Perusing the pages of any fashion magazine, a reader is reminded that, more than ever, "thin is in." These magazines echo the values of popular culture, speaking to women loud and clear: It is not enough to strive toward a physical ideal whose proportions defy the laws of nature and gravity. The successful modern woman is, at once, a sex symbol, a mother, and a CEO.

These expectations make many women feel inadequate. In some cases it can lead to anorexia nervosa and bulimia, two serious psychiatric disorders characterized by a preoccupation with food and an obsession with being thin. Anorexia is most prevalent in women in their early 20s, while bulimia tends to afflict a somewhat older group. As many as half of all anorectics become bulimic at some point, according to Dr. William Davis, executive director of Philadelphia's Renfrew Center for Eating Disorders.

Because the symptoms of these sometimes fatal disorders are often easy to hide, it is important to know their characteristics and warning signs:

Anorexia nervosa: The woman who is most prone to anorexia nervosa is typically a perfectionist. She demands much of herself, whether as a student, athlete, dancer, or all of the above. Like many high achievers, the anorectic suffers from low self-esteem. By depriving herself of food, she gains some measure of self-worth.

Gradually, she loses touch with reality. As her body fat disappears, her self-perception and value system distort. In her eyes, she is perpetually fat. Motivated by this skewed body image, she uses "will-power" to restrain herself and thus derives a feeling of mastery over her life.

The severe anorectic does not stop at refusing foods she craves. Eventually, she denies herself nourishment she needs. Failing to consume a minimum amount of protein, the anorectic becomes deficient in the amino acids necessary for healthy bones and simple bodily processes. In turn, she becomes increasingly listless, depressed, and energy-deficient. Many stop menstruating due to insufficient amounts of body fat, a condition that endangers fertility later in life. Some 15 to 20 percent of those who suffer from the disorder die.

Bulimia: An equally self-destructive disorder, bulimia is often coupled with other problem behaviors such as sexual promiscuity and substance abuse. Another type of bulimia is characterized by a compulsive need to exercise. Like anorectics, bulimics are tormented by unrealistic perceptions and expectations of themselves. Unlike the acetic anorectic, the bulimic binges on large quantities of food, comforted by the knowledge that she will purge herself shortly thereafter by inducing vomiting or using laxatives.

As in anorexia, the victim attains a false sense of control over her life and respite from feelings of worthlessness and desperation by repeating this process.

Depending on the severity of the disease, a victim may binge and purge as often as 20 times a day. Rapid weight fluctuation is an important warning sign, but because many bulimics become adept at hiding their ritual, it is often hard to detect. Bulimics spend long periods of time in bathrooms and most commonly mask their actions by running water. The effects of bulimia include dehydration, hormone imbalance, swelling of internal organs, and the depletion of necessary bodily minerals and electrolytes.

Judith Asner, director of the Eating Disorders Foundation of Washington, D.C., attributes the increase of the two disorders to both media and marketing trends. It is hard for anyone to ignore the proliferation of the "waif" look in magazines, movies, and television. And the "fat-free" claims that assault grocery shoppers reinforce the American obsession with losing weight.

This worshipping of thinness has not always held sway in America. "A society idealizes that which is most difficult to attain," says Asner. "When food and money was scarce, as was the case during World War II, the media enshrined the plumpened housekeeper and mother. Now that times are relatively prosperous, food is abundant, and leisure time is hard to come by, the media puts on a pedestal those women who laugh in the face of excess and spend their few free minutes trimming down to skin and bones." In such times, more voluptuous ideals, such as Guess jeans model Anna Nicole Smith are the exception rather than the rule.

Others see anorexia and bulimia as the result of more insidious societal trends. According to a study in the Journal of the American Medical Association, overweight people, especially women, are discriminated against in the workplace. Not only are overweight women hired much less frequently than overweight men, but they earn considerably less pay, the study found.

To blame sociological factors alone for anorexia and bulimia is inaccurate and futile, however. Only those predisposed to the disease will actually transfer these pressures into a disorder. A woman with a healthy self-image will not react to a photograph of an emaciated super-model with an urgent desire to lose 30 pounds.

Both anorexia and bulimia are curable. Recent attention has made treatment more accessible and full recovery more probable, and those who lack financial resources can get help by calling a hotline. Usually, hotlines will assess, then recommend a treatment that suits needs and resources of the victim. Treatment options range from psychiatrists to guidance counselors to eating awareness groups, which most schools provide free of charge.

NCND, Suite 800
216 West Jackson Blvd
Chicago, IL 60606

Answers nutrition questions and refers callers to dieticians.

800-366-1655

Lloyd Building, Suite 803, 603 Stewart St.
Seattle, WA 98101

Sponsors eating disorders awareness week and other events nationwide.

206-382-3587

Florida Inst. of Technology
150 West University
Melbourne, FL 32901

Sends free written information, refers callers to help in their area. Can forward calls to an eating disorders counselor.

800-872-0088

PO Box 7
Highland Park, IL 60035

Also known as ANAD, the association refers callers to help throughout the United States and in some foreign countries.

708-831-3438

445 East Granville Road
Worthington, OH 43085

Refers callers to professional help near their homes. Will also send a packet of information about eating disorders for $5.

614-436-1112

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