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Eating Disorders

Eating Disorders

Eating disorders affect both the mind and the body. Although deviant eating patterns have been reported throughout history, eating disorders were first identified as medical conditions by the British physician William Gull in 1873. The incidence of eating disorders increased substantially throughout the twentieth century, and in 1980 the American Psychiatric Association formally classified these conditions as mental illnesses.

Diagnosis

Individuals with eating disorders are obsessed with food, body image, and weight loss. They may have severely limited food choices, employ bizarre eating rituals , excessively drink fluids and chew gum, and avoid eating with others. Depending on the severity and duration of their illness, they may display physical symptoms such as weight loss; amenorrhea ; loss of interest in sex; low blood pressure ; depressed body temperature; chronic , unexplained vomiting; and the growth of soft, fine hair on the body and face.

There are various types of eating disorders, each with its own physical, psychological , and behavioral manifestations. They are classified into four distinct diagnostic categories by the American Psychiatric Association: anorexia nervosa , bulimia nervosa, binge eating disorder , and eating disorder not otherwise specified.

Anorexia nervosa.

Clinically, anorexia nervosa is diagnosed as intentional weight loss of 15 percent or more of normal body weight. The anorexic displays an inordinate fear of weight gain or becoming fat, even though he or she may be extremely thin. Food intake is strictly limited, often to the point of life-threatening starvation. Sufferers may be unaware of or in denial of their weight loss, and may therefore resist treatment.

Peak ages of onset are between 12 and 13 and at age 17. Among women of menstruating age, menstruation ceases due to weight-related declines in female hormones .

This illness has two subtypes: the restricting type, in which weight loss is achieved solely via reduction in food intake, and the binge eating/purging type, in which anorexic behavior is accompanied by recurrent episodes of binge eating or purging.

Bulimia nervosa.

Bulimia nervosa is characterized by repeated episodes of bingeing followed by compensatory behaviors to prevent weight gain. Compensatory behaviors include vomiting, diuretic and laxative abuse, fasting, or excessive exercise. Like the anorexic, the typical bulimic has an unusual concern about body weight and weight loss. Unlike the anorexic, he or she is acutely aware of this condition and has a greater sense of guilt and loss of self control.

Bulimia typically develops during the late teens and early twenties. In contrast to the typically emaciated anorexic, most bulimics are of normal body weight, although weight may fluctuate frequently. Physically, the bulimic may have symptoms such as erosion of tooth enamel, swollen salivary glands, potassium depletion, bruised knuckles, and irritation of the esophagus.

To qualify for a clinical diagnosis of bulimia nervosa, binge eating and related compensatory behaviors must take place at least two times a week for a minimum of three months. Sufferers are classified into one of two subtypes: the purging type, which employs laxatives, diuretics , or self-induced vomiting to compensate for bingeing, or the nonpurging type, which relies on behaviors such as excessive exercising or fasting to offset binges.

Binge eating disorder.

Binge eating disorder is characterized by eating binges that are not followed by compensatory methods. This condition, which frequently appears in late adolescence or the early twenties, affects between 15 and 50 percent of individuals participating in diet programs and often develops after substantial diet-related weight loss. Of those affected, 50 percent are male.

Binge eating disorder is diagnosed when an individual recurrently (at least twice a week for a six month period) indulges in bingeing behavior. A clinical diagnosis also requires three or more of the following behaviors: (1) eating at an unusually rapid pace, (2) eating until uncomfortably full, (3) eating large quantities of food in the absence of physical hunger, (4) eating alone out of shame, and (5) feelings of self-disgust, guilt, or depression subsequent to bingeing episodes.

Eating disorder not otherwise specified.

The category eating disorder not otherwise specified (EDNOS) is used to diagnose individuals whose eating disorders are equally as serious as anorexia nervosa, bulimia nervosa, or binge eating disorder, but do not meet all of the diagnostic criteria for these illnesses. An example of EDNOS might be a female who fulfills all of the criteria for anorexia but is still having regular menstrual periods, or an individual with all of the signs of bulimia who binges and purges less than twice a week.

Prevalence

Originally considered to be a disease targeting affluent white women and adolescents, eating disorders are now prevalent among both males and females, affecting people of all ages and from many ethnic and cultural groups. As many as 70 million people worldwide are estimated to suffer from these conditions, with one in five women displaying pathological eating patterns.

Most eating-disorder research focuses on females, who represent 90 percent of all cases. The additional 10 percent are males, a group that is often underdiagnosed due a widespread misperception that this disease only affects females. This belief also makes males less likely to seek treatment, frequently resulting in poor recovery. Among males, body image is a driving factor in the development of eating problems. Gender identity may also play a role in the evolution of eating disorders, with homosexual males more prone to this disorder than the overall male population.

