Tuesday, June 9, 2009

The nature of an eating disorder

The show Intervention recently kicked off their new season at the end of May. I don't watch every episode, but I do catch one every now and then. Last night's episode featured identical twin sisters, Sonia and Julia, both in their early 20s. I found this episode quite interesting, as there were many different issues displayed: biological factors, IDENTITY, family dynamics, co-dependency, and competitiveness.

Most of us already know that genetics has an influence on eating disorders, so I'm not going to discuss that at length. However, since these two girls were identical, there was a higher likelihood that if one developed an eating disorder, the other would as well. (study
here) The interesting thing was that their sister, the eldest of the three, did not develop an ED.

From the family standpoint, the biggest issue I saw was never treating the girls as separate individuals. Thus, they never truly were able to develop their own IDENTITY which can be a core issue of an eating disorder. As teenagers, the two physically developed differently, Sonia, the younger of the two, was thin and slim, while Julia was more curvy and considered the "chubby angel." This seemed to be when anorexia first reared its ugly head, starting with Julia who began to exercise and get into karate. Then, Sonia became interested in the sport, and everything escalated from there, having a snowball effect in illness and further competitiveness between the two. Each one wanted to be recognized for something of their own, especially Julia.

Then, they developed a major co-dependency issue, especially when both were attending the same college and living together. Eventually, they both left college and came home. This only further exacerbated their rituals and rules, leading to the two of them to "feed" off each other. I thought these scenes between the two of them really showed the effects of the nature of the illness. You saw how both were incredibly isolated, never leaving the house, declined visits to their older sister's house, saying harsh words to their sister and parents, their daily rituals, etc. It was incredibly sad for their older sister to hear the things they said to her, like that they were never close. But it truly did show the mark of the illness in how they were so void of emotion, feeling, and attachment from anything other than their disorder.

There was something else Julia said that I found startling. She said how she felt like Sonia was copying her in her anorexia and other behaviors, but at the same time, she was her nightmare too. Just imagine, being an identical twin, living together in the same
environment, with an eating disorder. It's like waking up to see she shadow of your nightmare in living form as the anorexia. How that must be so difficult.

At the intervention which the girls had separately, you could see how clueless, helpless, and distraught their parents felt. They simply did not understand the disorder nor how raising of them as "one" versus separates impacted the girls' lives so much. Even down to the letter they were supposed to write for each individual girl, they wound up writing the same letter for each girl. By the end of the show, they did realize this mistake.

Sonia and Julia did agree to treatment, although they worried about being separated. But it seemed for Julia, there was almost a sense of relief actually, at least that is what I saw. Both girls were treated at
Remuda Ranch in VA, though their treatment was separate except for dealing with their co-dependency issues. At the end of three months, they had reached a healthy weight and were maintaining it. They plan to go back to college in the fall and live in separate apartments.

I'd say my only real discrepancy was whether the "tough love" approach should have been taken. It's something
Intervention is known for. In many cases, it works, since there is usually an "enabler" involved. The interventionist said how the parents were enabling this, because they allowed it to go on. Clearly, Sonia and Julia were not doing well in the home environment together, so something did need to change. Whether it was exactly their parents is questionable. I think the dynamics did need some revising, however.

Did anyone else see this episode? What were your thoughts?


Kim said...

I didn't see the episode, but your summary was riveting!! I find that so interesting. Long before I developed anorexia, we had family friends whose twin daughters were anorexic. They seemed to struggle with many of the identity issues you mention here. I guess it's testament to the power of genetics, and also shows how environment inserts itself to create a perfect storm.

saa said...

Have you heard of LA Raeven? They are twins, Liesbeth and Angelique Raeven that make "art" about the dynanic that exists between twins and shared disordered eating. I read about them a few years ago but I can't find the articles now, I don't know if they are still around...they were censored a lot. What they were doing was extremely complicated and controversial..I was never even able to decide how I felt about it bc they seemed to be glamourizing their condition..but they claimed they were not. Here is one article.


I didn't catch the intervention episode but I enjoyed reading your synopsis.

Sarah said...

I saw this episode and really appreciated it, I found this one to be a better one on intervention involving eating disorders.

