Eating Matters

Book Review by Kevin Wolf

1. Ink in Water: An Illustrated Memoir (Or, How I Kicked Anorexia’s Ass and Embraced Body Positivity)
2. Eat and Love Yourself
3. Blossoms and Bones: Drawing a Life Back Together
4. Guts
5. Fat Free: Amazing All-True Adventures of Supersize Woman!

Eating is an essential part of life. When we have a problem with food it impacts everything else about ourselves. This review covers five books that relate to eating matters. These graphic works provide a variety of very personal stories (except Eat and Love Yourself which is fictional) of eating disorders. They reflect the memoirist’s environment, family history and often an additional trigger that leads to their eating disorder.  For most of the books reviewed here, the memoirists show how this triumvirate of events leads to their eating disorder. They provide varying degrees of details about therapeutic treatments and how well they worked. Before reviewing each graphic work in turn, I provide some background on eating disorders. These books do not cover all possible eating-related issues. Two stories (Blossoms and Bones, and Guts) have the memoirist as the writer and artist; while the last two (Ink in Water, Fat Free) have a separate illustrator.

These books are connected by sensitivity to and fragility about the author’s body image perceptions, other people’s words about appearance, or sometimes lack of support from people close to the author. Because of this fragility, these works may be of greater benefit to counselors, support people, or interested persons and not for people who are being treated for eating disorders or have body image triggers. Use your own judgement with respect to reading any of these works and any personal triggers. All works included herein include the caveat that the story presented isn’t meant to be a substitution for working with health professionals qualified to help people with eating disorders. These graphic works address several types of eating disorders. Any resources provided in these works are part of their stories. Though often mentioned, therapy or treatment methods are generally not detailed. I define major eating disorders (before) and provide some statistics (after) I provide my reviews of each work. Over the course of reading these works, I learned about the authors’ struggles and that their journeys to overcome their disorders are profound, difficult, and a work in progress. There are no easy answers, but learning someone else’s story could be a helpful start.

Background

I’ve found various descriptions of eating disorders including in the United States (the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), and internationally,  the World Health Organization’s (WHO’s) International Classification of Disease (ICD). From these and other sources, here are some of the major eating disorders:

• Anorexia nervosa: Significant weight loss from severe food restrictions; characterized by intense fear of weight gain resulting in malnutrition. Weight loss can also occur from excessive exercise (called exercise bulimia), self-induced vomiting, and taking laxatives or diuretics;
• Bulimia nervosa: Characterized by two behaviors: 1) Binges, which is eating a large amount of food in a two hour period that is more than one would normally eat given the context, and characterized by a loss of control while eating, and 2) Compensatory behaviors to prevent resulting weight gain, such as self-induced vomiting, subsequent food restriction, excessive exercise, or laxative use.;
• Binge Eating Disorder (BED) as in bulimia nervosa without the compensatory behaviors
• Avoidant/Restrictive Food Intake Disorder—Characterized by extreme “picky eating” to the extent that it impacts daily life and induces malnutrition (i.e., one can only tolerate eating a very narrow range of foods, sometimes due to intense sensitivity to texture, sometimes due to phobias of contamination or vomiting, sometimes for other reasons)
• Pica: eating items that has little or no nutritional value, including dirt, hair, or lead
• Other Specified Feeding or Eating Disorder (OSFED): Eating disorder that doesn’t fit into one of the other categories.

There are also related disorders such as Body Dysmorphia which is an intense fixation on appearance, often of a specific part of the body, to the extent that it becomes an obsession. In these cases, as often with eating disorders, the sufferer’s perception of how they look is drastically different from how others perceive them. The above eating disorders are not meant to be a comprehensive list of all eating disorders, but just for background; there are many variations that continue to be defined.

Treatments can include counseling, prescription drugs, cognitive behavioral therapy (correcting unhelpful ways of thinking, behaving and developing helpful coping mechanisms), or working with a dietitian who specializes in eating disorders. All of these should be under the supervision of a qualified health care provider; and having one’s own positive support system can be very helpful. Risks for any treatments should also be considered. Other treatments are mentioned as they arise for specific book reviews.

The graphic works reviewed here are all written by and about women, but men can face similar problems.  For some gathered statistics from the National Eating Disorders Association see the end of this post.