Risk Factors

Environmental, social, biological , and psychological factors all contribute to eating-disorder risk. Early childhood environment and parenting may have a substantial impact. Many sufferers report dysfunctional family histories, with parents who were either emotionally absent or overly involved in their upbringing. As a result, these children may not tolerate stress well, they may have low self-esteem, and they may have difficulty in interpersonal relationships. Children who have been abused either physically, sexually, or psychologically are also highly vulnerable to eating disorders, particularly bulimia. Those raised by eating-disordered parents may be at heightened risk due to repeated exposure to maladaptive food-related behaviors.

Professions, activities, and dietary regimens that emphasize food or thinness may also encourage eating disorders. For example, athletes, ballet dancers, models, actors, diabetics, vegetarians, and food industry and nutrition professionals may have higher rates of disordered eating than the general population. In addition to environmental and social influences, biological and psychological factors may also increase risk for eating disorders in some people. Low levels of serotonin , a neurotransmitter involved in appetite regulation and satiety, may be indicative of a predisposition to pathological eating behaviors. Similarly, as many as 50 to 75 percent of those who are diagnosed with eating disorders suffer from depression, a mental illness also associated with abnormalities in serotonin balance. Other psychiatric disturbances, such as bipolar depression, obsessive-compulsive disorder, seasonal affective disorder, post-traumatic stress disorder, attention-deficithyperactivity disorder, and addictive behaviors, are also common in people with eating disorders.

Causes

Societal influences also contribute to this illness. Increasingly, Westernized culture portrays thinness as a coveted physical ideal associated with happiness, vitality, and well-being, while obesity is perceived as unhealthy and unattractive. This has encouraged a growing sentiment of body dissatisfaction, particularly among young women. Endless images of unrealistically thin models and actors in all forms of media further promote body dissatisfactionone of the strongest risk factors for the development of disordered eating.

Abnormal eating patterns are most likely to develop during the mid- to late teens, a period of considerable physical, psychological, and social change. While the exact events that lead to the evolution of these disorders are unknown, there are two common milestones that can trigger disordered eating, especially in those with a biological predisposition. The first is the occurrence of a traumatic event, such as the death of a loved one or a divorce. The other is the adoption of a strict diet, which may be even more pivotal than a personal trauma. In fact, rigorous dieting has been identified again and again as the most common initiating factor in the establishment of an uncontrollable pattern of disordered eating.

Treatment Modalities

Treatment is based on a combination of psychotherapy, medication, and nutritional counseling. Goals include restoration of healthy body weight, correction of medical complications, adoption of healthful eating habits and treatment of maladaptive food-related thought processes, treatment of coexisting psychiatric conditions, and prevention of relapse. Depending on the severity of the illness, therapy may be conducted on an outpatient, day treatment, or inpatient basis.

Outpatient therapy.

Outpatient therapy provided by practitioners specializing in eating disorders is appropriate for highly motivated patients within 20 percent of their normal body weight and whose illness is mild or just developing. Treatment consists of cognitive-behavioral therapy, intensive nutritional counseling, support-group referrals, and medical monitoring. At the outset of treatment, a contract is established, outlining an anticipated rate of weight gain (usually between 0.5 and 2 pounds per week), target goal weight, and consequences if weight gain is not achieved. Vitamin and mineral supplementation and the use of liquid supplements to facilitate weight gain may also be indicated.

Day treatment programs.

Day treatment programs are being used with increasing frequency in place of inpatient hospitalization. This form of therapy provides an intermediate level of care for patients who require frequent monitoring but do not require treatment twenty-four hours a day. It may be used for patients who are not responding to outpatient therapy or who are stepping down from inpatient hospitalization. Treatment, which may take place four or five days per week from morning until evening, is similar in structure to outpatient therapy, but is provided on a more intensive level.

Inpatient hospitalization.

Inpatient hospitalization is indicated for patients whose eating disorder has reached life-threatening status. Criteria for admission to such programs are weight loss of 25 percent or more of ideal body weight or the presence of an eating disorder in a child or adolescent. It may also be necessary for individuals who are medically unstable. Usually, participants in inpatient programs are anorexic, although hospitalization for bulimia may be necessary if there is serious deterioration of vital signs, uncontrollable vomiting, or concurrent psychiatric illness.

The immediate goals of inpatient treatment are weight gain and stabilization of vital signs. In many cases, the patient is so fragile that complete bed rest is required. Eating is gently encouraged. In extreme medical situations refusal may be met with tube feeding or, in rare instances, intravenously.

Medication.

