On December 30 it was reported that the French model and actress Isabelle Caro died aged just 28 after battling anorexia. At one stage during her illness she weighed just 55 pounds.
In 2007 Isabelle Caro became the face of the 'No Anorexia' campaign by fashion house Nolita. Italian photographer Oliviero Toscani took the pictures which showed the controversial images of the model looking emaciated, so thin that her vertebra were visible through her skin.
Caro had spent time in hospital back in 2006 after she fell into a coma.It was thought she wouldn't survive then but she pulled through. The news of her death was reported widely in the run up to the New Year. The Associated Press report that she died on November 17 but details have only been made available recently.
Dr. Stacey Rosenfeld, a licensed clinical psychologist in New York told me:
"It's such a sad story. What's especially concerning is that pro-ana websites, which support disordered eating, are glorifying Ms. Caro's illness and death. Anorexia is both a physical and psychological illness that carries the highest mortality of all psychiatric conditions."
A few years ago Caro released a book called "The little girl who didn't want to get fat". Images and quotes from Isabelle can be seen here.
In an industry so obsessed with physical appearance it perhaps isn't surprising that Caro isn't the only model to have succumbed to the eating disorder anorexia. The Telegraph have previously reported on Brazilian model Ana Carolina Reston who died aged just 21, her death linked to extreme dieting. The Telegraph also report that another model died the same year after months of existing on a diet of lettuce leaves and diet drinks. Luisel Ramos died of a heart attack aged 22.
According to statistics from the the US based National Association of Anorexia and Associated Disorders, up to 24m people have an eating disorder of some kind, either anorexia, bulimia or binge eating and 20% of those with anorexia will die early from the complications of anorexia.
Dr. Deborah Franko is a professor in the Department of Counseling and Applied Educational Psychology at the Bouve College of Health Sciences at Northeastern University in Boston.
In an email Dr. Franko gave me her initial thoughts on the story of Isabelle Caro:
"This very tragic news will likely bring anorexia nervosa (AN) into the spotlight again, at least for a short time. Reminding the public that AN is the psychiatric disorder with the highest mortality rate of all disorders, as well as the deadly consequences of this disorder is an important message to continue to get out to the public, particularly to young girls and women."
Dr. Franko also gave her opinion on Isabelle's participation in the anti-anorexia campaign:
"It is not possible to actually know the effect of her participation in the anti-anorexia campaign, as this was not measured in any way. However, both her photos and her recent death remind people that AN is a tragic and deadly mental disorder. As for becoming an icon, unfortunately there are many, many images on the Internet that pro-Ana sites can pick up on and use. We have to continue to send messages that eating disorders are psychiatric disorders that can be treated and work toward prevention."
And on what can be learned from Isabelle Caro's story,Dr. Franko said:
"AN can be chronic, longstanding, and result in death. However, if treatment is sought, particularly early in the disorder, people can recover and go on to lead productive and healthy lives."
Commenting on what the fashion industry can/should do to help address this issue, Dr. Franko had this to say:
"There has been some movement on the part of the fashion industry, but there is a long way to go. The Council of Fashion Designers of America (based in NY) has made some recent strides. The non-profit organization I work with, The Harris Center for Education and Advocacy in Eating Disorders at Mass. General Hospital, has been working with the fashion industry, including a public forum in March 2010 (and another in March 2011), to address the health of models."
What is going on in the minds of people suffering from AN?
"AN is a mental disorder whereby the person suffering is highly (sometimes solely) focused on getting thin and maintaining that low weight. It is very hard for someone with AN to see the consequences of what she is doing, and often her cognitive capacity, social relationships, and psychosocial functioning are impaired because of this. Starvation has many physical and psychological negative effects that span all systems of the mind and body."
What kind of psychiatric work can be done to help?
"There are treatments for AN, notably family therapy for younger patients, and individual psychotherapy for adults. Medication has not been shown to be helpful in AN for the most part, unless the person with AN is depressed, in which case antidepressant medication can be effective. Hospitalization is often needed to address medical complications and low weight, but is most often short term."
How does the pressure on girls to stay slim contribute to AN?
"By creating a society where thin is associated with success, happiness, wealth, and attractiveness, young girls strive to be thin without recognizing the costs, both physically and mentally. Some have referred to the focus on thinness as a "brain drain" - girls focus on their bodies to the extent that other important issues (friends, family, school, activities) are left behind."
Is there anything that can be done to counteract this pressure on girls to look a certain way?
" Lots of things - parents can talk to their girls about it, pressure can be put on advertisers and media outlets to provide more realistic-looking models, schools can screen for disordered eating and offer prevention and information programs, legislators can cover prevention in school health programs, and girls can rally together against the increasing pressure for thinness."