"We aren't saying that if you wear a lot of makeup you will develop an eating disorder," explained Adrienne Ressler, national training director for the Renfrew Center Foundation. "But we have found some of our patients depend on makeup for self-worth. They treat it like exercising too much or wearing a size zero. A lot of our patients hide themselves behind makeup."
Have a hard time going completely barefaced? Ressler suggests giving up a favorite makeup item, like an eye shadow or fake lashes.
"We don't want to trigger too many feelings of anxiety," Ressler says. "We just want to empower women and help them realize that makeup isn't just a body-image issue, but women could be hiding behind it when they aren't standing up for themselves or dealing with their true feelings about something."
Going barefaced often gets a bad rap. A makeupless mug conjures up images of Plain Jane - and we know she never gets the guy - or worse, pics straight from the police blotter.
Remember Lindsay Lohan's mug shots?
Speaking of Lohan, when celebrities are photographed without makeup we often scrutinize them within an inch of their crow's-feet. The pressure! And when they are dolled up, we don't think twice. We expect perfection. Again, the pressure.
So it makes total sense for everyday women to think of makeup as the must-have enhancer. After all, a berry lip can do wonders for moods (and driver's license photos).
The problems come when women are afraid to leave their homes without the works. We are talking foundation, lashes, and lips. Is all that necessary to go to the gym?
But in the world of eating disorders, Ressler says, cosmetics all too often become a crutch. Women use makeup to draw attention to their faces instead of their bodies. Women who suffer from eating disorders often also have body dysmorphic disorder, a preoccupation with body image. Such women believe they can never, ever be skinny enough. In some cases that means they feel they can never, ever wear too much makeup.
In December, Renfrew commissioned Harris Interactive Inc., known for the Harris Poll, to administer a survey to 1,292 females over 18 to gauge their feelings about makeup.
Forty-four percent said they have negative feelings about themselves when they aren't wearing makeup. Sixteen percent said they were self-conscious without it, and 14 percent said they felt naked sans beauty enhancements.
When asked why they wear it, 44 percent said they use makeup to hide flaws, and 48 percent said they preferred the way they look with it.
Among women who said they wore makeup, 51 percent said they started from ages 14 to 16, and 27 percent began from 11 to 13.
"What do you think happens to a girl that learns to hide flaws she doesn't even have at 11 with makeup?" Ressler asked. "She may begin to think that's how she is supposed to look, because it's part of her belief system. That leads to self-esteem problems."
That was the case for Kaitlyn Bowman, 18, a senior at the Academy of Notre Dame de Namur in Villanova. Today she boasts naturally rosy cheeks and barely glossed lips. But she says that at her eighth-grade dance, she wore so much eyeliner and bronzer she could hardly recognize herself.
And over the next year, Bowman grew emaciated from not eating.
"I thought a lot of makeup was necessary for me to be pretty," she said. "I wanted to be a different person."
Eating-disorder survivor Kari Adams, 41, a mother of two in Princeton, has a similar story.
Adams, who suffered from anorexia and bulimia, began dabbling in makeup as a preteen. Her mother was a Mary Kay consultant, so she had her pick of mascaras, lipsticks, and foundations.
She remembers a particular Christmas when she was about 15, when it took her hours to go downstairs to open her presents. Why so long? She was getting her full glamour girl on.
At the height of Adams' eating disorder, she wouldn't leave the house without lip gloss, foundation, or mascara.
She was even addicted to acrylic nails.
"I couldn't even go out to get a cup of coffee," she said. "I just saw ugly if I didn't have lipstick on. It was sick."
These days, after six months of treatment at Renfrew that ended in August, Adams, who runs a dating service called Princeton Elite, is at a healthy weight. She's wearing a white T-shirt, sweatpants, and the perfect amount of mascara and gloss.
Will she go makeup-free Monday?
She's working on it.
"I go into a panic mode without makeup," Adams said, wincing. "Without it, I think I look awful, but I'm going to try to get past it and try it. It's part of the healing process."
Contact Elizabeth Wellington
at 215-854-2704 or firstname.lastname@example.org. Follow her on Twitter at ewellingtonphl.