The mirror has two faces: dancers have a special vulnerability to eating disorders, particularly anorexia. Schools and companies now take a more proactive role in helping them fight these inner demons, but some still fall prey to self-destructive behavior. Here is a special report on what the dance world is doing to help them, how to spot early warning signs, and what it takes to overcome the illness.

Anorexia. The word is charged with electricity in our culture and in the world of ballet. It is a feared and potentially life-threatening condition. Any dancer who slides down the slippery slope of anorexia is at risk of losing the physical mastery she has gained--not to mention her good health. However, major ballet companies across America are becoming more aware about eating disorders. Teachers and artistic directors are putting nutritionists on staff, organizing educational workshops, and watching closely for signs of the disorder. As a result, while the incidence of anorexia may be rising in the general population, it seems to be dropping in large ballet companies.

More prevalent in ballet, and almost entirely a female disease, anorexia is rarely seen in modern dance. Modern is more forgiving of, and even sometimes champions, diverse body types. Too, people often come to modern dance later, into their teens or even in college, when their bodies--and their perceptions of themselves--are more settled.

What exactly is anorexia? According to Dr. Charles L. Bardes, professor of clinical medicine at New York's Weill Cornell Medical College, it has less to do with one's degree of thinness and more to do with "the role that thinness plays in a person's life." Medical clues include compulsive behaviors like intentional vomiting and using of laxatives to lose weight. These actions stem from what Dr. Bardes calls "severe body image disturbance."

Often we see a thin dancer onstage and immediately declare her "anorexic." But no matter how thin she is, you would not necessarily be accurate. "I would urge spectators not to observe a thin dancer and speculate that she is anorexic," says Dr. Bardes. "That badge would require knowing a lot more about her personal psychological constitution than can be known by an audience watching figures on a stage."

Northwest Ballet, says, "Anorexia goes along with an obsessive-compulsive personality. It coexists with perfectionism." Sound familiar? Perhaps ballet attracts people who have a bent toward perfectionism. Sometimes that intense energy gets poured into a systematic plan to lose weight. Peggy Swistak, PNB's nutritionist, describes obsessive behavior typical of eating disorders. "She will have certain eating rituals that may include rearranging the food on her plate or excessive chewing."

Kay Mazzo, co-chair of faculty of the School of American Ballet, acknowledges the pressure to be thin. "There's definitely an aesthetic you have to have in ballet." But, she maintains, "it doesn't mean you have to be [just] bones." She describes the school's approach to anorexia. When they spot a problem, they contact the parents first, then initiate talks with the student. They arrange for the dancer to see a nutritionist, then a doctor. If the doctor feels it's necessary, he sends the student to a psychiatrist.

SAB maintains a health committee that meets monthly and includes a nutritionist (who Mazzo says is particularly good at getting the students to consider their future), a physical therapist, doctor, psychiatrist, and directors of resident and student life for students who board. "We don't want anybody to slip through the cracks," says Mazzo. "We always stress we want them to be healthy. We want them to deal with it in the correct way, because it [affects] the rest of their lives."

When Mazzo and other faculty members give auditions around the country, they are on the lookout for potential cases of the disorder. "When there's a girl who seems to be talented but is too thin, we won't take her," she says. "It's a warning to us. Let her stay another year at home and see what happens."

Eleanor D'Antuono, a former principal with American Ballet Theatre who teaches at the Joffrey Ballet School in Manhattan, the Nutmeg Conservatory in Connecticut, and New Jersey Ballet, has a practiced eye at spotting anorexia. She says she becomes aware of "behavior that's different, a glassiness in the eye, a different concentration level. Dancers who are anorexic are withdrawn, they don't connect with you, don't respond in the same way. If something doesn't go well, their frustration level is much higher. They are very compulsive. It's frightening."

D'Antuono explains why dancers are so susceptible to eating disorders. "Everyone in professional dance is driven. The need to be perfect is what throws them over the edge. Part of it is a lack of confidence, a desperate need for attention." She stresses how crucial it is to step in and help before it's too late. She feels that more teachers have become aware of this, helping to reduce the cases of anorexia among dancers. Another factor, she says, is "the horror stories of what has occurred later on in life."

