Eating Disorders: Anorexia and Bulimia
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Anorexia Nervosa
Anorexia
Nervosa is a disruption in normal eating habits characterized by an all
consuming fear of becoming "fat."
It typically starts in teenage women as a normal attempt to diet but
gradually leads to more and more weight loss, often more than 25% of original
body weight. There is an intense
preoccupation
with food and body
size, which may involve
compulsive
exercising. Anorexics intentionally
starve themselves, for although they are
emaciated,
they are convinced that they are overweight.
As the eating disorder progresses, many normal activities may stop. Menstruation ceases in women and there are a
number of physical symptoms of malnutrition such as lowered heart rate, low
blood pressure, decreased metabolic rate and sensations of coldness
particularly in the extremities.
People
with anorexia nervosa are obsessed with food and deny that they have a problem
or that they are too thin. They may be
able to work or study and have some social life but usually function far below
their potential. Frequently they are also depressed. Sometimes anorexics must be hospitalized to prevent
starvation. Other anorexics are able to
check the downward spiral of weight loss and maintain a steady but seriously underweight
condition. In all cases, even severe
weight loss does not diminish the perception of being "fat."
Consider
the following case of Deborah, a young woman suffering from anorexia nervosa:
--
Deborah developed anorexia nervosa when she was 16. A rather shy, studious teenager, she
tried hard to please everyone. She had
an attractive appearance, but was slightly overweight. Like many teenager girls, she was interested
in boys but concerned that she wasn't pretty enough to get their attention. When her father jokingly remarked that she
would never get a date if she didn't take off some weight, she took him
seriously and began to diet
relentlessly
--never
believing she was thin enough even when she became extremely underweight.
-- Soon after the pounds started dropping off,
Deborah's menstrual periods stopped. As
anorexia tightened its grip, she became obsessed with dieting and food and
developed strange eating rituals. Every
day she weighed all the food she would eat on a kitchen scale, cutting solids
into minuscule pieces and precisely measuring liquids. She would then put her daily ration in small
containers, lining them up in neat rows.
She also exercised compulsively, even after she weakened and became
faint. She never took an elevator if
she could walk up steps.
-- No one was able to convince Deborah that she
was in danger. Finally, her doctor insisted that she be hospitalized and
carefully
monitored
for
treatment of her illness. While in the
hospital, she secretly continued her exercise regimen in the bathroom, doing
strenuous routines of sit-ups and knee-bends. It took several hospitalizations
and a good deal of individual and family outpatient therapy for Deborah to face
and solve her problems.
Deborah's
case is not unusual. People with
anorexia typically starve themselves, even though they suffer terribly from
hunger pains. One of the most
frightening aspects of the disorder is that people with anorexia continue to
think they are overweight even when they are bone-thin. For reasons not yet understood, they become
terrified of gaining any weight.
Food
and weight become obsessions. For some,
the compulsiveness shows up in strange eating rituals or the refusal to eat in
front of others. It is not uncommon for
people with anorexia to collect recipes and prepare gourmet feasts for family
and friends, but not partake in the meals themselves. Like Deborah, they may
adhere
to strict exercise routines to keep off weight.
Loss of monthly menstrual
periods is typical in women with the disorder.
Men with anorexia often become impotent.
In
patients with anorexia, starvation can damage vital organs such as the heart
and brain. Excessive thirst and
frequent urination may occur.
Dehydration contributes to constipation, and reduced body fat leads to
lowered body temperature and the inability to withstand cold. Mild anemia, swollen joints, reduced muscle
mass, and light-headedness also commonly occur in anorexia. If the disorder becomes severe, patients may
lose calcium from their bones, making them brittle and prone to breakage. They
may also experience irregular heart rhythms and heart failure. In some patients, the brain shrinks, causing
personality changes. Fortunately, this
condition can be reversed when normal
weight is reestablished.
