Looking in the mirror was torture for Hannah Crawford

By Clare Mullaney
It wasn’t until Hannah was staring at a half-eaten Greek salad that she admitted she had a problem.
It was her first night in the outpatient program at the Renfrew Center in Philadelphia, the United States’ first residential facility for the treatment of eating disorders. Before coming to Renfrew, Hannah Crawford, whose real name she prefers not be used, had been following a strict diet of two apples and seven pretzel sticks a day. She was, in effect, starving herself.
Of the two meal options offered that night, Hannah, a sophomore at Bryn Mawr College at the time, chose the Greek salad, believing it to be the “safer choice” and healthier selection. But to make up for the minimal calories offered by the lettuce and raw vegetables, the salad contained a few extra ingredients.
Petrified, Hannah gazed down at a hard-boiled egg, a half a cup of cottage cheese, a tablespoon of nuts, and whole pita bread.
She had 45 minutes to finish the salad along with a bowl of ice cream that was quickly melting.
Hannah was so nervous that she couldn’t stop shaking. “I could barely hold my fork to put food in my mouth,” she recalled.
Hannah had the urge to separate each of the items in her salad and eat them one at a time, but at Renfrew, any abnormal food rituals were prohibited. She couldn’t cut up her lettuce into tiny pieces or dissect the salad’s contents to make sure they weren’t contaminated.
By the end of the meal, Hannah had only eaten some of the salad. Before coming to Renfrew, she thought she could finish a meal if she wanted and that turning off the fears surrounding food would be easy.
It was so much harder than she imagined. “I was so overwhelmed by all the food,” she said.
An estimated one-half to nearly four percent of American women suffer from anorexia nervosa in their lifetime. According to the National Eating Disorders Association, anorexia is characterized by self-starvation and excessive weight loss. Individuals with anorexia typically weigh no more than 85 percent of their expected body weight.
Hannah’s story describes the journey of many of these women.

The beginning
In fifth grade she began to monitor what she was eating, but by the beginning of middle school her anorexia took hold of her. To help her cope with the anxiety of starting at a new school, she became determined to lose weight.
Hannah became a vegetarian, but not because she was concerned about animals. “I pretended to care about animals,” she said. “It was just an excuse to cut something out.”
She began exercising excessively to burn calories and she dreamed of being on the reality television show Survivor, fantasizing about how she would lose weight in the wilderness.
Lunch at school became a burden. Hannah would pack the usual: a yogurt, an apple, and some crackers. At first, she ate all of her lunch, but as the days progressed, she began to eat less.
“I cut it down to 75 percent, then 50 percent, then I started getting rid of things,” she said. Eventually she ate nothing at midday.
The questions and comments from her friends became too much. “Hannah, why aren’t you eating?,” the middle schoolers would squeal. Or, “Hannah, you’re so healthy! How do you do it?” She decided to spend lunchtime in the library.
Then, the purging began. If her parents forced her to eat, she would stick her finger down her throat and vomit, trying to do it quietly so her family or schoolmates wouldn’t hear.
But despite the excessive trips to the bathroom, she still didn’t believe she had an eating disorder. “I thought I wasn’t sick enough,” she said. “I’m not skinny enough to be an anorexic.”
Throughout middle school Hannah grew four inches in height while losing some weight. In seventh grade, her school recognized that something was wrong and the administration alerted Hannah’s parents at the end of the year.
Her parents tried to get their daughter help, but they were frustrated. Hannah made her way through 13 different health professionals throughout middle school and high school, including nutritionists, psychologists, psychiatrists, and specialists in the treatment of eating disorders.
Hannah attributes some of the biggest difficulties of her anorexia to her mom and dad. “My parents didn’t really treat it like it was a problem, they treated it as if I was doing something to be obnoxious,” she said.

The obsessions remain
While she was living at home, Hannah never got the help she needed to overcome the disorder.
Rules, calculations, and measurements concerning weight were all that mattered. Hannah describes her anorexia as “black and white thinking.” Life was defined in terms of fat versus thin.
Hannah’s fears didn’t simply involve meals. The obsessions concerning food and weight entered every aspect of her life.
When Hannah would gaze into the mirror, a frequent ritual, she didn’t see a lean, 5-foot-9-inch figure. She saw someone else-someone with a distended stomach and bulky thighs.
She would meticulously weigh herself, not on one scale, but two. Hannah would then average the resulting weights. “Silly things,” she said, anything to give her the feeling of control.
Hannah held onto clothes that were too small and used a pair of jeans that fit her perfectly to measure if she’d gained weight.
When Hannah walked down the street and caught sight of a 12-year-old girl with tiny legs, she would cringe. “Why can’t I be like her?” she would think to herself.
When she went out to dinner, she refused to eat her meal if she saw an obese person in the restaurant because she was terrified that she would end up the same way.
“Life’s a trigger,” she said.
But with each of these behaviors, her anorexia only grew in strength. “The more you’re obsessing about food, the worse it gets,” she said.
Throughout her battle with anorexia, Hannah has faced a number of physical problems. She had stopped menstruating for about a year in middle school; she’s had low blood pressure, low iron, low potassium, low blood sugar, and acid reflux from the purging. Her hair thinned, her skin became dry. She had constant headaches and was always cold.
But these ailments didn’t matter. “It’s being the best at your eating disorder,” she said. For Hannah, that’s what was most important.
A new beginning
College marked a new beginning. “I didn’t want to be known as the girl with the eating disorder in college,” said Hannah. “I wanted to enjoy it.”
The start of her freshman year at Bryn Mawr went relatively well. Hannah had played volleyball, which had given her a reason to eat because she felt she was burning a significant number of calories during games and practice.
“After volleyball was over, I didn’t see any point in eating,” she said.
She was living on her own and no one was checking to make sure Hannah went to breakfast or ate before an exam. Her anorexia was winning.

