When clients with eating disorders come to counselor Mary McRae, they know the advice she gives is from first-hand experience. 

A survivor of a severe eating disorder in her 20s, she said the people who helped most in her recovery were others who had been through something similar — who could recognize behavioral patterns and provide accountability.

“It just helped a lot to have somebody like that, and to see that you could recover and carry on with a normal life,” McRae said on the eve of Eating Disorder Awareness Week, which runs Feb. 26 to March 3.

McRae did just that, later becoming a counselor herself. She hopes to help others through her practice in Kalispell.

McRae said while she was affected by anorexia, there are many different kinds of disordered eating. A common form that flies under the radar is binge eating. Like other disorders, it can bring a lot of shame that leads the victim to avoid talking about it. 

“There's just such shame, no matter which way the eating disorders show, there’s shame,” McRae said. 

She said starting a conversation about an eating disorder is one way to begin dismantling shame and start looking at how it’s affecting someone’s life. This could happen during a counseling session or through a screening at a doctor’s appointment, similar to the way people receive a depression screening when they visit their primary care provider. 

“You know, how do we open up that conversation? And how do parents and friends learn to mention that, because eating disorder clients can be very defensive, frightened and ashamed,” McRae said. 

McRae told the Daily Inter Lake in 2012 that she weighed 68 pounds when her friends and family intervened about her eating disorder. A school teacher in her 20s, she described herself as a perfectionist and soon fell into habits associated with anorexia. She began restricting calories and increasing her time at the gym. 

At her worst point, she would allow herself just 500 calories and then would go to the gym for two and a half hours of exercise twice a day. 

MCRAE'S EXCESSIVE exercise and calorie restriction is still in line with warning signs seen today. Eating Disorder Center of Montana Marketing and Outreach Manager Aimee Johnson said there are so many different kinds of things people can do while coping with an eating disorder depending on type of condition. But there are some common signs.

“Some things that we always think are important to look out for are people expressing disgust with their body, withdrawing from social activities that they used to love or social events that involve food. Dieting is one of the leading predictors of somebody experiencing an eating disorder,” Johnson said. “... Changes in mood and irritability is a big one, wearing baggy clothes or hiding their body. And then of course, there are some more specific ones, like if somebody is purging and causing themselves to throw-up, there could be scars on the back of their hands on their knuckles from doing that.” 

Eating Disorder Center of Montana has locations in Bozeman and Missoula, which offer outpatient treatments, virtual and in-person, as well as partial hospitalization/day treatment programs for eating disorders. Johnson said their partial hospitalization program in Bozeman is a little bit of a misnomer, because it’s not associated with a hospital. But it’s an intensive, daily treatment that sees patients come to the facility and spend all day, 8 a.m. to 4 p.m., with the staff and others suffering from eating disorders. 

Johnson said this includes breakfast, lunch and two snacks, as well group therapy activities, nutrition counseling and group outings. 

She said the group therapy approach is beneficial for those suffering from eating disorders. There are staff members present to help set the tone and be a go-to person for clients who need help processing their emotions throughout the day.

“That's really beneficial because it helps patients to learn how to manage their emotions between those tougher times like meals and therapy sessions. It helps them learn how to cope with their anxiety in healthy ways, rather than turning to negative coping mechanisms like eating disorder behaviors,” Johnson said.

But it can be hard to find a program close to home for many in Montana. Johnson said there are no residential facilities in the state that treat eating disorders. McRae often refers clients to treatment programs like the nationwide Emily Program, which has locations throughout Washington state — the closest being in Spokane. 

Johnson said insurance coverage can also be tricky for those looking for treatment.

“In rural and poorer states like Montana, unfortunately, Medicaid doesn't cover any of the higher levels of care that we offer,” Johnson said. “It doesn't cover dietician services for most patients — it does cover really extreme cases, like if you need hospitalization for an eating disorder, or if you need to see a therapist. But, it doesn't really cover any of that in-between care for eating disorders.”

ACCORDING TO the National Association of Anorexia Nervosa and Associated Disorders, there are 10,200 deaths in the U.S. each year caused by an eating disorder. McRae said in her 2012 interview that during the hardest parts of her battle with anorexia, she was afraid to fall asleep for fear of not making it through the night. 

She said speaking up about eating disorders will hopefully draw attention to the need for resources when it comes to treatment.

“We need to talk about it,” McRae said. “We need more resources because there aren't enough of us that work with it right now.” 

From a prevalent diet culture to the curated personas seen on social media, there are many pitfalls for developing an eating disorder in today’s society. Johnson said it’s important to speak about eating disorders in order to dismantle the stigma surrounding it.

“It's an issue that people don't think is an issue until they see somebody really struggling,” Johnson said. 

Eating Disorder Awareness Week is hosted by the National Eating Disorder Association. According to its website, it’s an annual campaign to educate the public about eating disorders and to engage in efforts to provide support for individuals and families affected by eating disorders. By clicking on the “resources” tab on their website, people interested in learning more about eating disorders can be connected with tools to help with everything from an initial screening to recovery and relapse.

Reporter Taylor Inman can be reached at 406-758-4433 or by emailing tinman@dailyinterlake.com.