When I first created this review, I was going to include a brief summary of each book with the type of eating disorder, it’s cause, and possible treatment. It was pointed out to me—and I agreed—that I’m not a clinician and whatever I write would be an oversimplification. Though book reviews are naturally simplifications, any summary here would be a step too far in that direction; and I would miss the nuance that eating disorders rarely have a single cause even if there appears to be a trigger, there’s often many causes that build up over time. Instead, I will provide enough details for the reader to get an understanding of each book as I review them below and suggest you read each graphic work for more information about each author’s struggles, causes, effects, and outcomes with their eating disorder. My book reviews follow.

Ink in Water: An Illustrated Memoir (Or, How I Kicked Anorexia’s Ass and Embraced Body Positivity)

From the start Ink in Water: an illustrated memoir by Lacy J. Davis (memoirist) and Jim Kettner (illustrator) has continuing story-line imagery. The cover provides the only color image of the author—head uncovered, hands on hips—kicking it in the rain to match its subtitle … or, how I kicked anorexia’s ass & embraced BODY POSITIVITY. The inside title page matches the cover except it takes the reader to the past with pouring rain followed by a two-page rain storm dedication; then the author is running through the rain, scarf flowing back and newspaper over head to protect her hair, toward the prologue. Most of the story takes place in Portland Oregon—known for its rain—and rain becomes a metaphor of dark gloom carried around by the author as she struggles with anorexia nervosa and exercise bulimia. But rain also becomes a symbol of hope and growth after a profound move toward honesty and self-acceptance. The fix is a work in progress. Her success comes from a mix of Overeaters Anonymous, building a support system, sharing her struggles with others, and specialized exercise. I highly recommend Ink in Water.

The work jumps around in time starting with attending Overeaters Anonymous (OA) meetings. For her “Every meeting started exactly the same … the same rumbling in my guts, the same wobble in my knees … the same musty smell of church basement … the same 12-step literature lined all the tables … and the same people showed up every week …” (pages 3-5). The graphic work then moved back to her youth when she enjoyed the punk scene. Even during her punk days when she appeared to not care about appearances, metaphorically growing in her brain was a “seed … [of a] thought I was maybe just a little TOO BIG” (16, emphasis in original). And she dwelled on this, until this seed grew. Lacy’s pain comes from low self-esteem. Her self-esteem was often connected to the people she dated. A bad break-up spirals her into that “seed” growing out of control. Over time she starts seeing foods as poisons to her body and eats less and less. Lacy purges her calories through massive amounts of exercise. Her eating issues start to slightly improve as she builds her support network with Gia, her friend, pushing her toward OA. Meetings for OA, took place in a clubhouse in northwest Portland called The Alano (92). In the graphic non-fiction work Philosophy: a Discovery in Comics by Margreet de Heer (NBM Publishing Inc., 2012) Margreet quotes Aristotle (page 45): “All human actions have one or more of these seven causes: chance, nature, compulsion, habit, reason, passion, [and] desire.” My emphasis in Aristotle’s quote matches my placement of Lacy’s eating disorder sources. Over intense experiences, we see her struggles and slow progress toward regaining some control over her life; including a specific workout to end her exercise bulimia.

This memoir is superbly illustrated by Jim Kettner, an important person in Lacy’s life story; Lacy, having a Masters of Fine Arts from the California College of Art in San Francisco, is an artist in her own right. Each chapter opens with a splash page setting the scene. Imagery is black and white with grey wash throughout. We watch Lacy almost becoming a stick figure as her anorexia deepens. Her college thesis defense has her saying “My work has primarily been about neuroplasticity. The negative patterns we create in our lives due to habitual thoughts … and the steps we can make to take control of those patterns.” (141) Lacy provides her own tentative picture of what “better” means to her with this image from the first panel on page 147:

Lacy’s medical issues are significant food restriction and purging, which both induce and are furthered by obsession with calorie counting and weight. She seeks help from OA and doctor office visits. Over the course of Ink in Water we learn ten of the twelve steps in OA. We also see other characters dealing with illicit drug addiction, and licit pain medication addiction after another’s knee surgery. My own unprofessional observation is that illicit drug use and eating disorders have some similarities in that they involve addictions, habitual behavior that’s hard to change, and require a diligent future to keep these problems at bay.

