What could cause an 18-year-old woman, already skeletally thin, to look in the mirror and see a fat person? And then to continue starving herself to make that heavier self go away?
There's no one answer. But Lauren Lazar Stern believes she's created a new way to help. Stern, an art therapist and licensed professional counselor specializing in eating disorders, recently self-published The Slender Trap: A Food and Body Workbook. It's a spiral-bound series of art and writing exercises to help people decide whether they have an eating disorder like anorexia or bulimia, then help them resolve the emotional issues that typically trigger the problem.
Stern, 57, with offices in Oakland, has had her own practice for 20 years. She sees up to 30 clients a week -- girls and women ages 10 and up, most in their late teens and 20s, many college students. Estimates of how many people have eating disorders vary widely, but Stern says the number is growing. "It's huge. It's rampant," she says. "There's so many calls I don't know what to do with them."
Many women with eating disorders have been abused sexually or emotionally. But one patient's disorder began with emotional trauma over the death of her grandmother.
Not eating, or eating and then vomiting, or binge-eating, are all ways to exercise control or seek attention. Left unconfronted is the actual pain. "These girls, a lot of them can't speak. They can't express themselves," Stern says. "Their authentic feelings become inaccessible and threatening."
Stern has long had clients do creative exercises like writing letters to their bodies, or making masks representing their eating disorders. The approach works, she says: In one case, a 10-year-old girl who hadn't eaten in three months started again after imagining she visited a tropical island where the monkeys ate bananas with her.
Slender Trap puts Stern's approach in print. Each of the 12 chapters contains a series of exercises. For instance, an exercise accompanied by a cartoon depicting an empty pedestal in front of a mirror instructs, "Draw a picture of the way you see yourself in the mirror ... and the way you think others see you on the pedestal." After each exercise, readers take stock of their self-image and emotional weather by ranking themselves on a scale and a thermometer.
Stern has sold 150 copies so far, many to her clients and other therapists. The book's step-by-step nature dovetails with her patients' obsessiveness. One client, a pharmacist in her 30s, completed the 259-page book in four weeks and has been binge-free for 53 days, Stern says.
Others are taking notice. The Something Fishy Website on Eating Disorders recently named Slender Trap its book of the month: "This book has a very friendly vibe and cartoonish drawings that make it feel like a journal mixed with art therapy assignments, rather than just homework you might not be too inspired to do."
Anorexia might seem a curious concern in an age when obesity is even more epidemic. But Stern says, "I think they're both the same. ... It's all about self-hatred." Like the protruding bones of anorexics, she says, "the weight just is a wall that keeps people away."