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COLORADO SPRINGS, Colo. - At the end, no amount of food would have helped Laurie Borden.
Her digestive system, damaged by years of starvation and laxative use, was long past working. When she did eat, an obvious gurgling would follow within minutes - the sound of food quickly passing from her stomach to the colostomy bag she wore for nearly a decade.
Borden, 38, of Colorado Springs, Colo., died June 1 after a 24-year battle with eating disorders.
"Anorexia Nervosa" is listed on her death certificate as the cause of death. Before she died, she directed her brother, a journalist, to name the illness in her obituary.
"She told me what to write," said Lark Borden, an editor in Washington, D.C. "She wanted for it to be well-known that she had died of anorexia, hoping it would help other people."
Anorexia or bulimia most often get attention when someone famous - Karen Carpenter, Princess Diana or a member of the Hollywood set - is afflicted. But experts say the diseases, in which people either don't eat or throw up what they do eat, are more common than people think. They report treating girls at younger ages and counseling more men.
It's estimated 1 million people suffer from anorexia and an additional 9 million from bulimia, but Doug Bunnell, past president of the National Eating Disorders Association, said those are conservative statistics.
Some view both as diets gone bad or lifestyle choices, but Bunnell says they are complicated illnesses with complicated treatments.
Anorexia - characterized by self-starvation and dramatic weight loss - has the highest mortality rate of any psychiatric illness, said Bunnell, clinical director of the Renfrew Center of Connecticut, which treats eating disorders.
"The best estimates are around 10 percent of the women with anorexia nervosa will ultimately die as a result of their illness," he said. "Most people still see these disorders as fairly benign. You don't really appreciate until you have it in your family how damaging they are and how much havoc they wreak."
Borden's spiral began several years before her family knew anything was seriously wrong.
It wasn't until Laurie Borden was in her 20s that her mom, Lura Borden, learned her daughter had been vomiting her meals since junior high when a friend commented about her hips.
But Laurie Borden was never heavy. "Her worst enemy was herself," her mother said. "She hated herself."
Her view of herself contradicted everything her mother and others saw: "She was so pretty, an honor student - she had it all."
And she was athletic, playing doubles tennis for Wasson High School. She and her mom played for fun at Portal Park, a block from their home near the University of Colorado at Colorado Springs.
High achievement is common among those with eating disorders. Sufferers are often perfectionists.
"They're people-pleasers," said Barbara Fleming, a licensed clinical social worker whose practice in Colorado Springs focuses on eating disorders. "They know what everyone around them needs, but they don't know what they need."
Low self-esteem is a hallmark trait.
"One of the characteristic features is quite often this profoundly negative self-assessment," Bunnell said. "It doesn't jive in any way with what you see in their lives."
Laurie Borden was born in 1966 in Rocky Ford, Colo., the youngest of three children. The family moved to Colorado Springs when she was younger than 1 year old.
Besides tennis, her big interest was aviation, a love passed from her dad.
The family often would go to the airport just to watch planes take off and land.
In high school, she was the state winner of the FAA National Aviation Essay Contest. The trophy still sits on a dresser in her bedroom.
Borden worked hard at her academic achievements, and just as hard at keeping her illness secret. Like many bulimics, she hid what she was doing, and her weight was normal.
After high school, she set off for college in Phoenix. But within a month or so, she came home. Her mother now thinks it was because she couldn't hide her eating disorder well in a dorm setting, although she used other excuses.
She also told her family she had been sexually abused there, which could have triggered the anorexia.
With college out of the picture, Borden worked at Best Products Co., a now-closed catalog-showroom store on North Academy Boulevard, and got an apartment nearby.
She was an excellent salesperson - polite, friendly and very goal-oriented, said Barbara Pollock, who was her boss. She moved up from cashier to manager of the jewelry department, a position she held from 1991 to 1994.
As Borden's work responsibility increased, her weight decreased, Pollock said.
At one point, she weighed just 89 pounds. She often complained of aches and pains. It was her body turning on itself - a sort of internal cannibalism.
She eventually stopped working and went on disability.
Borden's disease weighed heavily on her family.
"It was a nightmare for everybody," said her brother Lark Borden. "She would call me by phone, many times every week. I always would say, `You have to listen to your doctors,' which she never did."
