JOELLE ATTINGER, TIME MAGAZINE CORRESPONDENT: Stepping on a scale, a moment of dread for most people, especially for these -- women with eating disorders. Three times a week, it's a critical and courageous step in the battle for their lives.

TINA LAUER, ANOREXIA NERVOSA PATIENT: Stepping on the scale is the worst part of my day. I think I'd rather walk over hot coals in the morning than step on that scale.

ATTINGER: Soon after the weigh-in, it's time to measure blood pressure, take medications and eat.

LAUER: It's like a battle. I'm at war with myself. The part of me that wants to live is fighting the part of me that wants to die.

ATTINGER: Tina Lauer is 29.

LAUER: Every time I look in the mirror, I see an obese person who should be on a diet, and should not be gaining weight.

ATTINGER: She has been battling anorexia and bulimia for 14 years. She now weighs a mere 75 pounds. That's progress -- 12 pounds more than when she arrived a month ago.

DR. TIMOTHY WALSH, NEW YORK PSYCHIATRIC INSTITUTE: Her skin was drawn and had a pallor. She looked near death.

ATTINGER: But even as a walking skeleton, Lauer feels fat.

LAUER: I already felt obese when I came in, and now I feel even worse. My clothes are starting to get tight in the waist.

ATTINGER: Tina Lauer's internal struggles are typical of an anorexia nervosa patient.

WALSH: We really don't know what causes it. We really don't know why some girls will go on a diet, develop anorexia nervosa, and others don't, and most don't.

ATTINGER: Her relentless obsession has taken a dramatic toll.

LAUER: I had no energy. I had no muscles, really. I couldn't even -- I had a hard time just picking my head up off the bed off the bed. I couldn't read a paragraph and remember it.

WALSH: Anorexia nervosa affects almost all of the body's functions; the heart rate slows, temperature drops, blood pressure drops, the reproductive function shuts down completely.

WOMAN: Who in their right mind would eat this?

ATTINGER: Lunchtime -- another battle. Every bite, an epic struggle. The patients here have exactly 30 minutes to down their food.

You have to keep trying.

ATTINGER: They must face the counselor so they can't hide food in their clothes. When lunch is over, many patients have barely touched their food. Feeling full terrifies them.

LAUER: The eating disorder has sort of evolved into who I am. I already feel bad enough about myself, but at least there's -- even though it's unhealthy, I have some way of defining myself. And I am just afraid that once I get better, I am just going to be an empty shell.

DR. EVELYN ATTIA, NEW YORK STATE PSYCHIATRIC INSTITUTE: The treatment is tough. Patients come in with their own ambivalence about it. We are implementing a complicated set of rules and regulations and schedules for these patients, offering them food they are not sure they want to eat, and that's hard.

ATTINGER: After lunch, several patients are escorted to the bathroom. Their feet must face forward in the stalls. No secret vomiting allowed. Doctors say these are tough love tactics necessary to kick start patients into gaining weight. It's time now for Tina Lauer and the others to sit -- and sit. Compulsory observation for at least one hour to ensure that the patients don't purge.

SARAH LOVE, ANOREXIA NERVOSA PATIENT: Everybody was, oh, you look so good, you look beautiful, and I think I look terrible.

ATTINGER: After four months here, Sarah Love, age 22, is on the verge of release. She has just returned from a trial visit at home with her family. During the visit, her mom took her shopping for new clothes.

LOVE: That wouldn't fit, and the other one wouldn't fit, and I was just -- I was so embarrassed, because right in the middle of the mall, I started crying.

ATTINGER: When Sarah Love arrived here, she weighed even less than Tina Lauer, but now she has gained 44 pounds, and is holding steady at 110, 90 percent of her ideal weight. She regrets how anorexia has stolen her teenage years.

LOVE: I still haven't started menstruating, and it's been six years. I'll always have very fragile, weak bones, and my hair -- I used to have beautiful, thick hair. It used to be really long, and I had to get it all cut off, because it was dead.

ATTINGER: The doctors have told Love that the road ahead is still a challenge.

