years old is to lose weight, according to Margo Maine's "Body Wars: Making Peace with Women's Bodies."

As many as one-fifth of people with an eating disorder die from the illness, according to Eating Disorders Coalition, an advocacy group created to promote awareness of eating disorders as a public health priority.

Up to 3.7 percent of females suffer from anorexia nervosa, while as many as 4.2 percent of females have bulimia nervosa, according to the EDC. Nearly 4.5 percent of female and 0.4 percent of male college freshmen report bulimia in their first year of school

About nine out of every 10 people with an eating disorder are girls or young women, though 19-30 percent of young anorexic patients are male, according to the American Psychiatric Association.

In people with bulimia, between 50 percent and 70 percent of patients who received psychological treatment and medication recovered in the short-term, according to the APA. Other studies suggest that 30 percent to 50 percent of patients relapse six months to six years later, according to the APA.

CSU's Higgins said many of her patients see at least a short-term recovery.

"I think we see lots of success, or I wouldn't do this," Higgins said.

Other studies show that the biggest risk factor in people who develop eating disorders is dieting, said Danielle Oakley, a licensed psychologist and group coordinator at the Colorado State University counseling center. That's "pretty scary" given that 91 percent of girls and women between 14 and 18 are dieting, Oakley said.

"It's absolutely a body image issue," Oakley said.

Gyms and fitness centers can be breeding grounds for eating disorders, Oakley said.

"We tend to see it more in that gym culture in having the perfect body," Oakley said. "They're not thinking, 'Something's wrong here. I'm way too obsessed with this.' "

It was a flier on the wall of a CSU building that caught Radovich's attention during her freshman year of college. She was going to see her academic adviser when the flier, which had a list of eating disorder symptoms, "scared me."

"I was just looking at it saying, 'I do that, I do that, I do that,' " said Radovich, who was secretly throwing up in her dorm bathroom despite living with her closest childhood friend. "I called my sisters and said, 'I don't know what to do.' "

Her parents quickly set her up with a counselor in Westminster. Radovich said that to show support, her parents would drive from Arvada to Fort Collins, take her to the appointment in Denver and then drive her back to CSU; her parents would sit in the waiting room during her sessions.

"The hardest thing to say was, 'I'm struggling and I need your help right now,' " Radovich said.

Oakley said friends and family who approach people with eating disorders about getting help should be prepared for rejection.

"Don't let that discourage you from ever helping again," Oakley said. "Leave an open door for them to come back."

Also, avoid "anything that looks like you're taking that person's control," she said.

Mille Radovich knew she would have to pick and choose her chance to intervene with her daughter.

"She really is a strong, individual soul," Mille said. "Like most people, it has to be on you. She wasn't ready to hear, 'Jenna, you have a problem.' "

Nearly two years later, Radovich is recovering, though she says "it's a constant battle I deal with every day."

• 42: Percent of first to third grade girls who want to be thinner
• 45: Percent of boys and girls in grades 3-6 who want to be thinner
• 9: Percent of 9-year-olds who have vomited to lose weight
• 81: Percent of 10-year-olds who are afraid of being fat
• 53: Percent of
• 13-year-old girls unhappy with their bodies
• 78: Percent of 18 year-old-girls unhappy with their bodies.

Source: From "Body Wars, Making Peace with Women's Bodies": by Margo Maine, Ph.D., Gürze Books, 2000

"I would not wish what I went through on my worst enemy," she said. "It was unhealthy, disgusting, and it was dragging me down."

Radovich, a health and exercise science major who wants to be a physical therapist, is a certified personal trainer at the CSU recreation center, where she sees many students going down the same road she traveled.

"If I wasn't as confident with who I am and where I've been, it would be really difficult (to work there) because it's all around you," Radovich said. "I feel like I can help."

Her hope is that she can be a resource for people stuck in the same cycle she fell into.

"What they think is helping them is hurting them."

Radovich will tell her story March 3 during Eating Disorder Awareness Month at CSU, another step in recovery and another chance to stop the spread of eating disorders.

