- My diagnosis came as I was headed down a very dangerous path.
I had to learn that the illness wasn't my fault, that it was accumulation of many factors in my life.
- [Michelle] For Betsy Brenner, tennis has long been a way of escaping from the stress of life.
It's fueled her self-confidence and given her something to look forward to.
From a young age, she says the tennis court was also a way of coping with the emotions she was forced to suppress.
- I never allowed myself to feel negative emotions of any kind, sadness, anger.
It was all about focusing on all the positives in my life.
Nobody really knew the depth of the emotions that were stuffed inside me for decades.
- [Michelle] It all started when she was seven years old shortly after her baby sister was born.
She says the innocence of her childhood was shattered.
- My father just completely out of the blue told my mother he no longer wanted to be married to her.
It turned out he was having an affair with someone else in the community, and in those days, well-respected lawyers and people like him didn't just walk out on their wives and two young children.
But my mom went on as if nothing happened.
- [Michelle] As a young girl, Brenner says she learned that when something traumatic happens, she was to go on as if nothing happened.
She writes about her experience in her memoir, "The Longest Match".
Journal entries from her childhood reveal a preoccupation with food.
- [Betsy] I ate so much.
I want to go on a diet for real.
I have been eating a lot lately.
I don't wanna gain weight, but I don't wanna be preoccupied with calories either.
At a restaurant lunch, I had a salad so I could eat lots of breadsticks.
- [Michelle] By the time she was 33, she had lost both of her parents to cancer, but she says she couldn't properly grieve.
- I didn't know it was okay to feel sadness.
And when relationships are complicated, grief is complicated.
So I couldn't have begun to even explore what I was feeling and instead thought I was just supposed to go on being, you know, wife, mother, part-time hospital attorney, and again, just focus on the blessings that I was given.
- [Michelle] She's been married to her husband Jeff for 32 years and raised three children in Barrington.
But the emotions she was hiding even from them came to a head in her 40s when she was diagnosed with asthma.
- My eating disorder really had always been like a pot of water simmering on the back burner.
But when the perfect storm hit in my 40s, it was as if that pot of water was now coming to a rapid boil on the stove.
- [Michelle] When her asthma kept her off the tennis court, Brenner began restricting how much food she was eating.
- If I was gonna look like I was eating normally at dinner with friends, I had to make sure I got in a significant amount of vigorous exercise.
- [Michelle] It was a doctor who noticed Brenner's weight loss and diagnosed her with anorexia in her 40s.
- How could I have anorexia?
I was hardly emaciated.
I'm in my 40s, mother of three, high school tennis coach.
To have anorexia, don't you have to be a young white teenager or young adult?
I had a lot to learn.
- All right, ready?
$2.80 for the pork, $3.50 for the buttered noodles, $1.50 for the roll, and $0.75 for butter.
- [Michelle] For decades, the media have portrayed people with anorexia as being young, white, and oftentimes wealthy women.
But it's a disorder that affects women and men of all races, body types, and ages.
Dr. Amy Egbert is a clinical psychologist who works with people who have eating disorders.
She says the stereotype of someone with an eating disorder has hurt people of color.
- If somebody comes into your office and they look a certain way and your kind of conceptualization of an eating disorder is that you have to be thin, you have to be white, you have to be female.
If somebody doesn't fit that mold, you're not even gonna think to ask them those questions.
- [Michelle] Egbert says that ultimately means they're less likely to be diagnosed or to receive treatment.
- So if research is being done from clinics, guess who's not a part of that research?
Those groups.
- And as a result, they suffer, - Exactly, as a result, they're not included.
As a result, they may not even know that what they're struggling with is an eating disorder, and as a result, they're getting sicker and sicker.
- You do a lot of sit-ups.
I'm not going to treat you if you aren't interested in living.
- [Michelle] And while young women tend to be the subject of movies about eating disorders, Egbert says someone can develop it at any age.
- There are many different things that happen within life that might lead someone to change the way that they eat, to feel uncomfortable with their bodies.
And so although we used to think of eating disorders, like you said, in people who were only teenagers or very young, we are starting to realize that many people who don't fit into that group are suffering.
- There's so much shame and secrecy with any mental health issues, but I think for a woman in midlife with an eating disorder, there's even more shame and secrecy because so many people don't understand it's a disease, it's an illness, it wasn't my fault.
- [Michelle] And Brenner knows that had she not reached out for help sooner, she could have put her health at risk.
More than 10,000 people die of eating disorders every year in the United States.
Anorexia has the highest mortality rate of all the eating disorders - I didn't have 10 pounds to lose.
I always had a very small frame.
But getting back into tennis again after 20 something years, I developed this intense fear of gaining weight.
So then when I couldn't play tennis to ease that fear of weight gain because the asthma made me feel so sick and short of breath and out of control, the eating disorder was a way of feeling in control.
But it was actually the eating disorder that was in control, not me.
- [Michelle] Through therapy, she discovered the trauma she suffered as a child eventually led to her eating disorder, and she's hardly alone.
Studies show people who've experienced trauma are more likely to develop an eating disorder.
- We see that when it comes to eating disorders that the under root is anxiety, depression, trauma, your environment, your chemistry, your biology, and the eating disorder really is the symptom of those.
- [Michelle] Randi Beranbaum is the founder and director of Be Collaborative Care, an eating disorder recovery center in Providence.
- I think trauma and eating disorders have this co-occurrence because at the core of it, it's down to the identity of that person and sort of how they are able to get through this traumatic experience, that they're able to get through this trauma by numbing themselves out, by focusing, hyper-focusing on food and body.
- [Michelle] More than 90% of people who have an eating disorder are at a medically normal weight or higher.
But Barenbaum says diagnosing someone with an eating disorder is about much more than the number on the scale.
- If you are somebody who has been 170 pounds and all of a sudden you're 130 pounds, even if that 130 pounds is technically considered healthy, if that was achieved by not eating, preoccupation with weight, the level of restriction that is causing so many other health complications, that person's anorexic.
- [Michelle] After years of meeting with a dietician and a therapist, Brenner says she's grateful she no longer has an eating disorder.
Her frequent walks along the beach in Barrington give her time to reflect on how far she's come.
- It's always been my place whether I'm really happy or really sad or if I have a big decision to make or I'm feeling anxious, and it just always brings me peace, brings me joy.
- [Michelle] Brenner leads a support group for people in midlife who have eating disorders.
She wants them to know recovery is possible.
- I think when we get to this stage in life, there's nobody who hasn't been through something.
And I want everyone to know, no matter how long it's been or no matter what you've been through, it is possible to heal from past trauma and become healthier in mind, body, and spirit.
It's hard to get there, but if I can do it, anyone can do it.