Stubbornness and being "pissed off" are the emotions Natalie Harold attributes to her decision to fight back from a disease that took over her life five years ago.
"By the time my parents were concerned my hands were blue, they were chapped because I was dehydrated, I was always cold and my hair had begun to fall out," said the 19-year old Herndon High School graduate.
When she entered the ninth grade at Herndon High, Natalie Harold was diagnosed with an eating disorder.
"I lost 35-pounds in two-and-a-half months," said the James Madison University freshman who was not overweight before her dramatic weight loss.
At her skinniest, Natalie Harold weighed 104-pounds. Because she lost so much weight in such a short period of time, Natalie faced medical complications.
With her health deteriorating, Natalie Harold was taken to a doctor, and diagnosed with anorexia nervosa, an eating disorder often marked by an unnatural fear of weight gain, compulsive exercising, self-starvation and a distorted body image.
Within a year of her diagnosis, the young student made the transition from being classified as anorexic to having an "eating disorder not otherwise specified" or EDNOS.
"I switched from restricting [food intake] to periods of restricting to bingeing and purging," she said.
Bingeing and purging — also called bulimia nervosa — is an eating disorder in which people develop a secret pattern of binge eating, or eating large amounts of food at one time. The person then gets rid of the food through self-induced vomiting or taking laxatives and/or diuretics. Up to 50 percent of patients with anorexia develop bulimic symptoms, according to the National Association of Anorexia Nervosa and Associated Disorders.
Natalie Harold admitted her disorder began much earlier than high school. As a second grader she stopped eating meat; slowly after that she stopped eating other foods.
She does not know what caused her to stop eating.
"People think it's a choice that these girls make," said Dana Harold, Natalie Harold's mother. "But it's not, it's something bigger than that."
ROUGHLY 90 PERCENT of people with anorexia are young women ages 14 to 18, and most people with bulimia are females, ranging in age from teens to early 20s, according to the Penn State Eating Disorder Clinic.
In the last few years, the number of young children diagnosed with an eating disorder has increased, said Dr. Richard Levine, head of the Penn State Eating Disorders Clinic. In the field almost 15 years, Levine specializes in adolescent medicine, including eating disorders and depression.
The youngest patient Levine has treated with anorexia was 8-years old, although he has seen younger, he said.
"Eating disorders are serious medical problems in addition to being a serious psychological problem," Levine said.
Potentially irreversible medical complications in adolescents with eating disorders such as anorexia and bulimia include growth retardation, loss of dental enamel due to chronic vomiting, structural brain changes, puberty delay or arrest and lack of bone mass which can result in the on-set of osteoporosis and increased fracture risk.
"We have 18- or 20-year olds with the bone density of their grandparents," Levine said. "With the fractures."
These medical complications, including the increasing strain on the heart, can result in hospitalization for the severe cases and even death. Eating disorders have the highest mortality rate than any other psychiatric illness, Levine said. Young women with anorexia are 12 times more likely to die than other women their own age without anorexia.
EATING DISORDERS can affect men and women of all ages, race and demographic. There is no single cause for an eating disorder, according to the National Association of Anorexia Nervosa and Associated Disorders. Instead it is a "complex interaction between the biological issues such as genetics, metabolism," or other psychological issues. These issues include a culture that promotes thinness by placing thin looking women on television and magazine advertisements.
"We have to teach the kids media literacy, so they understand not to believe what they see in the magazines," Levine said.
"They are finding in a lot of these kids that depression is triggering these eating disorders," Dana Harold said. "It hurt me that [Natalie] felt like she had to do this. We knew we couldn't make the decision for her to get better. We just knew we had to be there for her to support her and pray for her."
Ultimately, Natalie Harold thinks depression may have triggered her eating disorders.
"Up until last summer I didn't think I was capable of being happy," she said. "The thing that was so frustrating about the depression is I have nothing to be unhappy about. I grew up in affluent county, I lived in a good home, I went to a good school. I didn't know why I was depressed or why I had the eating disorders."
During this time, Natalie Harold's family was trying to support her.
"It would make me so sad because I couldn't fix her, because mom's are supposed to fix things and I couldn't fix her," said Dana Harold. "I really encourage parents not to feel like they have to handle it on their own."
IT HAS BEEN 10 months since Natalie Harold has binged on food and then purged. Her decision to stop came after her psychiatrist told her the only way she could get better would be if she admitted herself into a treatment center.
"I am kind of stubborn and that pissed me off," she said. "So I decided on that day to not purge anymore. I just kept going."
After four years of treatment through outpatient counseling, meeting regularly with a psychiatrist and psychologist and other support systems, everything Natalie Harold had been told about ways to overcome the disease "just clicked."
Now on the road to recovery, Natalie Harold is open about her experiences because she wants parents to realize the prevalence and severity of the disease if not treated.
For some people diagnosed with an eating disorder the road to recovery can be a long-term battle, but it does not have to be a life-long battle, Levine said.
"The vast majority of young people recover from it," he said. "For young people we are looking for recovery, but it's recovery, it is not a cure. We cannot give you medication to get over it."
An advanced placement student in high school, Natalie Harold has already declared her major — psychology — and hopes to graduate college in three years, instead of four.
Once she is out she hopes to either work with adolescents or senior citizens.
"It took four years for everything to lock into place enough so I could take the steps to get better," she said. "I still have trouble and my eating patterns are still weird, but I am not purging."