It touched on a deep level for me and I bet for others as well. As you mentioned as how being identical twins, waking up to see the shawdow of your nightmare in living form as the anorexia, hit it perfectly. Within ourselves we may feel that 'twin', the ED, but to have it physical form as well had to be devistating.

Becky said...

Hey, I watched the episode too. It liked it a lot, and was so suprised they both agreed to treatment so quickly, especially not knowing if they'd be separted from eachother.

Anyways, I also have a twin sister (who as far as I know doesn't have any food issues). Although our bodies are a little different, comparing is inevitable. Having someone to always compare to definitely throws another wrench in the mix, and I totally understand. It was a great episode!

Cammy said...

I think the father was the one that affected me the most. When he said he thought he deserved to go to hell if his daughters died of this...that just broke my heart. Also, in the scene where they essentially shut out the older sister, it really hit home with me because it reminded me of the times I've blown off siblings or other family members because of the ED.

Just Eat It! said...

I question the tough love approach, too. I don't necessarily see eating disorders as being the same as an addiction. There are similarities, yes, but anorexia seems different to me than drug use.

Gwen said...

This episode really broke my heart. I know it's harder for me to watch the eating disorder episodes as it brings back memories of that nightmare that used to be my life. What's good about it is that it reminds me of how bad it actually was. It's too easy for me to romanticize that time in my life (The only thing i miss is being super skinny but the price was way too high). I don't recall the girls being identical twins. Wasn't one twin 5'7" and the other 5'4"? Is that possible in identical twins? Anyway, it was a moving story and this was a great post.

Tiptoe said...

Kim, I think that was what was so interesting about this episode--you could really see the interplay between genetics and environment.

Saa, I'm not familiar with the twins you mentioned, but from the article link, I can definitely see how they were very controversial.

Sarah, I agree this was one of the better ED intervention episodes.

Seeing anything in the flesh form from our mind's eye, just makes everything so real.

Becky, it's hard to say really how long it took them to agree to tx since we are only seeing the edited version. I think I've heard somewhere where it took a few hours in some cases. But not matter the case, it was just good that they agreed to go.

I also wonder if other twins who do not have ED issues compare their bodies ot each other?

Cammy, yes, the father's words were so sad. You could just see how helpless he was. And the scene with the older sister was really heartbreaking too. I think there are a lot of us that can relate to that moment.

JEI, I agree, there are definite components of addiction but not completely either. I think this is partly one reason why AA doesn't always work for those with EDs.

Gwen, I am glad that you realize the price to be thin is not worth it. There's just so much more to life than that.

I think the girls were identical. From my understanding, identical twins can have different heights due to environmental factors, their bodies, etc. It's only their DNA that is identical. JEI, care to answer that question?

Anonymous said...


This is Sonia from the show. I just got out of treatment and was looking up what others might have thought. I was afraid of being judged and thought badly about but seeing this thread made me feel better. They made a mistake in the hieght though. I'm 5'6 and Julia is 5'7, just an inch difference.

Interestingly, there are a few things that they left out, which is understandable since the show is only 45 minutes.

My dad favored Julia and Joanna, he was proud of them because they were always better at school and each did a sport. My two sisters both went through a "chubby" stage. When i played basketball at the same time Julia did Karate, my dad would complain about how it was a waste of time and never attended a game along with my sisters. My mom was only able to make it to two of my games since she worked.

I then got a job to help my parents out financially since my older sister used a lot of their money and they had to pay for us all. My parents never wanted to say no when asked for money because they wanted to provide for us and not have to go through what they went through. I saw this and made sure to help out when ever I could; such as cleaning the house, paying for my dog's bills and food, slipping money in their wallets and anything pertaining to Julia and I. Julia never had to work because i provided for her. I started her first bank account and payed for entrance fees for college for the both of us. The only time my dad was proud of me was when I was working. My sisters always out shone me.

Both Julia and I wanted to help out as much because my mom had MS and we wanted to help her. In college I had no social life and did everything to insure that I did well and made my parents proud. I would never do anything that they didn't agree with. My dad was overprotective, and rightfully so because of the things he went through, and didn't want us to anything that could be bad for us. Like going to the store at 9 PM or to a party, etc. I knew I had to be the perfect child.

