Editor's Note: The names have been changed to protect the identity of this 15-year-old girl who is struggling to overcome bulimia. It started three years ago.

Becca’s older sister was the first one to be suspicious. Her sister saw that Becca had been looking up Web sites on anorexia and bulimia. She told her mom about it.

Then there was a time the older sister heard Becca throwing up and told her mom.

Her mother, Kate, said for a year, they were in denial and tried to catch the young teen in the act. They thought they could stop her behavior by distracting her after meals with board games or car rides.

“But we didn’t realize, in her mind, if she took a shower at night and threw up, she would get rid of all she’d eaten that day,” Kate said. “At the time it seemed too invasive to go in and watch her take a shower.”

Kate said Becca thinks she’s too fat — she sees herself heavier than she is.

Becca stopped eating meat and eventually started eating mostly salads. Sometimes, she would binge on chips and dip, and candy bars.

Becca purged every night in the shower. She also took enemas, laxatives, diuretics and other medication.

Getting help

About a year ago, her parents took her to a doctor who warned her to stop throwing up and put her on some medication. Later, he sent her to a psychiatrist who suggested she go to a counselor on a weekly basis.

After months, the counselor told her family the message just wasn’t getting through and Becca was doing a lot of harm to her body.

She has kidney problems, an ulcerated esophagus, bouts with chest pain, low blood pressure and is at risk of having a heart attack.

In March, Becca was sent to a nutritionist at Cardinal Glennon Hospital.

Her mom almost canceled the appointment because Becca seemed to be doing better. She had started eating better and her attitude had changed.

She had danced all that week, which wasn’t uncommon. She’d been on the dance team for the last two years and took dance classes almost every day.

Just prior to her appointment, she received devastating news that she didn’t make her school’s dance team. For her, it was horrible news.

When she went to the appointment, the doctors wouldn’t let her go home.

It turned out Becca had been running on adrenaline. Her blood pressure was too low. Her heart rate was too high. Her kidneys were not working right. Becca had to stay two weeks.

She was able to go home for two weeks but when she had lab work done, it wasn’t good enough and she had to stay 11 more days.

Becca got to go home another two weeks but then had to go back for nine days.

The weight scales have been taken out of their home. They’ve been replaced with blood pressure machines. Kate said some mornings when Becca got up her blood pressure would be 65/40. She would be dizzy and pass out. She can’t do much at all.

For a couple of weeks, she was in intensive outpatient therapy three hours a day, six days a week. Part of the therapy was eating a meal there.

The outpatient therapy didn’t help.

Seeking inpatient treatment

It got to the point where Becca had to be with her mom or someone else constantly and the bathroom door had to be left open when she took a shower.

Even taking those steps, doctors told her parents the best chance of beating this illness before it beats her was to go to an inpatient treatment program in Kansas City.

“While she has been battling this eating disorder, we have been battling the insurance company to have her admitted to a higher level of care,” Kate said.

The insurance company didn’t want to cover eating disorders. They lump it as a mental-nervous disorder.

Kate appealed the insurance company’s decision but not before Becca got worse. She’s started throwing up during the day as if she couldn’t help it.

“I really think she can’t help it at this point,” Kate said. “Her body gets so used to doing that.”

Kate said after a long appeals process, the insurance company agreed to pay 60 percent for 30 days of treatment in a calendar year.

They took her there this month and a week into the treatment, Kate got the call that the insurance company wasn’t paying and they were going to discharge her. Several phone calls later, Kate got the situation straightened out — at least for now.

“This is the way it’s gone from day one,” she said.

She said 30 days at the hospital in Kansas City isn’t long enough but it’s a start. She believes her daughter needs a 90 to 120 day stay.

Becca’s hoping for 30 days. She wants to get out for the start of school in mid-August. She missed the last couple months of school last year because she was in and out of the hospital.

She’s on 10 different medications right now.

“If you look at her, she doesn’t look sick ... but none of the girls did when we took her (to the hospital in Kansas City),” Kate said.

At the treatment center, a nurse will be with her 24-7. No television. No cell phones. No laptops. No weight scales.

Receiving cards from family, friends and people from school truly make Becca’s day.

Why her mom is sharing her daughter’s story

She said at first, they tried to keep it a secret from family and friends but she found that wasn’t helping her daughter. Her friends’ parents needed to know.

She said many people have been praying on a daily basis for the family.

“It has helped us through a lot of this,” she said, adding the doctors at Cardinal Glennon have been very helpful.

Kate is sharing her daughter’s struggle because she wants to raise awareness about insurance companies. She wants Missouri to make insurance companies pay for these kinds of illnesses like they would other illnesses.

“If our daughter had leukemia, diabetes, cancer or even if she was addicted to alcohol or drugs, she would be covered,” Kate said in a letter to her U.S. and state representatives. “This is not right.”

U.S. Sen. Claire McCaskill wrote a letter back telling her about versions of a new Mental Health Parity Act that has gone through the House and Senate.

According to the F.R.E.E.D. Foundation (the Gail R. Schoenbach Foundation for recovery and elimination of eating disorders), the parity law would end insurance discrimination against mental health and substance abuse disorders for more than 113 million Americans, requiring full parity coverage with physical health benefits.

How much an insurance company covers would be up to individual insurance companies. A representative of Sen. McCaskill’s office said the bill demands that if the insurance offers mental health services, the services should be covered the same way as other services.

Kate wasn’t sure if this new law would address her situation so she’s not overly excited.

About bulimia

If you suspect your child has an eating disorder, take your child to a doctor for a medical work-up. Dr. Joyce Griffin, a licensed psychologist from CenterPointe Hospital in St. Louis, said usually a doctor will run blood work and be able to see the damage being done by an eating disorder. She said eating disorders cause serious and sometimes fatal medical issues.

She said a doctor will refer the child to a psychologist or a psychiatrist. She said someone with an eating disorder needs both treatment from a physician and counseling.

There are several Web sites with information about eating disorders.

According to BulimiaGuide.org, bulimia nervosa is an eating disorder in which a person engages in binge eating, followed by some type of behavior to prevent weight gain. Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again.

About 90 percent of those diagnosed with bulimia are female.

Symptoms include sore, bleeding gums and mouth; tooth enamel erosion from vomiting; dry, red, cracked lips, especially at the corners; swollen cheeks and jaws; swollen saliva glands; callused or discolored skin at finger joints from forced vomiting; and abnormal blood test results.

Other signs are that they are uncomfortable eating around others; skip meals; take small portions of food at regular meals; excuse self from table before others are finished; have odd food habits; isolates self; uses excessive amounts of mouthwash, mints or gum; exercises excessively; and can’t explain why large amounts of food disappear.

Medications such as antidepressants, various psychotherapies such as cognitive behavioral therapy, nutrition therapy, and other support interventions like yoga, art, and movement therapy are used. Treatment is delivered in various levels of inpatient and outpatient settings.

Typical costs of treatment reported in 2005 from several residential eating disorder centers averaged about $1,000 per day for 24-7 care. Reported costs for partial inpatient care (3 to 12 hours per day) ranged from $8,000 to $50,000 per month. Reported costs of outpatient psychotherapy ranged from $75 to $150 per one-hour session at private practices.

Teresa Ressel is a reporter for the Daily Journal and can be reached at 573-431-2010, ext. 179 or at tressel@dailyjournalonline.com.

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