The book title comes from her eating disorder being like ink dropped in a glass of water spreading its dark pall; while we also can see the closing rain water theme bringing the opposite to life by diluting the gloom.

Part of Lacy’s brief bio for Ink in Water states she is an eating disorder recovery specialist.

Eat and Love Yourself

What if you had a time machine and could go back and better understand why unhealthy habits started? Would that make a difference? That’s what occurs in Sweeney Boo’s first graphic novel, Eat and Love Yourself, a supernatural tale of Mindy who has an eating disorder. The script was translated from French by Edward Gauvin. I recommend Eat and Love Yourself for middle and perhaps high schoolers to start a conversation on eating disorders, but it’s not very edifying to other audiences.

Mindy buys a milk chocolate bar that’s labeled, “Eat and Love Yourself,” the book title. The chocolate bar is supposed to “bring back your fondest childhood memories” (the book has no page numbers; so, I can’t indicate where any quotes come from). Each piece of the chocolate bar allows her to become a misty purple/pink image while she’s back in time watching her younger life. Through these short early-life vignettes we see why she began to use food as a coping mechanism. These triggers include confusing lessons by her parents around Mindy’s meals, negative comments by a gym teacher, and bullying at school.  

  In her twenties Mindy has a lot of routines, like obsessively weighing herself after waking and before sleeping. Weight talk seems to follow Mindy around, whether a commercial on TV or other students talking to each other. The chocolate bar literally breaks that routine. For Mindy the chocolate is for her travel into her past not for “fond memories” but “food memories;” Or the chocolate metaphorically provides a window into her past to see the sources of her eating issues.

Will her misty, ephemeral present-day self understand that she can’t change the past? And speaking from experience, Mindy tells her (unable-to-hear younger) self, “That place inside you, that emptiness … it’ll turn into fear, anxiety.” Mindy can only observe her past, but can she change her present?

The only narration in Eat and Love Yourself occurs at the start of this graphic work. After that we see dialogue or cell-phone texts between the characters. The imagery is nice and there’s good coloration by Joana Lafuente. To the extent there are story breaks they occur either through calendar days or as each piece of the chocolate bar is eaten; eventually down to three pieces remaining. At one-point Mindy argues with multiple images of herself until she’s belittled herself into leaving a socializing situation.

There is only one occurrence of a health care practitioner in Eat and Love Yourself; when Mindy has a session with psychiatrist because she eats when she’s anxious. And he, not Mindy, does virtually all the talking; for example, he says, “… body dysmorphia keeps us from seeing ourselves as we actually are…” with possible triggers from TV, magazines, friends, family, damaging self-esteem due to self-punishing and negative reinforcement from others. Both ephemeral (current) & past Mindy are silent. The psychiatrist closes with, “… we keep trying to figure out the tools that will help you break this cycle [of filling her empty feeling with food].” No other diagnosis or treatments for Mindy are presented in Eat and Love Yourself. Eat and Love Yourself has a few relationship stories which are sometimes helpful (best friend, parents, or unrequited one) and sometimes hurtful (best friend, parents). Ultimately, Mindy decides she has to figure things out for herself.

Blossoms and Bones: Drawing a Life Back Together by Kim Krans is jam-packed with information and wonderful visuals, starting with the colorful cover, inside cover with shelves of pseudo salvation salves, bottled bromides, curative cornucopia, whimsical wonder drugs, and pithy positive plaudits. The back inside cover is filled with delightful acknowledgements drawn as sets of bunnies, cats, un-nested matryoshka dolls, … each with their own named grouping. There’s also a built-in rainbow-of-colors cloth bookmark. “[Blossoms and Bones is] a story about a skeleton who is starving, and the sunflowers that rise up & bloom golden petals of light no matter how empty the skeleton feels” (31). This is a tale of letting feelings roam, of starting small and going out of control, of letting things go and ultimately finding her new life. The author struggles with binge eating triggered by personal trauma including infertility and divorce. Despite the dark subject matter, the book has very funny moments. Kim’s story is her life in a Buddhist ashram with the tenet that this is her struggle; and at one point she even asks the reader to participate … if they like. I highly recommend Blossoms & Bones.

The book shows the author’s trek of written and drawn “feelings” of her eating problems that happened at age 38 due to “a series of unforeseen changes.” “Simply put, I could not stop either eating or not eating…I ate things that were frozen, in the trash, in other people’s cupboards, all in secret, all in shame.” (5) Her mother, aunts, and grandmother had a history of eating problems as well, illustrating the now well-established genetic basis for many eating disorders.

