DR. WALLACE: My cousin is 19 years old and she works out in the gym a lot. Our family attended a relative's wedding a couple of weeks ago and we hardly recognized her. We live in California and she lives in Arizona, so we hadn't seen her for a while. She was extremely thin and didn't eat anything at the large wedding reception except a small plate of salad! I was seated next to her and I asked her about her weight loss and she told me that her fiance told her she needed to "slim down." I told her I was worried that she may have an eating disorder, but she assured me that she didn't. My mom was equally concerned and spoke with her mom. When she discussed this with her, she told my mom not to worry because her daughter seems healthy and happy and that she doesn't have an eating disorder.

Now my mom and I are still curious and would like to know what the symptoms are when a person is actually anorexic? We have also read somewhere that anorexia nervosa can sometimes be fatal. Is this true? — Nameless, El Centro, Calif.

NAMELESS: The defining characteristics of someone who is anorexic are: intense fear of obesity, unhappiness with body image, the inducement of significant weight loss and refusal to maintain a minimally normal body weight.

According to the American Psychiatric Association, people who suffer from anorexia say they feel fat even when they are thin, or even emaciated. They are preoccupied with their shape, and often stare at themselves in the mirror. Their techniques for losing weight include eating less and avoiding fattening foods, self-induced vomiting, use of laxatives and extensive exercising.

To make matters worse, most anorexics do not believe they have an illness and are uninterested in therapy. Ninety-five percent of anorexics are females, and most are between the ages of 12 and 20. The mortality rate for this disorder is a shocking 15 percent.

What drives someone to self-starvation? The illness is often brought on by extreme stress. Many anorexics are considered model children. They are perfectionists, whose parents have set very high but inflexible standards for them.

The great majority of sufferers cannot overcome this illness by themselves and require the help and guidance of professional therapists to return to a normal eating pattern. Recovery is difficult; it often takes many months or even years. Too many don't make it and die from self-starvation.

Needless to say, anorexia nervosa is an extremely serious illness. The more that families know about anorexia, the better chance they have of diagnosing it in its early stages. Parents should be aware of the following warning signs:

1. Your teen has a tremendous fear of becoming obese that doesn't go away even if she (or he) is losing weight.

2. Your teen claims to feel fat even when thin.

3. Your teen continues to lose weight even when reaching the minimal weight for her (or his) height and age.

4. Your teen is losing weight but suffers from no known physical illness.

It would be wise for your aunt to see and read my answer to your question.

Dr. Robert Wallace welcomes questions from readers. Although he is unable to reply to all of them individually, he will answer as many as possible in this column. Email him at rwallace@galesburg.net. To find out more about Dr. Robert Wallace and read features by other Creators Syndicate writers and cartoonists, visit the Creators syndicate website at www.creators.com.

Photo credit: Steven Pisano