Eating disorders and characteristics

ANOREXIA NERVOSA Description: Severe weight loss, fear of fatness, distorted body image, body image overemphasized in self-evaluation, loss of period.Characteristics: Emaciated look, physically active, profound weight loss, loss of menstrual period, body image distortion, fear of weight gain Medical complications: General health, cardiovascular compromise, osteoporosis, metabolic slowdown, multiple organ compromise, suicide In adolescence, growth retardation, delay of puberty, peak bone mass reduction Anorexia nervosa has the highest mortality rate of any psychiatric disorder, as high as 20 percent. Death can occur after severe binging in bulimia nervosa as well. 

BULIMIA NERVOSA Description: Binging with a sense of loss of control followed by vomiting, laxative abuse, diuretics, extreme fasting or extreme exercise at least twice a week, body image overemphasized in self-evaluation. Sometimes food will be chewed then spit out.Characteristics: Individual "looks normal," binging and purging behaviors, individual overly concerned about body, secretive Medical complications: dehydration, heart problems, electrolyte disturbances, gastrointestinal problems.

BINGE EATING Characteristics: More prevalent: half of all clients of diet clinics are binge eaters, represented across all ages, equally represented between sexes, associated with problems of obesity Medical complications: cardiovascular, diabetes, musculoskeletal, infectious disease. 

next: Eating Disorders: Know When to Seek Help for Your Child
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Enjoying Christmas with your kids. Please note: I do not intentionally exclude others' family customs or holy days but these articles are from my personal experience and my own religious heritage. EMG

• Surviving Family Gatherings
  Parents who expect their children to be better behaved than usual when relatives are present are destined for disappointment and frustration. Here are some things to keep in mind if you will be taking children to visit relatives.

• The Perfect Gift for Kids
  Most kids can name off forty items advertised on television yesterday that they really, really, really want. We could buy everything on their lists and Christmas could still leave the family feeling empty, sad, and exhausted. The truth is, there is no better gift to give our children during the holidays than relaxed and loving time with the family. Children need their parents' attention and love more than any gift. We found a way to do it.

• Christmas Guidelines for Parents
  Ten ideas for ensuring a happy holiday season with children.

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  The Truth about Santa
  At some point in every child's life, parents must face the BIG question, What do I tell my child about Santa? When do I tell my child the truth? How do I tell my child that mom and dad are really Santa?

• The Importance of Traditions, even New Ones
  Christmas is a season, not just one day of gift-giving. Traditions make the season rich with love and sharing. Rejoice in your family traditions or create new family traditions if you have none. The memories will last forever.

• Simplify Christmas and Enjoy It
  Christmas spirit is willing but time, money, and energy are limited commodities, even in December. As the stress of over-extended calendars, bodies, and bank accounts begins to build, tempers get short and angry words abound. Such situations are not exactly the magic of our holiday dreams. There is a better way for families to enjoy the holiday season.

• Teaching Greedy Children to Give
  Giving is a rewarding experience but how do we convey that message to our children? Children learn by what we do, not by what we say. We can set an example of giving from generosity and love if we want our children to develop a generous heart. We can make the necessary plans for our children to experience the joys in giving.

• Don't Expect a Perfect Family Christmas
  In the middle of all my advice on how to enrich the holidays for your family, I think it would be a good idea to let you in on what things are really like in our house. Our family life is like yours. Even during Christmas, things go well at times and at other times, a wheel comes off.

• Getting Things Done with the Kids in Tow
  When there is something really important to be done, plan ahead for a children's activity to keep them busy too. Don't expect kids to like being neglected or understand just because your chores are "important". A little time spent preparing "work" for them will enable you to get your work done.

• Christmas Shopping with Kids
  Holiday shopping can be fun but it is also exhausting, especially for small children. To make the season a little brighter for the wee folk, remember to consider shopping from their perspective. These Twelve Secrets of Successful Shopping Trips were all learned from experience.

• Age-Appropriate Gift Ideas
  Grandparents have a hard time deciding what to give as Christmas gifts. This list is age appropriate and guaranteed to please. Grandparent Giving Guidelines are also included.

• Let Christmas End Slowly
  With such a huge, commercial build-up, children can easily be disappointed by an event that lasts less than an hour. Christmas is more than opening gifts, or at least it should be. Children need for Christmas to have a gentle conclusion. We need to plan rituals and traditions for ending Christmas gradually.

next: Surviving Family Gatherings with Kid