She struggles with completing this work with a self-imposed deadline of 30 days which she later extends to a 40 days completion. It’s almost in diary form with virtually no edits. She doesn’t know if she’s writing about her eating disorder, sugar addiction, depression, or … “perhaps it’s about the four pregnancies that came & went with no babies.” (31)

Blossoms & Bones is a mix of journaling around illustrations; word ballooned skeletons, words every which way on pages, and repetitiveness. She states in her first introduction there was no design, rewrites, thumbnail sketches; she just let the art and words of raw emotion flow like an open faucet. She wants others with related addictions (“food, drink, pills, porn, prescriptions, pizza, promiscuity or painkillers” (7)) to know she’s there with them. She’s letting her skeletons out. Words (all caps) on the page may go every which way (circle around, along the borders, upside down, along edges of page, …), be large/small, blackened, hollow, in floating bubbles, scratchy, all hand-lettered, crossed/scratched out, spiraling, and carry emotions (anger, shame, fragility, loudness, …).

Skeletons, or parts thereof, appear on most pages. Initially, pleas for wanting to eat pepper the pages. She asks and answers herself: “How do I help people? … By being honest.” (11) Arrows might move your eyes about the page or change the direction of the book from portrait to landscape to upside down. She often explains every image on the page. Self-Guilt (“I can’t believe you are so focused on yourself and your first world problems when you are lucky to even have FOOD TO EAT”) and shame are apparent. I recommend you just read this book to see how it flows and congeals. Pages 16-17 writ large and small provides “all the things you I should not eat” and very little on the list “… I definitely know … I definitely should eat.” There’re breaks with almost nothing on a two-page spread. The skeleton bares her pain, honesty, eating disorder; and there’s gorgeous imagery (mountains, flowers, scribbled self-portrait (shown below)), too; all in black ink. Sometimes the reader sees the detritus of Kim’s life; and she wonders where it all came from (her imagination?).

Kim creates pseudo-mad-libs where she leaves the reader to fill in the blank with their own story that they want to let go of (67). She argues with herself, reflecting the tennis match many individuals with eating disorders play in their heads between the compulsion to listen to their eating disorder and their wish or pressure from others to overcome it and get well.

Kim provides her “Spectrum of Dis-Orderly Eating” (69) from unconscious (positivity; e.g., thoughtful, healthy, discerning) … balanced … to eating disorder (negativity; e.g., critical, ashamed, paranoid, bingeing, purging, starving). She concludes the first half of her story with “I start slowly … tenderly … begin to write this book …” (111). After her pain, Kim provides her ice cream sundae of shame (136-137) which shows the reality of her binging.

Kim’s pages of “thank you” repetitions should be carefully read for the story between the “thank yous.” (184-189) Kim Krans’ tale is valuable lesson in self-discovery and healing by taking a self-imposed exile to honestly bare one’s own pain and perhaps it can help others do the same.

Guts by Raina Telgemeier is a wonderful addition to her ongoing memoir series (including Smile (2010) and Sisters (2014)). Guts covers the origin and treatment of her stomach problems when the author was in fourth and fifth grades. Other themes include bullying, friendship, overcoming shyness, finding one’s passion, and learning to empathize. This tale might help grammar school and older students, parents, family practice doctors or pediatricians, and therapists—perhaps specializing in eating issues—understand, diagnose, and treat children with similar difficulties. The author’s Ghosts (2016) graphic novel was also reviewed at graphicmedicine.org because it included a character with cystic fibrosis. I highly recommend Guts for its honesty, and sensitivity to grammar school difficulties.

Under stress when asked to do a class presentation, Raina gets frightened, has stomach pain, and flees to the bathroom. Jane, Raina’s friend, walks Raina to the nurse’s office. In another scene, a classmate bullies Raina by asking if she’s “a poopy diaper baby?”  (47) Raina’s teacher, who didn’t see the bullying, forces Raina to act nice to the bully. Stomach aches continue. (49)

Guts is visually pleasing with minimalist, smooth, simple renderings of persons, places, and things. Colors are by Braden Lamb. Pseudo-chapter breaks occur periodically with a wordless image on a page. There’re some amazing images of Raina experiencing vertigo’s feeling of falling by showing the floor fall away and Raina holding on by her fingertips to the few tiles that remain. Raina draws her child-self green when feeling nauseous. Some talk therapy sessions are wordless, which allows the reader to reflect on what happened earlier in the book.