Scientists
have found that many patients with anorexia also suffer from other psychiatric
illnesses. While the majority have
co-occurring clinical depression, others suffer from anxiety, personality or
substance abuse disorders, and many are at risk for suicide.
Obsessive-compulsive disorder (OCD), an illness characterized by repetitive
thoughts and behaviors, can also accompany anorexia. Individuals with anorexia are typically
compliant
in personality but may have sudden outbursts of
hostility and anger or become socially withdrawn.
Bulimia
Bulimia
is a cycle of uncontrolled
binge
eating following by purging. People with bulimia nervosa
consume
large amounts of food and then rid their bodies of
the excess calories by vomiting, abusing laxatives or diuretics, taking enemas,
or exercising obsessively. Some use a
combination of all these forms of purging.
Because many individuals with bulimia "binge and purge" in
secret and maintain normal or above normal body weight, they can often
successfully hide their problem from others for years.
Bulimia
can range from a mild and relatively infrequent response to stress to an
extremely debilitating pattern that absorbs nearly all of a person's time,
energy, and money. In its most severe
forms, binge eating and purging may occur ten or more times a day.
Bulimia
usually begins
innocuously
as
an attempt to control weight. Purging
may seem to be a convenient means for a person to overeat without gaining
weight. It can quickly become a
destructive process that cannot be controlled.
Persons with bulimia are often aware that their eating patterns are
abnormal and out of control and that their lives are dominated by their eating
habits. They may feel quilty and
depressed after a binge. Over time, the
cycle becomes more and more dominant in the person's thoughts and behavior. It may
impair
personal relationships and interfere with other activities, leading to
depression, isolation, and lowered self-esteem. Once caught in this pattern, the resulting shame and sense of
helplessness may make it difficult for the person to seek the help that is
needed.
Physical
effects can also be serious. Frequent
vomiting can cause permanent tooth damage from erosion of tooth enamel as well
as damage to the tissues of the throat and esophagus. Kidney problems and seizures are also possible. Electrolyte
imbalance with consequent risk of serious cardiac problems is also a
significant danger.
Consider
the case of Lisa, a young woman suffering from bulimia.
--
Lisa developed bulimia nervosa at 18.
Her strange eating behavior began when she started to diet. She too dieted and exercised to lose weight,
she regularly ate huge amounts of food and maintained her normal weight by
forcing herself to vomit. Lisa often
felt like an emotional powder keg--angry, frightened, and depressed.
-- Unable to understand her own behavior, she
thought no one else would either. She
felt isolated and lonely. Typically,
when things were not going well, she would be overcome with an uncontrollable
desire for sweets. She would eat pounds
of candy and cake at a time, and often not stop until she was exhausted or in
severe pain. Then, overwhelmed with
guilt and disgust, she would make herself vomit.
-- Her eating habits so embarrassed her that
she kept them secret until, depressed by her mounting problems, she attempted
suicide. Fortunately, she didn't
succeed. While
recuperating
in the hospital, she was referred to an eating
disorders clinic where she became involved in group therapy. There she received
medications to treat the illness and the understanding and help she so
desperately needed from others who had the same problem.
Family,
friends, and physicians may have difficulty detecting bulimia in someone they
know. Many individuals with the
disorder remain at normal body weight or above because of their frequent binges
and purges, which can range from once or twice a week to several times a
day. Dieting heavily between episodes
of binging and purging is also common.
Eventually, half of those with anorexia will develop bulimia.
As with anorexia, bulimia typically
begins during adolescence. The
condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their
strange habits, do not seek help until they reach their thirties or
forties. By this time, their eating
behavior is deeply ingrained and more difficult to change.
Bulimia nervosa patients--even those
of normal weight--can severely damage their bodies by frequent binge eating and
purging. In rare instances, binge
eating causes the stomach to rupture; purging may result in heart failure due
to loss of vital minerals, such as potassium.
Vomiting causes other less deadly, but serious, problems--the acid in
vomit wears down the outer layer of the teeth and can cause scarring on the
backs of hands when fingers are pushed down the throat to induce vomiting. Further, the esophagus becomes inflamed and
glands near the cheeks become swollen.
