First of all, Michael was in the public eye from the age of 5. He was abused physically and emotionally by his father throughout his childhood. Make no mistake — emotional abuse can be just as horrible as physical abuse. Physical abuse has a stopping point — a slap or a spanking, and it’s done for the time being. But emotional abuse is like water dripping on a stone. Self-esteem never gets a chance to develop when a person is severely emotionally abused.

Michael’s father telling him what an ugly nose he had over and over was one of the precipitants for Michael’s body-dysmorphic disorder.

Michael was depressed, had anxiety, was extremely thin, and had maturity fears. He didn’t want to be fat. His appearance was of primary importance to him.

If we look at the symptoms of anorexia nervosa, we find that depression and anxiety are usually high, weight is low — a BMI of 15.6 in Michael’s case — and certainly maturity fears. This explains Michael’s comfort in being with children. He had a soft, childlike nature. It is often said that a person stops growing emotionally at the exact age when the disorder starts — whether it’s an eating disorder or substance abuse. The drug use is another matter. 40-50% of people with eating disorders can have substance abuse issues. With anorexia, as others have commented, drugs will definitely dampen the appetite.

Too often in our culture, people say, “Oh, he didn’t have an eating disorder. He was just thin.” Michael had too many etiological factors in his history for him to be “just thin.” Many more people are anorexic besides those who look “just thin.” It is so sad that Michael wasn’t able to get the help that might have changed his life.