I first met Kayla Kovall when her mom Kim and I worked together on a church committee. A pretty blonde girl about to enter junior high school, Kayla was an exceptionally polite child, always impeccably dressed and groomed. Underneath the idyllic façade, however, Kayla was very unhappy. Her classmates cruelly teased Kayla, calling her fat – even though she most certainly was not. The incessant teasing was terribly painful for Kayla, and for Kim as well.
This "innocent" name-calling and "typical" bullying behavior unfortunately had quite an impact on Kayla's outlook on life. The pressure to fit in – to be perfect – was tremendous. So I wasn't surprised when I learned that Kayla had entered rehab for treatment of an eating disorder that had taken hold of her over the course of nearly a decade.
Hiding the truth
SK: From what eating disorder did you suffer?
Kayla: I started with anorexia and restricting my food intake, then escalated to bulimia, purging whatever food I did eat.
Kim: Kayla over-exercised as well.
SK: At what age did the eating disorder begin?
Kayla: I was 15 and in the 10th grade.
SK: How long did it go on before someone discovered there was a problem?
Kayla: Almost three years. People suspected it but didn't confront me until I was a senior in high school.
Kim: My gut feeling told me something was wrong, but when I questioned Kayla, she denied it. She was very convincing, and I wanted to believe her. Girls with this disorder are secretive and good at hiding it, and I wasn't educated about the disorder or aware of the signs.
SK: What are the signs?
Kim: Signs of bulimia are brushing her teeth every time she ate or went to the bathroom, going missing after a large meal, teeth marks on fingers or hands, or exercising after every meal. With anorexia, signs include cutting up food into little pieces, or being afraid to eat or even look at food. People with eating disorders constantly comment on their body and others' bodies.
SK: Kayla, how did you feel the first time you realized you could control her weight?
Kayla: It was a really good feeling. I got compliments all the time. Then I got out of control and got really good at losing weight. When people told me I was skinny or tiny, I absolutely loved it. Some people with eating disorders refer to it as "Ed" or "Eddy" because they feel like it's a whole other person inside of them. They're not themselves when "Ed" or "Eddy" is in control.
SK: What do you think prompted the eating disorder?
Kim: Kids in school called Kayla names like Fat and Godzilla. She had a low self esteem and a desire to become thin to be accepted. When she started losing weight she received compliments, which fueled the disorder. Kayla also became very involved with dancing. Although dance helped her gain confidence because she was good at it, being in front of the mirror and constantly looking at her body didn't help.
Kayla: For me, it was mostly about control. There were family issues with my father being controlling, and I had a controlling boyfriend during my senior year of high school. Dance played a role because I always compared myself with other dancers.
SK: Was the eating disorder an ongoing problem or an on-again/off-again behavior?
Kayla: It was on-again/off-again for the first year. When I realized how well it worked, I made it my job. It was all I thought about, all day, every day.
Kim: The disorder had control over Kayla's mood and thinking. She was like a different person. When things stressed her out, the disorder became worse.
How it affects the family
SK: How did you deal with it as a family?
Kayla: My mom confronted me. I denied it at first; but she knew I was lying, so I finally confessed. Mom got books for me to read, but I wasn't ready to get better at that time, so I just came up with different ways to purge or restrict.
Kim: I read books and hired a counselor for Kayla as soon as I found out. I had to handle this all on my own and felt very scared and alone. I wouldn't wish this disorder on my worst enemy.
SK: Kayla, did you recognize that you had a problem?
Kayla: I realized I had a problem, but I didn't care. It wasn't a big deal because I was in control, and I felt good.
Kim: Kayla knew it wasn't normal behavior, but she was overcome by the disorder. She told me that when you're involved in the disorder, you don't realize or care what you're doing to your body.
SK: How did the disorder change Kayla?
Kim: Kayla was not herself. She was moody and constantly asking about her body and looking in mirrors or windows at her body. She exercised every time she ate something, or she'd overeat a lot in one sitting and then disappear.
SK: Were others outside the family aware of the situation?
Kayla: Others were aware, but they didn't want to deal with it. They just talked about it behind my back.
Kim: A friend told me she saw what Kayla had written about herself on the Internet. People knew, but nobody talked to me about it – it is so taboo. More people need to talk about this disorder and not be ashamed. It is a dangerous illness. Everyone rallies around someone with cancer or heart disease to lend support, but with this disorder, you are all on your own.
SK: Kim, what did your friend read about Kayla on the Internet?
Kim: Kayla wrote very disturbing things about herself and what she was doing. The Internet has sites for girls with eating disorders that offer "support" and teach them how to hide their disorder, how to lose weight, how to purge and restrict food. I believe the Internet fueled Kayla's disorder more than anything else.
SK: Did you involve your family physician?
Kim: Early on, I expressed concerns with the doctor about Kayla's behavior. She wasn't concerned because at that time Kayla's weight was normal. I informed the doctor that Kayla was always exercising and feeling bad about her weight, but she offered no information. I don't think pediatricians are educated enough about eating disorders. Kayla's doctor should have been able to provide more information or direct us to a counselor.
