In August, Reality Winner stood before a federal judge, ready to accept a plea bargain of more than five years in prison for sharing classified information with journalists. Surrounded by dozens of reporters, attorneys, and activists who have followed her case, the whistleblower told the court something deeply personal that she had not even shared with her closest family members before her arrest.

Winner struggles with depression and bulimia.

“I try to be optimistic, and then they just surprise me and I’m just like, I signed a plea deal to get help.”

Weeks later, Winner made a distressed phone call from a crowded Oklahoma county jail that she called a “filthy warehouse.” She questioned why she gave up her right to a trial in a bid for stability and medical treatment, even if it was in prison, where her bulimia has gotten more severe. “I keep saying it can’t get worse,” Winner said, through tears. “I try to be optimistic, and then they just surprise me and I’m just like, I signed a plea deal to get help.”

In the run-up to arriving at her final prison assignment, Winner spent 16 months in various jails — bouncing between county jails across three states, where she was at times held in isolation or not allowed to go outside for weeks, as she was transferred to prison after sentencing. In mid-October, she was finally transferred to a federal medical center in Fort Worth, Texas, a facility designed for female inmates with special mental health or medical needs, where she will serve the remainder of her time.

Winner’s sentence is the longest of its kind under the Espionage Act, a World War I-era law used in recent years to send journalists’ sources to prison, even as comparable defendants have simply gotten probation for “mishandling classified information.”

With her move to prison, Winner’s determination to seek treatment will likely be crucial in an institution known for perpetuating, rather than alleviating, mental illness.

Of the approximately 2.3 million incarcerated people in the U.S., the former National Security Agency contractor is among the many who languish behind bars despite needing intensive medical care. Though the Bureau of Prison Statistics does not collect data on inmates diagnosed with eating disorders, a 2017 report from the agency said that incarcerated people showed “serious psychological distress” three to five times more, as a percentage, than the general U.S. population. Incarcerated women are acutely affected: Two-thirds of those included in the survey by the Bureau of Prison Statistics reported a history of mental health problems.

Winner’s record sentence means that her young adulthood will be spent between two institutions where her body has been subject to frequent scrutiny that few ordinary citizens face: the military and prison. But her eating disorder began well before her secretive work in the NSA and the U.S. drone program, and the illness was not an unfamiliar one in her household. Being thrust into the public sphere by the political nature of her high-profile arrest turned what had been a private struggle with mental illness into something Winner would have to recount to friends and strangers alike in an increasingly desperate attempt to seek relief.

Bulimia is an illness in which individuals binge on food and then engage in compensatory actions, such as excessive exercise or regurgitation. “The disorder is a constant struggle for me and even now is the most pressing internal challenge in my day-to-day survival,” Winner told the federal judge in August. She said that without proper treatment, she fears that bulimia could become her “only coping mechanism” to handle the stress of incarceration.

Eating disorders are sometimes misunderstood as a conscious decision or picky eating, said Sondra Kronberg, a clinical nutrition therapist in Long Island, New York, when in fact they can have lethal consequences. “It is the mental disorder with the highest rate of death and mortality,” said Kronberg, who is also a spokesperson for the National Eating Disorders Association.

Winner’s older sister Brittany Winner said that eating disorders and a focus on thinness “runs in the family.” For Reality, the condition collided with many of the daily hardships of the American carceral state, such as the strip searches that she was subjected to when she left for court hearings, which she dreaded.

“It’s hard for people who haven’t obsessed over eating to understand what that is like.”

Because she keeps a vegan diet, Winner experienced severe anxiety in jail about finding appropriate foods, something that earns little sympathy from those who see it as a choice to follow a fad, her sister said. “It’s hard for people who haven’t obsessed over eating to understand what that is like,” Brittany Winner said.

Reality Winner’s friends and family describe her as a woman whose professional and personal lives have a common thread of idealism and high self-expectations, traits she has maintained even while incarcerated. A friend from her CrossFit gym challenged Winner to do 5,000 pushups in a month — which she finished in 19 days, while in jail. Winner’s environmentalism and opposition to animal cruelty motivate her strict vegan diet, elusive in jail where — only thanks to the generosity of a church — she ate fresh fruit and vegetables about once a month.

“It is a priority for her that she eats clean and that she has a clean conscience,” said Brittany Winner. “I think it’s about doing the best that she can.”

The downturn in Reality Winner’s health while in custody was the second chapter of her illness. When Billie Winner-Davis pulled Winner’s medical records after her arrest, she learned that her daughter had been diagnosed with bulimia years before, in her early 20s, while working on a drone program at Fort Meade, Maryland. At the time, Winner worked 12-hour days translating the intercepted communications of terror suspects; she would eventually receive a commendation for aiding in “600 enemies killed in action.”