Getting the right help
By the first semester of her sophomore year, Hannah was on a downward, spiraling path.
She had been seeing a therapist and nutritionist a few times a week through Renfrew, but the center eventually refused to treat her through their outpatient program because they said she needed a higher level of care.
For Hannah, that’s when something clicked.
She recognized that she wasn’t healthy enough to be in school. “I wouldn’t have made it through the semester with my grades or physically if I had stayed,” she said.
Hannah decided to take a three-week leave from Bryn Mawr and enroll in Renfrew’s intensive residential treatment program.
Treatment was hard at first, with Hannah going from eating very little to three substantial meals a day.
It took her longer to recover than she had anticipated. She ended up staying at Renfrew for three and a half months and was eventually forced to withdraw from school for the semester.
But Hannah thinks of her time in Renfrew’s residential program as “the marker for where my recovery really started,” she said.
With the help of a nutritionist and a psychologist, Hannah gradually began to increase her meal’s proportions, leaving Renfrew with an intake of 4,000 calories a day.
Things were finally turning around and Hannah was able to return to Bryn Mawr for the second semester of her sophomore year.

A relapse
During Hannah’s junior year, one of the doctors in Bryn Mawr’s health center was paged at 2 a.m. Hannah had taken 50 laxative pills because she believed they would help her lose weight. She was bent over in pain. “I was puking my brains out and couldn’t stand up,” she said.
She was taken to Bryn Mawr Hospital and treated for dehydration. It had been about a year since Hannah was released from Renfrew’s intensive treatment program. “Anniversaries are always hard,” she said.
Hannah had gained weight since her time at the center and she was feeling disgusted with her body. “That’s the hardest part, just roughing through the storm when you feel like absolute shit, absolutely miserable, just not used to your body,” she said.

Learning to live
Today, Hannah is 21 and a senior at Bryn Mawr. She still struggles with anorexia, but it’s not the same. “You can’t lose what you learned,” she said.
She knows her anorexia is something she’ll have to deal with everyday. She’ll still sit down in her psychology class and see her legs, which she still perceives as large and bulgy. “I’m like, eww, that’s gross,” she said. But the thoughts don’t keep her from going out to dinner with her friends or eating in the dining hall.
Hannah has made the choice to recover. “I was waiting for someone to save me,” she said. “That was never going to happen. I had to save myself.”
Hannah realizes that her eating disorder was never about food. “It’s really a coping mechanism to deal with hurt feelings, really upsetting feelings,” she said.
Her obsessions surrounding weight were only a means of managing symptoms of anxiety and depression. “It’s a way to numb yourself from the rest of the world,” she said.
Hannah no longer looks for ways to hurt herself and wants to move forward. She’s now learning how to enjoy her free time, time that before had been consumed with obsessions concerning food, weight, and appearance. “You have to learn how to live all over again,” she said.

The future
Today Hannah knows so much more about herself than she did. She’s strong now and says she is ready to take on life at full speed.
Hannah hopes to pursue a career in clinical psychology, particularly working with women and adolescents, and she wants to get married and have children. But, she knows none of that can happen if she’s unable to manage her eating disorder.
As Hannah moves forward, she never forgets the girls whose lives are still consumed by anorexia and bulimia-girls who drop out of school, live with their parents, can’t get jobs.
“People can get used to living in hospitals. It’s safe. It’s easier,” Hannah said. “You can escape from life.”
One of Hannah’s favorite quotes is by Erica Jong, an American writer and feminist, who once wrote, “And the trouble is, if you don’t risk anything, you risk even more.”
Although Hannah once believed that her anorexia gave her control, she now realizes how much narrower her world became as she desperately tried to limit her intake of food. By attempting to control life, she was only taking it away.
“I realize that the risks outweigh the benefits,” she said confidently. “Life is so much better than the eating disorder.”