As in anorexia, bulimia may lead to irregular menstrual periods. Interest in sex may also diminish.
Some individuals with bulimia
struggle with addictions, including abuse of drugs and alcohol, and compulsive
stealing. Like individuals with
anorexia, many people with bulimia suffer from clinical depression, anxiety,
OCD, and other psychiatric illnesses.
These problems, combined with their impulsive tendencies, place them at
increased risk for suicidal behavior.
Causes of Eating Disorders
Anorexia
nervosa has been known for over a century but it is only since the early 1970's
that bulimia, not associated with anorexia, has been known to professionals. One out of every one hundred women may
become anorexic. Estimates of the frequency of bulimia vary from five out of a
hundred to twenty out of a hundred in college age women. Men also develop anorexia nervosa and bulmia
but in far smaller numbers. Both
disorders appear to be on the increase.
Experts do not know the causes of these disorders nor why they are
increasing, but most agree that biological, psychological, and social factors
all play a part.
Least
is known about biological factors. Some
evidence suggests that eating disorders may develop as a response to inherited
predispositions
to mood swings
and depression. Other evidence reveals
an increased incidence of major depression and alcoholism in blood relatives of
persons with bulimia or bulimic variations of anorexia nervosa. Antidepressant medication under the supervision
of a physician has been found helpful to some individuals in controlling the
binge-purge cycle.
More
attention has been paid to the psychological development of persons with eating
disorders. It is speculated that
anorexia may function as an attempt to gain control over life or life
circumstances when a person has felt little control in the past. It may also serve as an avoidance of the
bewildering
complexities of
physical and emotional maturation.
Individuals with anorexia are often compliant "model children"
who tend to be intelligent, perfectionistic, and have high personal
standards. They often want to please
others but have low self-esteem and problems with
assertion.
They will also frequently be depressed. High expectations within their families may
be another contributing factor.
Persons
with bulimia also suffer from low self-esteem but tend to be less
passive
than persons with
anorexia nervosa. Individuals with
bulimia tend to be more socially active, are more likely to date, and may use
alcohol and drugs. Research suggests
that persons with bulimia have a higher general level of anxiety than
others. Thus the binge-purge cycle may
function as a mechanism for relieving anxiety and emotional stress.
Social
factors also seem to contribute to eating disorders. Excessive emphasis within our culture on slim, boyish figures for
women makes it increasingly hard for the adolescent girl, already worried about
herself and her body, to feel acceptable.
Increasing numbers of teenage girls resort to extreme diets or purging
in attempts to make their maturing bodies conform to the expectations of
society. Some of these individuals will
be trapped in the destructive pattern of eating disorders. Females have traditionally felt more
pressure than males to conform to physical
stereotypes
of what is acceptable. This may explain
why so many more females than males develop eating disorders.
Treatment of Eating Disorders
An
important first step in overcoming an eating disorder is for the person to
acknowledge to him or herself and to helping professionals that an eating disorder
is a problem. Medical and psychological
help should be sought from individuals experienced in the treatment of such
disorders. A complete physical
examination including lab tests will often be necessary.
Psychotherapy
is also usually necessary. It may
include individual and/or group therapy.
One immediate benefit of such therapy is the feeling of relief at no
longer having to keep such an important part of one's life a secret. Psychotherapy will often focus on improving
self-esteem. It may be
supplemented
by nutrition
education, discussions of eating habits, and food selection.
This
combination of medical, psychological, and educational treatments can be
effective on an outpatient basis. In
extreme cases, e.g., a person with anorexia nervosa whose weight is extremely
low or a person with bulimia who is completely out of control, temporary
hospitalization may be required. What is most important is that professional
treatment be sought as quickly as possible.
Attempts at self-help are rarely successful, and the longer the disorder
remains
unchecked
the harder
it may be to
overcome.