by KRISTIAN GRAVENOR

In a grassy corner of West Verdun sits the building where emaciated adult Quebecers go to fight starvation. “Seeing a 50-pound adult woman is sometimes a very startling and jarring thing,” says Dr. Howard Steiger, who, over the course of a year, oversees 350 anorexics and bulimics at the Douglas Hospital eating disorder clinic. It’s the province’s largest and he’s led it for 19 years. “We get the most extreme cases that exist.”

Much has changed in the game of eating disorders and misconceptions are many. One false notion is that eating disorders are largely harmless. In fact, there is no bigger psychological killer.

“Unfortunately,” says Steiger, “anorexia nervosa is known to have the highest mortality rate of any mental health problem. Something around five per cent [of anorexics] could eventually die.”

Montreal women have literally been dying of starvation. “I know of people who have died of anorexia, especially when the problem persists,” says Steiger. “They fall out of treatment and suffer the effects of starvation, either dying of physical causes or later committing suicide.”

Biology trouble

Last year and in 2003, Steiger and his team were involved with important discoveries that link biology to anorexia. The problem lies in the 5-HTTLPR gene that manages the flow of serotonin in the brain.

“There’s quite a change in the way we understand the cause of eating disorders,” he says. “Some years back, the prominent view was to view it as a social, culturally-driven phenomenon, as an extreme on the normal dieting in western societies in general. But the evidence points out that we have to look at biological elements. Some people carry a vulnerability that makes dieting very dangerous for them.”

Yet the DNA trail led some to believe that there’s simply an anorexia gene that you either have or don’t. The truth is trickier.

“It’s a complex syndrome that’s determined by multiple interacting genes,” Steiger says. “The genes don’t mean anything unless you have the multiple stimuli that activate them.” The genetic predisposition must be triggered by “stress lived in very important stages in life that would amplify the risk. And the final ingredient is dieting.”

Steiger calculates that 30,000 Quebecers suffer eating disorders, almost all of them young females: one per cent of females between 12 and 30 battle full-blown anorexia with another four per cent suffering a lighter variety. Another eight to 10 per cent of Quebec females suffer from bulimia, a binge-eating condition derived from the Greek term for “ox-hunger.”

Anorexia and bulimia were once considered peas in a pod, both believed to be the creation of cultural notions of beauty. Steiger says recent discoveries suggest that the description only holds for bulimia, which—unlike anorexia—is limited to wealthier countries.

“Recent studies looked at cross-cultural and historical data and shows that anorexia occurs beyond the cultural context,” he says. “There’s less evidence of it increasing than we had anticipated. What has increased is bulimia, but it’s not found cross-culturally. It’s pretty much restricted to those weight conscious thinness-pursuing cultures.”

Food therapy

Eating-challenged patients come to the Douglas from throughout the province, and about one in 20 of them is deemed sufficiently serious to be kept inside the mental health facility. Force feedings, however, are almost extinct. “I can’t think of having used that over the past few years,” says Steiger.

There are a variety of subspecies of the illness, including one called orthorexia, so-called health food junkies. “Some people have obsession with health foods,” Steiger says. “People get into rigid systems of foods.”

Unlike many other mental health diseases, medical treatment for eating disorders is based more on proper eating than pills. “The core of treatment is usually not medicated,” says Steiger. “The main medication is food. Once anorexia gets locked in, people start suffering the consequences of malnutrition and dietary distress, so the first is to nourish themselves properly and then focus on their attitudes to eating and weight.”

The life-saving strategies involve group therapy, individual therapy and psychotherapy, but ultimately the answer lies in talk. “At the most immediate level it’s helping people rethink their idea about weight and body image,” says Steiger. “You help them contradict themselves, you help them re-evaluate their beliefs or encourage them to try other ways.”