Who's vulnerable?

There are more than 5 million Americans who have a clinical eating disorder -- meaning their symptoms meet the medical criteria -- and probably millions more who have an unhealthy relationship with food. In fact, a recent survey of 4,000 women between the ages of 25 and 45 found that 75 percent of them don't eat or think about food in a normal way.

Treatment centers are seeing an increase in adult women seeking therapy for their eating disorders. At the Remuda Ranch in Wickenburg, Arizona, for instance, the number of women between 30 and 40 has risen 300 percent in the past seven years, according to Edward J. Cumella, Ph.D., executive director of the eating- and anxiety-disorders clinic. And the centers are responding to this demand by tailoring treatment tracks just for these women, many of whom are moms.

Denise Delmers of Shelburne, Vermont, was one of them. A mom of three, Delmers always felt she had to be perfect.

"I was supposed to do everything and be everything for my daughters, my husband, and my job -- that was my role. And if I couldn't do it, I was a failure," she says. The one thing she could do for herself was to get back to her high school weight. "Looking thin and attractive was something I could do really well," she says. To lose weight, she began to run, setting an eight-mile-a-day goal that she pushed herself to meet, no matter what. And she became anorexic.

For years she was in denial, feeling that she had a handle on her weight. Finally, her husband, her parents, and her colleagues at work convinced her that things really weren't okay. When she checked herself into a center to get treatment, she weighed 87 pounds. She is five feet five inches tall.

Delmers's quest for perfection doesn't surprise the experts. "Many of the anorexic and bulimic moms I see do everything," says Margo Maine, Ph.D., a clinical psychologist specializing in eating disorders and coauthor of The Body Myth: Adult Women and the Pressure to Be Perfect.

"They work outside the home, they volunteer, they're the ideal parent -- and they're expected to be all that and more without any role models that have gone before them to show them how, since their own mothers weren't typically expected to work outside the home. We're out there, all of us twenty-first century moms, on our own, and we're understandably overwhelmed by all that's expected of us."

Of course, not every mom translates the challenges of motherhood into an eating disorder -- the equation seems weighted by biology and circumstance. Like me, 80 percent of adult women with eating disorders had similar issues with food when they were younger. It's part of their makeup. Studies on families and twins have suggested that you're 12 times more likely to have anorexia if a relative battled the disease in the past, and 4 times more likely to develop bulimia if a family member has experienced it, too. And scientists now think you have more than a 50 percent chance of inheriting a genetic tendency for bulimia or anorexia.

Research has also shown that women who are prone to anxiety, depression, and obsessive-compulsive behaviors are more vulnerable -- and for those women, anorexia or bulimia can be triggered by the everyday stress and chaos that comes from raising kids, says Dena Cabrera, a clinical psychiatrist who works with the moms' groups at Remuda Ranch. Another trigger: sleep deprivation, which can contribute to depression and feeling out of control.

Gretchen Sortzi, a former anorexic, gained 100 pounds when she got pregnant. "After my daughter was born, I didn't recognize my body," she says. Sortzi, of Enola, Pennsylvania, started "obsessing about every calorie," lost 40 pounds in the first 12 weeks, and 60 more by her daughter's first birthday. But the loss came at a huge cost, emotionally and physically. "I was consumed by my quest for a perfect body and the shame that went with starving myself. I was wracked with arthritis, lost an inch and a half of height, and had to spend about $50,000 on my teeth, which were ruined from being malnourished," she says.

Micromanaging our postbaby bodies instead of our overly stuffed lives can feel like the surest way to gain a semblance of control. It makes a weird kind of sense; after all, starvation is a drug. Like alcohol and marijuana, it numbs you, distracts you. It keeps you from feeling what's going on in your life. For me, this held immense appeal -- in college, when I felt at sea, and after Henry died, when even the microscopic spaces between my cells seemed to ache.