A six-week inpatient treatment center did not help, nor did counseling. She also spent time in psychiatric facilities, her mother said.
Oddly, even when she wasn't eating, Borden enjoyed organizing meals for families in her church who lost a loved one or were suffering an illness. But with her own family, holiday dinners were usually disastrous. Borden would want to go home even before the meal was finished.
When she did gain a little weight, the family didn't dare tell her she looked good. Such simple words would send her backward again.
In 1996, Borden moved back home. Early on, she had enough strength to help around the house some, but as she deteriorated, her days were spent watching TV in a recliner or talking on the phone to doctors or church friends.
Lura Borden looked after her husband, who suffered from emphysema and heart problems, as well as her daughter. It was rare that any of them left the house, and then only to go for car rides.
Harold Borden, a plumber, died in 2001 at 72.
And Laurie would still try to cook meals.
"She always wanted to fool with food but never wanted to eat it," said her mom.
Laurie Borden appeared near death at his funeral. In a sleeveless dress, she looked skeletal.
"She enjoyed the spectacle of being anorexic," Lark Borden said. "She showed off the state of her body. My father's funeral - it was awful."
At the same time, though, she would tell her brother she was sorry for what she had done to herself and to the family - sometimes she'd say it a dozen times in a phone conversation.
Her biggest regret was the colostomy bag, which her mom recalls her getting around 1997.
Years of abusing laxatives - she told her mom that at one point she was taking more than four dozen at a time - shut down her digestive tract, and a portion of her intestines had to be removed.
"She was so disgusted by that bag," said Faye Collacott, who helped care for Borden during the last months of her life. She didn't want others to see it and would spray room fresheners constantly for fear it smelled.
Collacott formed a sisterly bond with Borden, and they'd spend a lot of time talking about life and her disease. But Collacott knew, like others did, that much of what Borden told her was not true.
The disease had starved her brain.
"I'm not going to call them lies, because it was her reality because of the disease," Collacott said. "It was controlling her totally, and there was no returning back to mental health."
In advanced stages of the disease, malnutrition causes loss of memory, irrational thoughts or fears, and cognitive impairment.
Besides the physical and mental deterioration, the disease kept Borden from people her own age. Her best friends and biggest supporters were her mother and older parishioners from Vista Grande Church of God.
"The eating disorder is a very jealous and abusive partner," said Bunnell, the expert from Connecticut. "It requires a lot of devotion in the extent that you have to devote yourself to tending to the anorexia. There's not a lot of time left over for adult life."
Treatment for anorexia is arduous and expensive and usually not covered by insurance.
The average recovery time is four to seven years and can include individual therapy, nutritional therapy, psychiatric medications, family therapy and medical monitoring, Bunnell said.
The earlier treatment is sought, the better the chance of recovery. With appropriate care, Bunnell said, 80 percent of patients can recover fully.
For Laurie Borden, it was too late.
One April day, paramedics were called to the Borden home. She had been in the bathroom three hours, trying to change her colostomy bag. She could no longer walk and was on oxygen.
The paramedics urged Lura Borden to get help. A few days later, her daughter was taken by ambulance to Penrose Hospital. She was later transferred to hospice care.
"Laurie knew she'd never come home," her mother said.
Women from her church, her mother and Collacott were constant companions during her seven weeks at the hospice.
Collacott would play the song "Angel" by Sarah McLachlan - one of Borden's favorites.
About two weeks before she died, Borden ate a slice of cheese pizza, yogurt and a Popsicle - more than anyone had seen her eat in years.
She died shortly after noon June 1, just 65 pounds on her 5-foot, 8-inch frame. A woman from church was with her, holding her hand.
Lura Borden is still sorting through her daughter's things. She's found unopened bills and still-sealed get-well cards from years ago.
Her daughter's birthday is next month, and she suspects it'll be a difficult day. But she's also found solace.
"In a way it was a relief to know that she's not hurting," she said. "I miss her a lot, but she didn't have any life. It wasn't a pretty life."
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(c) 2005, The Gazette (Colorado Springs, Colo.). Distributed by Knight Ridder/Tribune News Service.
