By Peggy O'Farrell
The Cincinnati Enquirer

Two years ago, Emily Kryman weighed 90 pounds when she checked into the Johns Hopkins Eating Disorders Program in Baltimore.

She'd only recently been taken off a feeding tube - a necessity because, locked in the grip of anorexia nervosa, she was starving herself to death.

Today, life has done "a 180" for the 21-year-old Ludlow woman and marketing major at the University of Cincinnati.

She weighed about 130 pounds when she left Johns Hopkins in the fall of 2001. Her weight dropped as she struggled to adjust to life outside the hospital, but it's holding steady now as she balances classes, work and family demands.

"I'm doing a lot better," Kryman says. "My weight is stable at about 112, which is not where the hospital wanted me, but it's stable."

She sees a therapist regularly and takes medication "to help me with my head and my thoughts," she says.

Anorexia is an insidious disorder. The disease is about control, not food, and people affected by it often starve themselves or exercise excessively because their weight is one of the few areas of their lives that they feel they can manage. Up to 20 percent of patients who don't get treatment die from suicide or the physical complications of starvation. Among patients who do get treatment, the mortality rate is 2 to 5 percent.

Kryman says she's learned a lot about herself and managing anorexia, but it's all too easy to slip back into dangerous habits.

"I really have to keep on top of it," she says. "The eating is a lot better. It's my confidence and self-esteem that need work, but I've come a long way."

She's eased up a little on her class schedule. "My grades were great," Kryman says.

Kryman had to go to Baltimore for treatment because there are no residential treatment centers for eating disorders in Greater Cincinnati, and treatment options are dwindling nationally because of lack of funding. Many health insurance plans don't cover inpatient treatment and limit coverage of outpatient therapy. Eating disorders often require years of treatment for a successful outcome.

Learning to eat normally again has been a struggle, she says.

"It's pretty much become routine again and a habit," Kryman says. "But when I'm under stress, it's more difficult."

Anorexia and its behaviors - eating rituals, lying, hiding from friends and relatives - can easily take over a patient's existence, and it's often easier for patients to live with the disease than face the factors that contribute to it.

Kryman says she's learning.

"I'm trying to focus on different things instead of letting anorexia run my life," she says.