
DATE: Sunday, September 14, 1997            TAG: 9709120065

SECTION: DAILY BREAK             PAGE: E10  EDITION: FINAL 

COLUMN: Imperfect Navigator 

SOURCE: Alexandria Berger 

                                            LENGTH:  113 lines

DIANA LONG BATTLED EATING DISORDER

ABSENT FROM the coverage surrounding Princess Diana's death was the effect eating disorders had on her public behaviors and private decisions.

Millions in developed nations suffer from this group of disorders. About 90 percent are adolescents and women.

Earl Spencer, Diana's brother, alluded to how eating disorders affected his sister as he eulogized her, noting that they were merely a symptom for feelings of unworthiness. What he did not say was that eating disorders are difficult to cure.

Victims have enormous willpower and therapists find patients wanting to keep their disorder, even after recognizing its dangers. Recovery is dependent on awareness, behavior modification and therapeutic intervention.

Diana was initially disabled by bulimia nervosa, characterized by repeated episodes of consuming large quantities of food in a short time, then vomiting or purging herself. She typified eating-disorder victims by verbalizing her feelings of loneliness, social isolation, low self-esteem, self-hatred and shame.

Therapy requires that a patient acknowledge his or her affliction, in much the same way as an alcoholic. As Diana admitted: ``It's a disease of self-punishment. It's a secret disease. Your self-esteem is at a low ebb. You don't believe you're worthy or lovable.''

Diana fought her way back in therapy, which can take months, even years. But because she had been denied any support or comfort from the royal family, the princess turned to the people and sought to bask in the warm glow of the public limelight, which could wrap its arms around her.

In her speech on AIDS, she stated, ``There are no known bad side effects from giving a hug.'' Feeling safe nurturing others, Diana needed to learn it was OK to nurture herself. While giving a hug, she got one. She could feel touched and loved.

With eating disorders and obsessive-compulsive disorder relatives (10 percent to 20 percent of those with eating disorders also have OCD), addictive behaviors are natural cousins. The more Diana was hugged by the public limelight, the more she needed to be in it.

Once the bulimia was under control, she replaced bingeing on food with bingeing on the public's admiration of her. As a substitute for purging her food, she became addicted to exercise as weight control, a pattern seen in anorexia.

Anorexia nervosa, bulimia's twin, is characterized by starvation. Exacerbated by a distorted body image, victims see themselves as fat, no matter how thin they become. Menstruation ceases. Excessive exercise and food obsessions take place. Nothing else matters.

In both anorexia and bulimia, relapse is not unusual. Diana slipped backward but managed to survive.

About 5 to 10 percent of anorexia nervosa patients eventually die of complications of the illness. Bulimarexia, a combination of both disorders, is the most dangerous, with victims starving, bingeing and purging, all at once.

One-third to two-thirds of anorexia nervosa patients also suffer from depression. A family history of depression or OCD is important. In Princess Diana's case her sister Sarah suffers from anorexia nervosa.

Researchers believe eating disorders are a result of biological, psychological and environmental factors. It is not known whether people inherit a gene that, under certain conditions, goes awry.

Because mostly young women are affected, there may be a strong link between the body's hormonal and metabolic changes in puberty and early adulthood that, in turn, trigger alterations in the brain, causing an eating disorder to occur.

Diana suffered postpartum depression after the birth of her first child, Prince William. With her pregnancy's extreme hormonal changes, followed by delivery and depression, came bulimia.

In some cases, antidepressants such as Prozac seem to help. In others, they are of no use. However, patients are required to gain weight before using the medication.

Until she fell in love with Edam ``Dodi'' El Fayed, Diana remained on an insecure treadmill. At the time of her death, Diana no longer seemed to need the media or the public for fulfillment. She had filled herself up and was ready to pursue balance.

Still, addictions are hard to break. In her 16-year quest for worthiness, Diana had addicted the press and public to her as well. She had flirted, teased and made love to the cameras too long.

With her death, we mourned. We, who fed her when she was most hungry for nourishment, were finally able to hug her. MEMO: Write to Alexandria Berger, c/o The Virginian-Pilot, 150 W.

Brambleton Avenue, Norfolk, Va. 23510. ILLUSTRATION: Graphic

MORE INFORMATION ON EATING DISORDERS

Books:

The Secret Language of Eating Disorders'' by Peggy Claude-Pierre,

founder and director of the Montreux Clinic.

French Toast for Breakfast'' by Mary Anne Cohen. Food for Love''

by Janet Greeson.

Father Hunger: Fathers, Daughters & Food'' by Margo Maine.

Dying to be Thin'' by Ira M. Sacker and Marc Zimmer.

The Deadly Diet'' by Terence J. Sandbek.

When Food Is Love,'' by Geneen Roth.

Appetites: On the Search for True Nourishment,'' by Geneen Roth.