During that time, Winner shared vague but dark worries with her mother about the anxiety she felt over her work.

“You really hope that all of your information is correct when you are watching a screen and you watch somebody go poof,” Winner-Davis recalled of her daughter’s concerns.

The prevalence of eating disorders in the military doesn’t come as a surprise. A Defense Department study published in June notes that “several factors could increase risk” of military personnel developing the disorders, such as regimented lifestyles and strict regulations on personal fitness and weight, which include measuring waistlines as part of fitness tests. The already “relatively high rates of mental health disorders” among service personnel, combined with exposure to trauma, also put them at increased risk for eating disorders, the report added.

An estimated 5 to 8 percent of servicewomen are diagnosed with an eating disorder, an incidence rate 11 times that of their male counterparts, according to the report. The study called for additional research on the topic, as women make up a “rapidly” growing demographic in the armed forces.

Winner went from being an low-profile veteran to a newsworthy name when she was arrested by federal authorities. She was widely reported as the source for a June 2017 article in The Intercept on an NSA report detailing phishing attacks by Russian military intelligence on local U.S. election officials. The Intercept received the document anonymously; The Intercept’s parent company First Look Media has contributed to Winner’s legal fund through the Press Freedom Defense Fund since learning of her arrest.

The secretive nature of her former employment followed Winner as she went from being a trusted security state insider to incarceration while subjected to a gag order. She was denied bail after government attorneys claimed that she was a flight risk capable of harming the country should she await trial outside prison. The government argued that she held “very valuable information in her head,” which she could leak if released. By making that argument — and winning with it — the government ensured that this nonviolent offender would be held in a small county jail for well over a year before any treatment for her eating disorder could happen.

Winner tried her best to maintain her plant-based diet during the months of confinement before she had been found guilty of a crime. She often made meals of peanut butter and chips. On other days, she “celebrated” getting black-eyed peas or white potatoes, according to Winner-Davis, while others in detention ate biscuits and sausages.

Her cellmates in Lincoln County Jail, the small Georgia prison where Winner spent her first 15 months behind bars, would watch in awe as she used a table in their common area like a StairMaster for up to two hours. Winner was allowed outside on most days for a mere 30 minutes, which she spent running barefoot in circles around the small jail yard. Diet and exercise, her mother said, are her mechanisms to curb “self-harming” tendencies. (Asked about Winner’s diet while in custody, the Lincoln County Jail referred The Intercept to the U.S. Marshals Service. Lynzey Donahue, a U.S. Marshals spokesperson, declined to comment.)

“One doesn’t choose to have an eating disorder. They can choose what to do to get better. Obviously, there’s not a lot of choice around that in prison.”

Treatment for an eating disorder is more involved than meeting a patient’s criteria for what they will eat, and appropriate treatment would likely address whether insistence on dietary restrictions is part of one’s eating disorder, said Kronberg, the therapist. However, the first part of treatment for an illness that is “serious and deadly,” she said, is getting well-nourished.

“One doesn’t choose to have an eating disorder. They can choose what to do to get better,” said Kronberg. “Obviously, there’s not a lot of choice around that in prison.”

Whether a prisoner eats a nutritious meal — or even three daily — is the luck of the draw. The infamous former Arizona Sheriff Joe Arpaio bragged that he served meals just twice a day. On the other hand, Connecticut Gov. Dannel P. Malloy recently touted his move to spend more on prison food — from a daily average of $2.95 per person to $3.25 — as both a practical and moral choice. In California, the state Senate faced little opposition to a new bill that guarantees prisoners plant-based diets; it passed unanimously in May.

These disparities persist despite incarcerated people’s legal rights to adequate, nutritionally balanced meals, said David Fathi, director of the American Civil Liberties Union National Prison Project. For example, a federal law passed in 2000 provides strong protections for incarcerated people who seek special meals for religious reasons. Nonetheless, Fathi said he is “amazed” by how many facilities will “fight tooth and nail” to resist offering common diets, such as halal, kosher, or vegetarian.

“The reality is you are never going to save significant amounts of money by cutting corners on food,” he said. “If you want to save money on incarceration, the only way to do that is to lock up fewer people.”

Winner’s transfer to the Fort Worth federal medical facility is already bringing her some relief, said Winner-Davis. The Bureau of Prisons told The Intercept in an email that its units serve “no-flesh” entrees at every meal, fresh fruits daily, and fresh vegetables “frequently.” Winner-Davis said her daughter has seen a psychologist and is exercising regularly.

Whether Winner will continue to rely on her own ad hoc methods to treat her bulimia or start a new chapter under reliable professional care will become clearer over the coming months. Winner, who will soon turn 27 in prison, will begin to discover if her plea deal with the government brings her the relief she bargained for.

“It just shouldn’t be this hard to just survive the system,” Winner said.