As seen in the St. Paul Pioneer Press on August 19, 2011.

“The Bully” is not fussy about age, gender, shape or size. It affects an estimated 70 million people worldwide, mostly women. “The Bully” is a code name commonly used to distinguish behaviors associated with eating disorders from the patient. This can clarify the fight for family and friends: they’re fighting a condition, not the person they love.

Although eating disorders afflict more people than breast cancer, many are misinformed or poorly educated about them, says Jillian Lampert, director of communications, outreach, and research for The Emily Program.

Theories about causation are evolving. “For years, the paradigm was, mom caused it,” says Becky Henry, an “unwilling expert” and author of a self-help book for families to understand the illness, treatment options and coping strategies. The mother of a young woman with an eating disorder, she offers insight to others who are “beyond the denial stage” by coaching and speaking to families and health care providers (www.justtellhertostop.com).

Eating disorders can be deadly, but Lampert says they need not be.”People die in our community every year of an illness that’s treatable,” she says. “We refuse to be complacent. … There is hope and help and recovery.”

At nine locations in the Twin Cities and one in Seattle, The Emily Program offers inpatient and outpatient options along with dozens of therapy groups that are an adjunct to individual treatment plans. One in 20 adolescents struggles with an eating disorder, says Lampert. In addition, more males are seeking treatment as awareness increases that this is not just a female problem.

One need not be a fashion model to suffer from an eating disorder. Appearance can be deceiving and diagnosis problematic. It took two years before Henry’s daughter was diagnosed in 2002 because, she admits, she lied to her physician and psychologist. Diagnosis is based on criteria established by the American Psychiatric Association and can fall within three categories: Eating Disorder Not Otherwise Specified; Bulimia Nervosa; and Anorexia Nervosa. Behaviors that offset food intake such as vomiting, exercising excessively, and using laxatives and diuretics are involved in some, but not all, of them.

According to the Academy for Eating Disorders, eating disorders carry both psychosocial and medical implications. The mental illness can affect self-image and relationships, as well as work, school and athletic performance. Many physical symptoms result from starvation and purging, including dental enamel erosion, abdominal distress, anemia, kidney dysfunction, life-threatening irregularities of the heart rhythm and more.

Riding the roller coaster of success and setback is emotionally taxing. The shame brought on by the eating disorder leads to secrecy and lying. The self-loathing combined with the brain dysfunction often keeps people from obtaining help and moving toward recovery, Henry explains.

Eating disorders can co-exist with alcoholism, anemia, mood disorders, diabetes, and drug addiction so treatment for more than one condition may be necessary. One eating disorder can morph into another. Because various treatment options are available, families can become consumed with searching for the right fit. Treatment is expensive and insurance coverage is not always available.

Henry titled her book “Just Tell Her to Stop” to underscore a common misconception that was directed to her. “These complex and confusing illnesses lead many well-meaning friends and family to ask the parents of a child with an eating disorder, “Can’t you just tell her to stop that?” As many people with eating disorders feel their lives are out of control and believe controlling their food intake will restore it, Henry says, that question is not helpful.

Henry has survived for more than a decade by making a conscious choice to enjoy life despite persistent heartache and stress. “It’s like the oxygen mask on the airplane,” she says. “If mom doesn’t put hers on first, how can she save her kid? … It will take work, but you can be happy even if your child is not.”

Nurturing relationships when The Bully is in the house can be tough. On Oct. 1, Henry will launch Date Without Ed, an initiative to encourage families to enjoy a meal at St. Paul’s Q Kindness Café without discussing eating and the accompanying baggage. She knows from experience how difficult it can be to find something else to talk about.