At another point, on the school bus a girl—over several panels—asks Raina, “So what is your deal? … You give away your lunches, you didn’t want Michelle’s salad … Do you have an eating disorder??!” (146; emphasis in original).

While being counseled, we see Raina’s troubled feeling scale from 1 to 10 pictorially represented. (151) At another point, Raina uses happy images as metaphor, then “literally” bursts her own thought balloon. The reader gets to see Raina’s inner thoughts which can appear terrifying to her.

At the back of Guts there’s an Author’s Note that provides the most medically technical part of Guts. Raina’s lifetime treatments included: talk therapy, cognitive behavioral therapy, mindfulness training, EMDR (Eye Movement Desensitization and Reprocessing is a therapy that’s supposed to reduce stress from traumatic memories or other events from one’s past), and exposure therapy; meditation apps, unnamed medications with some success. “… But I’ve realized that my phobias and worries are just part of who I am. … I’ve been treated for everything from celiac disease to Crohn’s disease to ulcerative colitis and, after many negative results, I’ve learned there’s nothing medically ‘wrong’ with my stomach. I just have a sensitive system and must be careful about what I eat   … when I’m stressed out, I’m more likely to have digestive issues.” Raina suggests if you have stress related problems seek help from a trusted advisor, and she encourages getting your feelings out: talk, write, draw comics, make music, plays, etc. “It takes guts to admit how you feel on the inside, but chances are, others will be able to relate” (214-215).

Fat Free: Amazing All-True Adventures of Supersize Woman by Jude Milner and illustrated by Mary Wilshire is a short memoir of the author’s struggle with being overweight to a work-in-progress of weight loss and exercise. She provides a good amount of background (including brutal honesty of childhood trauma) of the causes of reaching as much as 450 pounds, but there is some lack of details on the treatments. The reader shouldn’t look on this work as a “how to” lose weight, only that it’s possible. Treatments include talk therapy, attending a weight reduction resort, surgery, and gym exercises. I recommend this graphic memoir.

The artist (Mary Wilshire) presents the work in penciled, un-inked form. As explained in “a note on the art” by Richard Milner the author’s husband and book scripter), “The result is a mosaic in varying shades of emotional intensity. Wilshire’s drawings masterfully capture the body language, gestures, and facial expressions of the author at every age, weight, and emotion.” There are a few photographs of the memoirist, her school, childhood home or her family at the start and one of her at the end of Fat Free. There are some superhero-type tropes sprinkled within. For example, the cover shows the memoirist flying in cape; and an early scene has a devil-like nemesis retailer ask young Jude “You like chocolate? …First one’s free;” causing Jude to freeze, faint, then flee from the store to keep her identity secret. (3-4)

At age 8, Jude’s mother takes her to a doctor; because Jude has gained a significant amount of weight that year. A smoking male doctor prescribes diet pill of amphetamines to Jude without mention of any risks or side effects.  Jude lies to the doctor that she only eats two apples after school and he suggests she eat only one! At a family gathering Jude, age 12, hears appearance-related polka lyrics that she takes personally; followed by a very descriptive page of her balancing on diet pills with talking heads and negative words (e.g. “Ever heard of Weight Watchers?” “Blimp” …) swirling her into adulthood (11), This image is also the back cover of Fat Free.

Like in The Secret Life of Walter Mitty—written by the famed essayist, storywriter, and cartoonist James Thurber—Jude appears in many food-related fantasized scenes (e.g., The Avengers, Star Trek …) of how she liked to be and not how she actually is. This fantasy-life gives her a temporary (unhealthy) reprieve from her childhood trauma of sexual assault, separation from her parents for an extended time period, and humiliation at the hands of a male police officer. She joins an activist group (PHAT; people honoring all themselves) and has short stints in unhappy occupations (including, phone sex entertainer). A lot of events are condensed.

