You see them in the supermarket, their fragile bodies splashed across the covers of tabloid magazines. But you also see them at work, at school and at home. A few are Hollywood starlets and New York fashion models, but most are just normal American women -- your co-worker, your niece, maybe even your own daughter. And they are killing themselves in their quest to be thin.

According to a recent study by the National Institute of Mental Health (NIMH), an estimated 10 million Americans suffer from an eating disorder. Nine out of 10 of those sufferers are women, and the majority are in their teens and 20s, with 10 percent of college-aged women exhibiting anorexic or bulimic behavior.

Whether they are slowly starving themselves or trapped in a cycle of binging and purging, the consequences of their quest are deadly serious. Eating disorders have the highest mortality rate of any mental illness: 15 percent to 20 percent of all those suffering from a serious eating disorder will die, according to NIMH's latest numbers.

Those who survive run the risk of heart problems, osteoporosis, organ failure and infertility. Less than half of anorexics and bulimics will achieve a full recovery. The majority will spend the rest of their lives in a daily battle against their bodies, and as the years pass, the number of women engaged in that battle continues to grow.

'Fixing' themselves

What motivates these women to go to such extreme lengths to be thin? And why, despite all the attention eating disorders have received in recent years, is there so much confusion over what causes the problems in the first place and how to treat them once they've begun?

The answer to both those questions begins with this: Eating disorders are not about being thin, at least not ultimately.

"Girls with eating disorders have a problem with body image," said Franciscan Father Dave Pivonka. "But that problem is masking deeper problems that are the real source of the behavior."

So, what are those deeper problems? According to Father Pivonka, who serves as Franciscan University of Steubenville's vice president of mission effectiveness and, for more than a decade, has provided spiritual direction to young women struggling with eating disorders, the problems can run the gamut from sexual and physical abuse to, more commonly, something as seemingly simple as overly critical parents or a fear of becoming an adult. Rarely is there just one contributing factor. Generally, there is a combination of problems that culminate in the onset of the eating disorder.

Mary Ann Hayes, a licensed Catholic counselor who works with the Alpha-Omega Clinic in Bethesda, Md., agreed with Father Pivonka's assessment and noted that the most common causes of eating disorders stem from problems in the home, including poor communication, parents with unrealistic or rigid expectations and emotionally distant fathers.

"The girls come to believe they won't be loved for being, or even allowed to be, who they are," said Hayes.

Coping mechanism

And that is what eating disorders are really about. For all the various contributing factors to eating disorders, the belief that something is very wrong with them and that they are funda_mentally unlovable is universal among girls struggling with anorexia and bulimia. They are not waging a war against their bodies simply because they want to be a Size 4. Rather, controlling their weight, whether through self-starvation or the binge and purge cycle, is their way of "fixing" themselves. Moreover, they deny themselves the most basic form of self-care -- eating -- not only because they often don't know how to care for themselves, but because they usually don't believe themselves deserving of such care.

Hayes also pointed out that eating disorders are typically the means by which these young women attempt to control their feelings, their life and the world in which they live. They channel their emotions and energies into their battle with food because it is something they can, or at least think they can, control. Their eating disorder becomes a coping mechanism, a potentially deadly coping mechanism.

Societal factors

According to Father Pivonka, the adoption of that particular coping mechanism can't be separated from problems in the wider, post-Christian culture.

On one level, he said, young women are constantly told by the media, advertisers and the entertainment industry that being thin equals being beautiful and happy. Girls with an already poor self-image buy into that to a dangerous degree, believing if they can only become thin enough, all their other problems will be solved as well.

"When they're presented with this ideal and realize that's not what they are, it just confirms all the other negative things about themselves they already believe," he added.

Even more problematic, Hayes said, is the breakdown in family and community life.

"The only way we believe we are loved is because we have experienced being loved," Hayes said. "But we're so isolated from one another that a lot of these girls never experience that."

Therapists' failure to recognize and address the spiritual hunger that plagues both the culture and their patients bears part of the blame for the abysmal recovery rates found among those struggling with eating disorders, said Hayes. So does the complexity of the problem.

"Eating disorders affect all aspects of the person's being -- the way they think, the way they cope, their physiology. It's systemic," she said.

Accepting Christ's love

In her own practice, Hayes responds to the systemic nature of the problem by treating the whole person -- mind, body and spirit. Like most therapists, she addresses family dynamics, struggles with control and perfectionism and other relational, physical and emotional contributors to the illness. But she also incorporates aspects of Pope John Paul II's theology of the body into her therapy sessions, discussing what it means to be an embodied creature and helping her clients find ways they can value their bodies for more than their appearance.

She also encourages them to come to see eating as a communal activity that nourishes the soul as well as the body. And, she recommends they spend time in front of the Blessed Sacrament.

"The more they develop a personal relationship with Christ, the more that's going to help correct the dynamics that triggered the problem in the first place," she said.

According to Father Pivonka, that relationship is critical to achieving full recovery.

"Many of the girls I work with can tell you God loves them, but believing it is another story," he said. "That's where grace comes in. The eucharistic grace is especially substantial. They need that help to come to a deeper realization of why Christ came and believe they have value and worth.

"If they don't come to believe that, they're never going to want to get better. And they have to want it. If somewhere along the line the girl doesn't make the decision that she wants to get better, she won't."

Emily Stimpson writes from Ohio.