A mannequin lay under a sheet on a table. People gathered in the small room, each carrying a piece of paper. “No one sugarcoated it,” said Tiffany Fraser, of Mitchell. “I had to sit through my own funeral.” Tiffany, 33, struggles with anorexia - meaning she severely restricted her food intake. Her turning point during an eightmonth treatment program was a seven-day workshop called Inward Journeys. Her family members wrote eulogies, while treatment center staff members portrayed her family and read the letters.

“I had two options - not change or change,” she said in an interview with The Daily Republic. “I chose to turn my funeral into a funeral for my eating disorder.”

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It is National Eating Disorder Awareness Week, and Tiffany wants the public to be aware eating disorders affect more people than they think.

According to the National Eating Disorders Association, 20 million women and 10 million men deal with eating disorders at some time in their lives. Consequences she and millions of other anorexics have suffered included severe dehydration, dry hair and skin, hair loss, growth of a downy layer of hair all over the body - including the face - to keep the body warm, reduction of bone density and abnormally slow heart rate, and low blood pressure.

The mock funeral was a drastic move, not common among treatments for anyone in a program like Inward Journeys, said Laura Tanzini, the psychotherapist who devised the funeral.

“Tiffany mentioned to me her mom said she didn’t want to bring her home in a body bag,” Tanzini said.

Tanzini, who has run the workshop for 20 years, added the process for individuals in the workshop is intense and specific to their recovery. It gives her the chance to work with patients on a deeper level than in individual sessions. She said during one of her individual sessions, Tiffany mentioned her mother’s comment, which led Tanzini to contact her family to write the eulogies.

“I’m not sure it would have been effective for all clients,” Tanzini said. “If we hadn’t done the mock funeral to that extent for Tiffany, she was going to kill herself with her restricting behavior. She was doing it even during treatment.”

Tiffany’s attitude immediately changed after the mock funeral because she saw the impact it would have on her family, Tanzini said.

“I bawled,” Tiffany said. “It was an eye-opening experience for me.”

After that, she began the “refeeding process,” during which she gained 40-50 pounds. She cried during almost every meal. She wasn’t forced to eat, but asked to eat the entire meal, Tiffany said.

“You’re like Thanksgiving Day full all the time,” she said.

Tiffany returned home two weeks ago. She spent eight months in two treatment programs - two months at Sierra Tucson Treatment Center in Tucson, Ariz., and six months at Rebecca’s House in Lake Forest, Calif. She took the year off from teaching fourth grade at L.B. Williams Elementary School to attend treatment.

The first two months were extremely strict, Tiffany said. She was not allowed a cell phone. She could only make short outgoing phone calls. She could write and receive letters. She was not allowed to leave the treatment center.

Rebecca’s House gave Tiffany more freedom. She lived in houses with other clients and went to the treatment center during the day. By the end of treatment, Tiffany said she did her own grocery shopping, menu planning and cooking.

Now that she’s home, she has moved back in with her parents to get her feet on the ground.

She is on a strict eating routine - a bagel with peanut butter, a glass of milk and fruit for breakfast; a sandwich, rice or chicken, and a salad for lunch; and a larger supper like pasta, chicken and a vegetable.

If Tiffany feels like she doesn’t want to eat, she has a strict plan for that, too - she calls her support system. She’ll talk to her mom, a friend or one of her therapists.

The diet that went too far

At 16, as a Mitchell high schooler, Tiffany and her friends went on a diet that started her down the road to anorexia.

“My OCD (Obsessive Compulsive Disorder) and need for perfection took it one step further,” she said of the diet. “I figured if I was going to diet, I was going to do it the right way.”

She began restricting her food and found she didn’t like the way she looked. She was a healthy girl, she said, but that didn’t matter. She saw herself as fat.

Despite all her successes - sports, 4-H, rodeoing - Tiffany’s focus became her disgust with her body image. She did well in basketball and volleyball, she won awards in 4-H and rodeoing, but she still was not happy with how she looked.

Kathy and John Fraser, Tiffany’s mom and dad, said they noticed her daughter’s issues with food in late high school.

“We’d notice she’d do a beautiful job preparing this wonderful plate, but wouldn’t eat much,” John said.

“She wouldn’t touch any of the food. She’d pick at it and put a napkin over it,” Kathy said.

At her lightest, Tiffany was a skeletal 90 pounds on a 5-foot-5-inch frame. She often got weak and had to sit down or she would pass out - and she passed out often, she said. She survived on 250 calories per day - five carrots at lunch or five bites of cottage cheese. The average active person should consume 2,000 calories each day.

She withdrew from her family and friends because she didn’t want them to know what she was doing.

“It drove such a huge wedge between my family and myself,” Tiffany said. “It was the one thing I could control.”

She rode her horse almost every day. However, her therapist, Mary Dressing in Sioux Falls, told her she could no longer ride because she had become so fragile. She has been seeing Dressing since 2009.