SK: Does counseling help?
Kim: Having the right counselor is so important. Kayla wasn't comfortable with her first counselor, so she didn't open up, or she lied. After counseling, Kayla would be better for awhile, but as soon as she got stressed out, she'd use the disorder. When Kayla went to Pittsburgh for her freshman year of college, I tried to get her more extensive care, but she didn't want any part of it. She didn't want to get better. Until they're ready for help, even hospitalization won't help. Luckily, Kayla eventually realized on her own that she didn't want to live with this demon anymore and asked me to find a place to go get help. We took her to The Renfrew Center in Philadelphia.
Kayla: People asked me if I was okay, if I was doing well. It's hard, because the person with the eating disorder has to come around on her own. No matter what efforts others made, I didn't want to hear what they were telling me. I thought I was fine and ignored anything anyone said. I was skinny and happy and liked what I was doing.
SK: Kayla, did you ever talk to your friends about it?
Kayla: I was on vacation with friends, and we were talking about really deep stuff when it just kind of came out. We had watched a television show about drug rehab and eating disorder interventions, and it triggered me to confess. I felt like I just couldn't hide it anymore. Trying to purge and restrict isn't easy when you're on vacation with friends. All I was thinking about was how much I probably weighed and how much I gained and how fat I looked.
Can you prevent eating disorders?SK: Looking back, what would you have done differently?
I would have stopped the bullying sooner. I wish I would have recognized the signs of the disorder and gotten Kayla counseling sooner. I'm not sure that hospitalization at Renfrew would have worked when she was 16, but I'd still recommend it.
Kayla: I wouldn't have done anything differently. My mom handled the situation well. You can't pester someone with an eating disorder about getting help, but you can try to scare them about what could happen. That's what worked for me – seeing girls my age in rehab who had already suffered heart attacks, liver failure, osteoporosis, and infertility. That was scary. And thinking about the future, too, and not being able to achieve your life goals because you're too sick to handle situations that lead to those goals. I wouldn't have done anything differently to get me to this stage of my recovery.
SK: Is there a way to prevent this from happening to others?
Kim: Parents should educate themselves and be aware of the signs. Our society is so focused on body image. It's not what we see – or think we see – in the mirror that brings true happiness. Don't comment on people's looks or body types. Steer clear of fashion magazines, and keep extra patrol of the Internet. There are websites for these disorders which teach girls and boys how to perfect their eating disorder.
Kayla: Just like abusing alcohol and drugs, eating disorders are how some people cope. I do believe that parents and friends can look for early signs and perhaps prevent it. And show girls other ways to cope with stress, like horseback riding, reading… different hobbies to get them to take their minds off the stresses in life.
SK: Can schools help by controlling bullying?
Kim: We should have seminars for parents and classes for kids on the signs and dangers of eating disorders. We need to promote self esteem by reinforcing someone's personality, not their looks.
Kayla: Schools can help. If teachers see a student being bullied or suspect that something is going on, they should sit the kids down and see what's wrong. But bullying doesn't just occur in school; most of the time it happens outside of school. Kids use the Internet and cell phones to bully.
It's not about the food
SK: What else do you want readers to know?
Kim: Eating disorders are dangerous and life threatening, something I didn't fully realize until I saw the women at Renfrew. There were women in their 30s and 40s still dealing with this disorder. Some of the younger girls had already had heart attacks, kidney failure, or problems with their teeth, throat and stomachs. These women are smart and kind-hearted, but most of them are perfectionists, and all have self-esteem issues.
This disorder is a coping mechanism. The women described a feeling of numbness when they use their symptoms. When upset or stressed out, they used purging to rid them of their bad feelings and afterward felt calm and numb. By restricting and controlling their food intake, they felt they had control of their life.
Kayla: I want people to know that this is a very hard thing to get through. It takes a lot of work, and usually more than one or two tries, to overcome it. It is so important for the person with the disorder to want recovery; it cannot be forced.. The young 14- and 15-year-old girls in rehab talked about how they'll use their symptoms when they get back out. They'll be the people who end back up in rehab in their 30s and 40s.
Look for the signs early. Look for a significant weight loss in a short time period, unusual food rituals like cutting up food or spitting food into a napkin. People suffering an eating disorder push friends away and don't want to hang out with anyone. Look for use of laxatives or diet pills.
Don't get mad at someone for having the disorder or get upset with them if you catch them purging. Simply ask, "What do you think is causing this to happen?" and explain how dangerous the disorder is.
And one last REALLY IMPORTANT THING!!! It is not about the food! It is always about some kind of issue like stress, school, control… something the person can't handle in her life that causes her to do this. It is a coping mechanism.
SK: To parents, siblings, teachers, friends – If you suspect that someone is struggling with an eating disorder, look for symptoms, ask questions, and don't let him or her tell you that everything is okay. This disorder will not go away without help, and help is available. The National Eating Disorders Association (NEDA) is a non-profit organization dedicated to supporting individuals and families affected by eating disorders. Check out their website at NationalEatingDisorders.org for more information on eating disorders and how you can get help.