Jude goes to graduate school in psychology. She gets her graduate degree (but doesn’t say if it’s a Master’s or PhD) and doesn’t mention if she was counseled at that time as part of her studies. Jude has several attempts at losing weight by medical means. She rejects bariatric (or gastric) balloon surgery (surgical insertion of saline-filled balloon; limits room in stomach to feel full faster; requires lifestyle changes; has serious risks) (38). She goes to an “eating disorder center” where treatments include group and individual talk therapy. She has aerobic exercises while at the eating disorder center. She loses a drastic amount of weight in 30 days.

A gym in her building starts her on the road to more consistent exercise and becoming a fitness trainer. She seeks being counseled. Over-exercising causes a leg injury which requires surgery. While on vacation, a jet ski accident motivates her to get weight loss surgery (the type of surgery isn’t named; her stomach is made smaller, so it’s probably gastric bypass surgery). She loses 40 pounds and goes back to her fitness therapy program. She concludes with “exercise to build back strength; and talk about emotions; change eating habits; and understand how surgery affects your life; this isn’t just for my clients, it’s for me too!” (62)

Jude’s brief book biography includes her being “a pioneer in developing crucial support and recuperative programs for obese patients.” (66)

In conclusion, eating disorders (defined earlier) have many causes with possible triggers that spiral food intake or lack thereof out of control. There are ways for one to move back toward taking control, which is usually a work in progress with the help of health care providers, a support system, and self-motivations. I recommend these graphic works as a tool to help those—health care providers and people who are part of a support system, especially—understand the struggles of people with eating disorders.

I found that the National Eating Disorders Association (NEDA) provides a very long list of eating disorder statistics with their sources. Here are some very selective statistics and mostly quoted from NEDA’s website (see their website for sources):

• Between 0.9% and 2.0% of females and 0.1% to 0.3% of males will develop anorexia
• Young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers.
• Females/males are 75%/25% of individuals with anorexia nervosa; and males are at a higher risk of dying, in part because they are often diagnosed later since many people assume males don’t have eating disorders.
• Though most athletes with eating disorders are female, male athletes are also at risk—especially those competing in sports that tend to emphasize diet, appearance, size and weight. In weight-class sports (e.g., wrestling, rowing, horseracing) and aesthetic sports (e.g., bodybuilding, gymnastics, swimming, diving) about 33% of male athletes are affected. In female athletes in weight class and aesthetic sports, disordered eating occurs at estimates of up to 62%.
• A 2007 study asked 9,282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that 3.5% of women and 2.0% of men had binge eating disorder during their life
• At any given point in time, 1.0% of young women and 0.1% of young men will meet diagnostic criteria for bulimia nervosa.
• A 2007 study asked 9,282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that 1.5% of women and 0.5% of men had bulimia during their life
• Up to 40% of overweight girls and 37% of overweight boys are teased about their weight by peers or family members. Weight teasing predicts weight gain, binge eating, and extreme weight control measures.
• An estimated 3% of gym-goers have a destructive relationship with exercise. Some studies have found that number may be even higher, including a 2008 Paris study that found that up to 42% of gym-goers have a destructive relationship with exercise.
• In a more recent [than 2000] study, 1/3 of female patients and 1/6 of male patients with Type 1 diabetes reported disordered eating and frequent insulin restriction.
• Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives. [2005 study]
• In 1996, [U.S.] Congress passed the Mental Health Parity Act, a law that requires plans to provide the same annual and lifetime overall limits for mental health benefits as for other health conditions.
• When presented with identical case studies demonstrating disordered eating symptoms in white, Hispanic and African-American women, clinicians were asked to identify if the woman’s eating behavior was problematic. 44% identified the white woman’s behavior as problematic; 41% identified the Hispanic woman’s behavior as problematic, and only 17% identified the black woman’s behavior as problematic. The clinicians were also less likely to recommend that the African-American woman should receive professional help.
• Researchers studied records of 1,885 individuals evaluated for anorexia nervosa, bulimia nervosa, and EDNOS [eating disorder not otherwise specified] at the University of Minnesota outpatient clinic, over 8-25 years. Researchers found an increased risk of suicide for all eating disorders studied. Crude mortality rates were 4% for anorexia nervosa; 3.9% for bulimia nervosa; and 5.2% for EDNOS, now recognized as OSFED [other specified feeding or eating disorder]. [2009 study]

_______________________________

I thank Cora Glazier, a social worker in private practice in Austin, Texas, for her suggestions and comments in an early version of this review