By Gretchen Keiser

Near St. Joseph’s Hospital in Atlanta, along Peachtree-Dunwoody Road, a clinic has opened up in the last eight months which treats the largely hidden, but life-threatening problem of serious eating disorders.

At the F.A.C.E. clinic -- which stands for “Freedom from Addictive and Compulsive Emotions” -- those suffering from anorexia nervosa, bulimia and compulsive overeating are being treated in a pioneering way, according to those running the clinic. Instead of receiving standard medical treatment for their physical symptoms, or traditional psychological counseling for their eating behavior, they are being helped to understand their illness as an addiction. Their treatment, which includes medical care and intensive group therapy, has as its base the successful model established by Alcoholics Anonymous using a spiritual ladder of 12 steps to overcome addictive behavior and begin healing.

While the eating disorders receive much less attention, there are similarities between these disorders and alcohol and drug addiction, according to Dr. Guy Chelton, medical director of the clinic.

Since 1977, Dr. Chelton said, he has been working with the belief that those suffering from eating disorders are struggling with an addiction “to feelings” associated with food and eating, “feelings that people use to relieve emotional pain and to feel better about themselves.” The addiction is not to food, he said, but to the complex of emotions that are triggered by eating, swallowing, fasting, and by sensations of fullness and emptiness. It may also be connected to the acceptance or praise they win for their appearance.

Public attention has been drawn to eating disorders in the last few years, largely because of the disclosures by celebrities that they have struggled in secret with one of the conditions. Singer Karen Carpenter died of medical complications believed to be related to anorexia nervosa.

One of the baffling aspects of eating disorders is that those afflicted -- usually, but not exclusively, young women in their teens and early 20s -- are often high achievers in school and other activities, masking great emotional pain.

People with anorexia nervosa diet stringently and restrict their calories to the point where “they starve, they literally starve,” Dr. Chelton said. This pattern of severe and constant dieting causes serious medical problems and can be fatal. “They just literally aren’t eating enough,” Dr. Chelton said.

Yet the person suffering is blind to the problem. One young woman who is being treated at the clinic came in weighing 48 pounds, but struggling with feeling “fat.”

Those with bulimia are caught in a cycle of “bingeing and purging” -- eating tremendous amounts of food in binges and then purging their bodies by inducing vomiting or using laxatives. People with bulimia may “binge and purge” once a day or 20 times a day, Dr. Chelton said. Their weight remains relatively constant, but they believe they are overweight. They are also damaging their bodies by this abusive pattern and are caught in a web of secretive and deceptive behavior to hide their bulimia.

Bulimia is far more common than anorexia nervosa, according to the directors of the F.A.C.E. clinic, who say they are receiving calls from people who have suffered with bulimia for 10 to 20 years.

The third group, addictive overeaters, are people who are binge eating, but not purging and simply gaining weight and becoming obese. The different behaviors can also overlap, the directors said. An overeater can begin to diet and then become anorexic, failing to stop the diet when an appropriate weight is reached.

Struggling to explain the emotional dynamic that fuels an eating disorder, Dr. Chelton said those afflicted are frequently “overachievers,” who are “using all their talents to ‘look good.’”

In part, he blames a culture which emphasizes surface values and accomplishments, communicating to young people that appearances are what matters.

“The “A” is more important than whether or not the student gets the subject. The whole culture is involved,” Dr. Chelton said. “The emphasis is on whether one got an A or A+ or B or B+ rather than understanding it.”

In addition, he said, young women, especially, are given conflicting messages by society: be thin, be attractive, but be a good cook, be casual enough to eat at fast food restaurants, be stylish enough to eat fancy food. “Many of these pressures are opposite to one another,” he observed. “The bulimic has tried to resolve it by eating all the good things and throwing it up.”

There are also family patterns that appear frequently among those with eating disorders, including a family history of addiction, perhaps to alcohol. Certain groups of people, including those for whom physical appearance is very important, like dancers, gymnasts, flight attendants, actors and athletes, seem prone to eating disorders, according to those who direct the F.A.C.E. clinic.

“Bingeing and purging” and eating disorders have become a serious problem on college campuses, where officials are taking steps to curb the behavior and help students afflicted, said Barbara Chelton, who is the administrative director of the F.A.C.E. clinic. The University of Georgia has a counselor affiliated with F.A.C.E. working with students who have already undergone a four-week intensive recovery program at the Atlanta clinic and are now in follow-up care. The clinic staff has also given programs at Georgia State, Georgia Tech, Emory, Kennesaw and Brenau, Mrs. Chelton said.

By the time a person seeks help, there is usually a dramatic crisis forcing them to do so, Mrs. Chelton said, perhaps losing a job or failing at school.

One unusual aspect of the F.A.C.E. program is its modeling upon wisdom gleaned from other programs helping those with addictions. Like Alcoholics Anonymous, it begins with a spiritual step of admitting that the disease has made the person’s life unmanageable. Those entering talk about and write down all the ways that the disorder has affected their lives, acknowledging that it is having devastating effects and that it is out of their control.

Step two is to believe that a higher “Power” can restore the person to health and sanity and step three is to turn your will and your life over to God as you understand Him. This yielding of trust and faith is critical to the success of the program, those running it believe.

While there is an intensive component of group therapy and a controlled reestablishment of balanced and healthy eating patterns as part of the daily program, the spiritual element is critical to avoiding a relapse, the directors say.

As in AA, those at F.A.C.E. speak of being “recovering “ addicts, who are facing a life of abstinence from the use of food for recreation or pleasure. Another part of the program is for those who are recovering to help and support newcomers who are struggling to admit their illness.

Mary L., an effervescent 26-year-old Atlanta accountant, will mark her first anniversary June 6 of a year free from bulimia. Her warmth and outgoing personality belie the fact that she suffered for 11 years with the illness, beginning at the age of 15 to “binge and purge.”

“You just feel fat and it’s overwhelming,” she said, struggling to describe the interior pain which she had endured since being a teenager.

Her thinking used to run as follows: “I feel fat, therefore I look fat, therefore I am fat and I’m no good,” Mary said.

“You don’t realize that it’s a sick way of thinking,” she added.

While she was aware of her eating patterns, she was not aware of herself and her feelings, Mary said. “I never knew I had no self-esteem, I never knew I was lonely, I never knew I was angry and resentful.”

The spirituality dimension is a “surrender,” Mary said, which opened up “all these options, usually things that you have never considered.” Her first trust was in the doctors who were treating her and the other members of her therapy group, she said. Then it opened up to God, she said, and she simply reached out for Him, letting go of the feeling that she wasn’t “good enough for God.”

The 12 steps are also used as the basis for recovery by Overeaters Anonymous, a network of support groups for compulsive overeaters throughout Atlanta and nationally. The F.A.C.E. clinic program meshes with O.A. where possible, especially in long-term support for those recovering from severe eating disorders. The F.A.C.E. program itself is made up of four weeks of intensive treatment seven days a week, followed by seven weeks of after-care and up to two years of follow-up care.

The program’s criteria for success are “complete abstinence” from the abnormal eating behavior, a willingness to attend follow-up care sessions, and a commitment to helping new patients and staying in “recovery,” Mrs. Chelton said. While they have only been open since last June, 70 to 75 percent of their patients have been able, so far, to maintain their recovery.