Dr. Bardes: "The main long-term complications involve the bones and the heart. Bone loss resulting in osteoporosis [can lead to] fractures of the spine and hip. The heart complications involve abnormal heart rhythms, which can lead to loss of consciousness or sudden death. There is also an unusual 'refeeding' syndrome, in which people who have been starved suddenly eat again and develop symptoms of heart failure."

At Sarah Lawrence College in Bronxville, New York, which has a strong modern dance program, eating disorders are seen as reflecting social and media ideals. "Almost every woman in this country has [concerns] about her self-image," says Emily Devine, a member of the SLC dance faculty. "One of the things we're trying to do is change the aesthetic culture a little bit." How are they embarking on this change? They require the dance students to sign a form at the beginning of each year acknowledging that if faculty feel a student is harming herself, the department reserves the right to refer the student to health services and deny access to classes. The dance department maintains an ongoing dialogue, including meetings with the entire program of 65 to 75 students, follow-up, and workshops with alums who are dancers and nutritionists. Plus, Health Services at SLG sponsors a support group for students with eating disorders.

John Magnus, artistic director of the Joffrey School and a colleague of D'Antuono's, teaches the most susceptible age group: 15-year-olds up to professionals. He says he is surprised how little he has come across it--"really only a couple of times" in two decades of teaching. But he finds any conversations about weight with dancers to be terribly delicate. "If I start talking to a dancer about weight, it's very, very tricky. People have a hard time accepting corrections now. A lot of artists are very insecure, and I worry about sparking something off. Some will do anything to get weight down."

Magnus speaks for all devoted teachers when he says of the relationship between teacher and students, including the struggles of weight and health, "Dancing is a slow process. It's a partnership."

And Devine speaks for a new, more inclusive aesthetic when she says, "All kinds of people are beautiful when they're dancing."

Amanda Smith, a longtime contributor to Dance Magazine, is on the faculties of Coe College and Hofstra University.

12 WARNING SIGNS OF ANOREXIA

How can you tell the difference between normal weight loss and an eating disorder? If you are concerned about a student or colleague, the 12 warning signs below might help determine if she has a serious problem.

"If someone looks excessively thin, keep an eye on them over a period of time," suggests Dr. Linda Hamilton, Dance Magazine's "Advice for Dancers" columnist. If what you see points to anorexia, inform a teacher or artistic director of your concerns. Dancers are more likely to listen to a person of authority (whom they trust) than a peer. It is critical she gets help before the severe lack of nutrition leads to injury due to weakened bones or irregular heart activity.

These pointers have been gathered from several sources including Charles L. Bardes, M.D., professor of clinical medicine at Weill Cornell Medical College, and Peggy Swistak, consulting nutritionist for Pacific Northwest Ballet. --Jennifer Stahl

1

Dance becomes lethargic and shows a loss of athletic power. Has a hard time retaining stamina through long combinations.

2

Has trouble concentrating and/or memorizing phrases.

3

Starts wearing baggier clothes to hide body

4

Constantly chews gum or drinks coffee and diet sodas (if this is a dramatic change).

5

Goes through a growth spurt, but doesn't gain the appropriate amount of weight to match the new height.

6

Soft body hair grows on face, arms, or other surfaces. Meanwhile her scalp hair thins and might even fall out in patches.

7

Her skin becomes dry, with a pale, orange tint that is most visible in the hands.

8

She gets light-headed or dizzy while dancing.

9

A once outgoing dancer might attempt to hide in the crowd or move to the edges of the studio to draw less attention to herself.

10

She isolates herself from other dancers and becomes withdrawn. She starts acting secretive.

11

If the anorexia also has elements of bulimia, she might gain a chip-munk-like took around the chin because of swollen glands in the neck. Her knuckles may show abrasions.

12

Stress fractures are a red flag if they coincide with skipped menstrual periods. This is known as the Female Athlete Triad: disordered eating, no menses, and osteoporosis.

Toby Diamond, consulting psychologist for Pacific