We both just left treatment and are still mantaining weight. I discovered that I had extreme OCD and that was one of the reasons I couldn't stop my eating disorder behaviors. Also, I found out when afraid of the unknown, I automatically seeked Julia out and she did the same. We were each other's comforts.

But at the moment we are living in different cities, in order to establish our own life and make our own choices with out the influence of the other.

Tiptoe said...


I'm thrilled you commented on my blog and shared your perspective here. I knew there would be details left out in the show, so it is really nice to hear some clarity on things.

It's good to know you felt better reading this blog entry. I try hard to keep it about observations versus being judgmental. I can only imagine how hard it might have been for you to look up this episode. I think in general though, the episode showed a lot of interesting points on the development of eating disorders. It is good to know now that you discovered how your OCD played a big role for you and the ED.

I'm so glad to know that both you and your sister are out of treatment, maintaining weight, and establishing your own identities. I wish you much luck in continued success in treatment and in life. Feel free to comment here or e-mail anytime.

nicole halpert said...


I am a mother of 18 year old anorexic identical twins. I did not see the show. But, surfed the net and heard about it. My twins also are very OCD in their behaviour, have been all their lives.

As parents, we never called them twins. Never referred to them as such, never compared them, or even dressed or did their hair the same - quite, the opposite. They got along as young girls, but at puberty, the OCD temperament was hard to take. High school and making friends was an issue. Especially, for the one that developped ANA first. Her emotions always ran through her stomach. Despite therapy, support etc. ANA entered our lives three years ago. We had help from experts at the Adolescent Clinic here in Montreal. Therapy. Nutritionist, Suport groups etc. But, our other daughter - who had always been the follower in the twin relationship - did not want to look different (heavier) and a year later, dieted, counted calories etc.

The last year has been hell. Hell. We sent one away this summer - wonderful things happened to her and to both of them really did well during the separation, getting to find out who each one is - as an individual, and not as a person who compares herself to the other.

But the ANA was still there. Loss of weight during the summer months was quite a shock to us when we saw E. come home. And, upon the reunion of both under the same roof, the relationship came to a head last week. We ended up in ER with the one that had left. She was disoriented, stressed etc and binged for the first time.

Over the course of a week of despair etc. We have opted for a more tough love approach: we will support the recovery, not the illness. We are no longer buying special food. We are no longer accepting not facing the disease and seeing a doctor. The one that started the ANA had a terrible experience during gym class yesterday - and, with a combination of different experiences over the week and of our tougher approach i.e. decide to get help or move out - both of them have decided to see the doctor tomorrow and seek help : support groups for ANA, therapist etc.

But, I told them it will not be easy. They hinder on each other's successes - they compete about everything : standing up, walking etc. And, even who reads the most books (I call it litterary bulimia)

Anyway, I do not know if without going to a facility, recovery will be possible. I do not know if we will have to separate them soon, not to have them live in the same house. I think it is quite telling that Julia says in conclusion: we are now both living in different cities, in order to establish our own life.. etc.

I do know - that if we ever succeed at saving their lives, I will write a book (or something) about the experience of twins and ED which is supposed to be common - but, where I find that we are so isolated as parents and caregivers. Anyone with comments, etc. feel free to email me -

- Question about the OCD: did medication come into play?

Tiptoe said...

Hello Nicole,

Thank you for sharing the story of your twin girls who suffer from AN. AN is certainly like a "devil in disguise" character, and I'm truly sorry that your family has had to deal with it.

It sounds like the last few years have been a roller coaster ride. It does sound like from what you have said having them separate was helpful for each other's recovery. It might be something that will need to be done on a longer term than just a summer, or perhaps, like Julia and Sonia, to be at a facility where they have separate treatment tracts but are able to be together in a controlled environment. That way, they are still separate but able to work through their issues with each other.

Unfortunately, I do not have the answers to your situation, but I am glad and thankful to hear that both are willing to receive additional help. I think your story is a good example of how heredity can play such a role in EDs, and I think many would benefit from reading a memoir about it.

As for the OCD, I do not know whether medication came into play. It is something that can be a useful adjunct to therapy at times.

I wish you, your girls, and your family the best. Recovery is a hard road, but one where support is essential.