Warning: Self reflections may be distorted by socially constructed ideas of beauty.

“I’ve been called a fat girl since I can remember,” recalls Ashlea Ramirez, a freshman from Houston.

Ramirez has been struggling with an eating disorder called Not Otherwise Specified, NOS, since the sixth grade. NOS is an eating disorder that has behaviors similar to that of anorexia nervosa and bulimia nervosa. Newly identified cases of anorexia have been identified in 40 percent of girls ages 15-19. There are 10 million females and 1 millions males who are fighting battles with eating disorders in the United States, according to the National Eating Disorders Association. For Ramirez, these behaviors heightened when she began wrestling in the eighth grade. She says she did anything and everything to make her weight class for wrestling. She would throw up, not eat for days and use fat wraps, laxatives and water pills to lose weight.

Even when wrestling was over, the behaviors continued to intensify.

Some try to fit the standard of what the world sees as beauty, but once the eating disorder is started, it usually goes past this image into a dangerous, impractical personal view. Of American women, 80 percent are dissatisfied with their appearance, according to the National Eating Disorders Association.

“They just can’t see themselves for what they are,” asserts Dr. Allen Knehans, professor of nutrition.

What many don’t realize is that eating disorders, such as anorexia nervosa, are mental illnesses. It has “little to do with food,” says Dr. Knehans. Even though it is seen as a physical problem because of eating (or lack thereof), it originates in the brain. They can look at themselves in the mirror and see a completely different body than you or I would see when looking at them. Because they don’t understand the reality of their unhealthy state, many times those suffering with anorexia nervosa are resistant to treatment.

When she entered high school, Ramirez says she felt like she was not beautiful. From the ninth grade until her senior year, Ramirez learned “all the little techniques” to lose weight. Ramirez says that she would usually binge to the extreme but would feel extremely guilty and stop eating for a few days after the binge.

Her heaviest weight was 235 pounds, but by her freshman year in high school, she weighed 148 pounds. She knew she didn’t look like the “pretty girls” that had boyfriends and with this distorted body image came depression. The average American woman is 5-feet-4-inches tall and weighs 140 pounds, compared to a model who is 5-feet-11-inches and weighs 117 pounds.

With the dangers of bulimia, binging and purging, the person believes they can get to a certain weight. Many times, the person will know the dangers, but will think he or she can stop when he or she wants to. This causes a secret life — a life separate from a social life because he or she feels embarrassed of the tactics being used to lose weight. This secret life usually continues because those suffering do not get treatment.

During high school, Ramirez started dating someone older from Houston. While in this relationship, she began to notice her depression. When she and her boyfriend would fight, she would blame herself. She tried a few methods to combat these negative feelings. Along with her NOS behaviors, Ramirez says she cut her thighs so that no one would notice. While she cut, she felt that she “needed to be punished” for all of her “wrongs.” She drank alcohol to help induce sleep and sometimes to induce alcohol poisoning. Because she kept this dark part of her life hidden from her friends and family, Ramirez says she felt alone and angry with herself.

Ramirez graduated high school early so that she could attend OU with her boyfriend, but this August the relationship ended when she went home one weekend. Ramirez wondered whether it was because she had gained weight over the summer.

“The night we broke up, I went crazy,” Ramirez says.

That night, she drank an entire bottle of NyQuil and an entire bottle of vodka.

“I felt like I didn’t deserve to live,” says Ramirez. She sent text messages to her ex-boyfriend and other friends to say goodbye. She went to sleep that night, hoping that she would never wake up again.

By the end of that night in August, Ramirez’s friends and family knew everything about her eating disorder and depression. She commented that by having her family know, it “broke a wall” inside of her because she was “tired of faking it” and “swallowing all the problems.”

What many people don’t realize is that eating disorders are mental illnesses. Assistant Director for Clinical Services at Goddard Health Center, Maggie Poole, says that people practice these dangerous behaviors because they want to gain a sense of control and cope with emotions.

“It goes beyond the pressures to be thin . . . they can’t see themselves for what they are,” Dr. Knehans says.

Norman dietician Kimberly Davis suggests that many eating disorders are overlooked by family, friends and medical doctors because they are seen as vanity issues instead of mental and coping issues. Davis says she believes “people don’t know the gravity or the depth” of eating disorders.

Like many people who have suffered from eating disorders, Ramirez felt relieved once she opened up to her family and friends. She says she feels more confident and strong and is beginning to see herself as beautiful for the first time in her life.