WALSH: There's no magic bullet for anorexia nervosa, the magic bullet, if you will, is calories.

ATTINGER: This clinic ups the calorie intake with liquid supplements. 80 percent of the patients that leave this clinic have gained enough weight to fall into the normal range for their height and weight. Still, relapse rates for both disorders are high. Most of the women here have been hospitalized before.

WOMAN: I just felt very huge

LOVE: I have a hard time making decisions on what to eat.

WOMAN: If I eat at all, I look like a pig.

LAUER: I don't like what I see.

ATTINGER: Do you think you want to be as thin as anorexic patients?

WOMAN: Absolutely.

(CRYING)

ATTINGER: Each week, patients shuttle from meeting to meeting, group and individual psychotherapy, sometimes family therapy, as well. The staff also uses an approach called cognitive behavioral therapy, where patients work on changing the destructive thought patterns automatically associated with food.

ATTIA: Cognitive behavioral therapy aims to take apart the assumptions that someone may have, and essentially relearn the way

that you think about the cues around you, and the way you think about yourself.

ATTINGER (on camera): Eating disorders such as anorexia and bulimia are a silent epidemic across America. The victims are mostly young women. Both anorexic and bulimic patients experience similar body distortions and obsessions with food, and both disorders appear to be on the rise in the United States.

(voice over): One to two percent of all American women have anorexia, bulimia affects even more. Outward social and cultural pressures of a society obsessed with thinness play a role in promoting both disorders, but some scientists are increasingly focusing inside the human body for answers as to precisely what causes these disorders.

WALSH: One of the things that's remarkable is that the patients take on a cookie cutter sort-of quality, so that many of their complaints, many of their concerns, many of their behaviors are identical.

ATTINGER: Dr. Timothy Walsh oversees both the eating disorders clinic, and research at the New York State Psychiatric Hospital.

WALSH: My belief is that anorexia nervosa, at its root, includes a problem with brain chemistry. My hunch is some of these chemical changes help explain why the disorder, once established, is so persistent.

(MRI MACHINE BEEP)

If one does images of the brain using CAT scans or MRI techniques, you find that the brains of people with anorexia nervosa are smaller than they should be.

ATTINGER: Walsh points to this alarming report from Canadian researchers, which claims that even after recovery of weight, patients with anorexia appear to have smaller brain sizes than people who never had the disease. It concludes, "there may be an irreversible component to the brain changes associated with this illness." The behavioral implications of having a smaller brain are not yet clear.

WOMAN: That's good. What does that smell like?

ATTINGER: But for Sarah Love, recovery seems palpable. During her last week in the clinic, she and other eating disorder patients are busy relearning the basics of life: how to shop for healthy foods without getting hung up on calorie counting, then, how to cook and eat a balanced meal, and even how to look in the mirror.

In an outing nicknamed Torture Tuesdays, Sarah Love and another patient go to the mall. Their goal -- not to buy clothes, but to get used to looking at their new bodies with pride, instead of despair. A makeover, at the cosmetic counter, helps complete the new look.

LOVE: I don't even remember a lot of what I was before, that's how scary it is. I was -- people have told me I was so sick that my memory wasn't working. My brain was not functioning.

ATTINGER: Despite her fears, Sarah Love has made great strides, but she has already experienced several hospitalizations. She is determined to make this her last.

LOVE: It takes just about every piece of courage. You've got to have faith.

ATTINGER: For Tina Lauer, who is still a patient at the clinic, there is much work ahead.

LAUER: I see a person who is extremely overweight when I look in the mirror. I hate the way I am. I wouldn't wish this on my worst enemy. I'm scared to get better. I'm scared to find out what I really can accomplish in life. I'm basically scared to live.

(END VIDEOTAPE)

Sarah Love? She has found life very difficult without the institute's special care. Two weeks ago, she had pneumonia and weighed 62 pounds. They put her in the hospital. Her parents were afraid she would die, but now, Sarah Love is recovering in intensive care. I'll be back with a final thought, in a moment.

(COMMERCIAL BREAK)

© 1997 Cable News Network, Inc. All Rights Reserved.

Terms under which this service is provided to you.