She couldn’t control the physical changes. She began losing her hair, she lost her period and began having dental issues. She also starting growing a fine hair all over her body, which happens to anorexics to keep the body warm.

“When my parents talked to me, they said I didn’t make sense,” Tiffany added. “I would ramble from one subject to the next.”

She did not see her 90-pound self as skeletal. She saw that person as fat. Even now when she sees pictures of herself at that weight, Tiffany wishes she could be at that weight again. It’s called body dysmorphia - she can’t stop thinking about perceived flaws in her body.

Tiffany is also an alcoholic. She said many who have an eating disorder also have co-current addictions.

When she turned 21, Tiffany said she became the kind of person who couldn’t have just one drink. She’d go to the bar and be the last one to leave. Her alcoholism was treated along with anorexia during her eight months in treatment.

At Rebecca’s House in California, Tiffany’s therapist told her the amount of alcohol she drank likely saved her life.

“Because of the calories,” she clarified.

She said anorexia and drinking really took over when she was 27 or 28.

“It consumes your day,” she said. “I spent the day teaching and went home to find how to get around eating and how to get my next drink.”

In 2011, her family had finally had enough and planned an intervention.

“She was pretty far away from the family,” Kathy said.

“But that was her choice,” John said. “We tried to include her but she didn’t want to be.”

Kathy started talking to her daughter’s friends to find out more about what was going on. She needed to know everything before an intervention occurred.

A strong support system

As she walked the halls of L.B. Williams Elementary School a year ago, Tiffany’s friends and co-workers couldn’t help but think she looked like a walking skeleton. They didn’t judge her for it but were concerned, Tiffany said.

She credits many for her decision to enter treatment. Not only has her family been a strong support system, but her colleagues at work have been extremely supportive, she said. She credits them for lovingly encouraging her to get help.

After her family sat down and revealed they were concerned for her, Tiffany came to the realization she needed help.

Tiffany first attended treatment in 2012. She went to Denver for four weeks, where she was treated for her anorexia, but not alcoholism. When she came home, she relapsed and started restricting food again.

Sierra Tucson and Rebecca’s House treated both her anorexia and alcoholism. Not only has she not restricted her food for four months, she has been sober since May 28.

“I found out through treatment who my true friends were,” she said. Many people she went to the bar with stopped contacting her during treatment and haven’t bothered talking to her since she returned home.

But that’s OK, she said, because she needed to change her friends anyway.

Tiffany found friends who would leave a restaurant if she didn’t feel comfortable around the alcohol. She also found friends who would be open and honest about her diseases, and were willing to help her stay on the right track.

As she continues her journey toward a better life, Tiffany said she changed her lifestyle from isolation and going to the bar, to hanging out with friends and visiting her niece and nephew.

“My niece is the light of my life,” she said. “When my sister said, ‘If treatment doesn’t work this time, you can’t be a part of her life,’ that was an eye-opener as well.”

Tiffany also found support groups, like Alcoholics Anonymous, that work for her. She said her sponsor helps her stay sober.

Her twice-weekly therapy sessions with Tanzini and Dressing greatly enhance her drive to remain sober and continue eating. She is now at a healthy weight, she said, though Dressing does not reveal the number to her. Tiffany does not have a scale at home and when she visits the doctor, she steps on the scale backward. However, Tiffany guesses she’s around the 140-pound mark.

“I would not wish an eating disorder on my worst enemy,” Tiffany said.

Her journey is not over, nor will it ever be. She will deal with anorexia and alcoholism for the rest of her life. She often struggles, she said. She’ll have times when she doesn’t want to eat. She’ll sometimes want to have a drink.

At these times she’ll employ coping mechanisms - deep breathing, listening to music, visiting her niece, talking to family or friends, journaling and prayer.

The memory of her mock funeral also pushes her to keep on track.

“They gave me the eulogies to keep. If I have a moment when I think I can skip a meal and no one’s going to know, I take a minute and read those,” she said. “I go back and remember what that meant to me.”

She also remains on a relapse prevention plan with her therapist Mary Dressing.

One piece of advice Tiffany offers to those dealing with similar diseases is this: “Reach out. If someone offers help, take it.”

For those concerned about someone struggling with an eating disorder, she says to be careful about approaching it. Coming on too strong can push the person further away.

And for those who have no support system: “Email me. I will be their support system. If my story can help one person, it’s worth it.”

Tiffany is working to create an eating disorder support group in Mitchell, hoping to help others who struggle with any type of eating disorder - anorexia, bulimia, binge eating, purging, night eating, among others.

Tiffany plans to get back to work in the fall. But for now, she is working on herself, her habits and relationships. She also hopes to get back on her horse as soon as possible.

“I feel amazing,” she said. “I’m so looking forward to what life has to offer this time around.”

- Tiffany encourages anyone who needs to talk or needs help with an eating disorder to email her at tiffanyfraser1980@gmail.com.