Medication is increasingly becoming a routine part of treatment for eating disorders. Antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), are the most effective and most commonly used medication in treating this spectrum of illnesses. They are found to be of greatest benefit when used in combination with therapy, and are of little value if offered on their own. In the case of anorexia, these medications are most effective if employed after successful weight restoration is achieved, at which time they can be useful for relapse prevention and the treatment of coexisting psychiatric conditions. SSRIs are also used in preventing binge relapses among bulimics, although their effectiveness ceases once the medication is discontinued. Although antidepressants have also been employed in the treatment of binge eating disorder, outcomes have not been sufficiently positive to warrant recommendations for their use.

Outcomes

Individuals are usually considered to be ready to terminate therapy once they have achieved a healthy body weight and can eat all foods free of guilt or anxiety . For a complete recovery, extensive treatment may be required from six months to two years, and for as long as three to five years in cases where other psychiatric conditions are present. For some, eating disorders will be a lifelong struggle, with stressful or traumatic events triggering relapses that may require occasional check-in therapy to restore healthful eating patterns.

Eating Disorders throughout History

Although eating disorders first came to widespread attention in the 1970s, self-starvation and other pathological eating practices are found throughout recorded history. Bulimia was widely known in both Greek and Roman societies and was recorded in France as early as the eighteenth century. Self-starvation for religious reasons became widespread in Europe during the Renaissance, as hundreds of women starved themselves, often to death, in hopes of attaining communion with Christ. During the nineteenth century, as corpulence stopped being viewed as a symbol of prosperity, self-starvation became common again. The incidence of eating disorders varies widely among cultures and time periods, suggesting that they can be encouraged or inhibited by social and economic factors. Eating disorders have most often been seen in affluent societies and are rarely reported during periods of famine, plague, and warfare.

Paula Kepos

Of individuals with anorexia nervosa, 50 percent will have favorable outcomes, 30 percent will have intermediate results, and 20 percent will have poor outcomes. The prognosis for bulimics is slightly less favorable, with 45 percent achieving favorable outcomes, 18 percent having intermediate results, and 21 percent with poor results. Among both anorexics and bulimics, 5.6 percent will die of complications related to their illness. Those who receive treatment early in the course of their disease have a greater chance of full recovery on both a physical and an emotional level. A favorable prognosis is also likely with an early age at diagnosis, healthy parent-child relationships, and close supportive relationships with friends or therapists. With early identification and treatment, eating disorders can be prevented from becoming chronic and potentially lethal.

see also Addiction, Food; Anorexia Nervosa; Bulimia Nervosa; Eating Disturbances.

Karen Ansel

Bibliography

American Academy of Pediatrics (2003). "Policy Statement: Identifying and Treating Eating Disorders." Pediatrics 111(1):204211.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: Author.

Berkow, Robert M., ed. (1997). The Merck Manual of Medical Information Home Edition. Whitehouse Station, NJ: Merck Research Laboratories.

Cassell, Dana, and Gleaves, David (2000). The Encyclopedia of Eating Disorders, 2nd edition. New York: Facts on File.

Costin, Carolyn (1996). The Eating Disorder Sourcebook. Los Angeles: Lowell House.

Pritts, Sarah D., and Susman, Jeffrey (2003). "Diagnosis of Eating Disorders in Primary Care." American Family Physician January 15.

Rome, Ellen S., et al. (2003). "Children and Adolescents with Eating Disorders: The State of the Art." Pediatrics 111:e98e108.

Stice, Eric; Maxfield, Jennifer; and Wells, Tony (2003). "Adverse Effects of Social Pressure to Be Thin on Young Women: An Experimental Investigation of the Effects of 'Fat Talk.'" International Journal of Eating Disorders 34:108117.

Woolsey, Monika M. (2002). Eating Disorders: A Clinical Guide to Counseling and Treatment. Chicago: American Dietetic Association.

Internet Resources

American Psychiatric Association (2001). "Men Less Likely to Seek Help for Eating Disorders." Available from <http://www.nlm.nih.gov/medlineplus>

American Psychiatric Association. "Practice Guideline for the Treatment of Patients with Eating Disorders." Available from <http://www.psych.org>

Anorexia Nervosa and Related Eating Disorders, Inc. (2002). "Males with Eating Disorders." Available from <http://www.anred.com/males.html>

Devlin, Michael J., and Walsh, Timothy B. (2000) "Psychopharmacology of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating." American College of Neuropsychopharmacology. Available from <http://www.acnp.org/g>

National Eating Disorders Association (2002). "Males and Eating Disorders." Available from <http://www.nationaleatingdisorders.org>

National Eating Disorders Association (2002). "What Causes Eating Disorders?" Available from <http://www.nationaleatingdisorders.org>

Renfrew Center Foundation (2002). "Eating Disorders: A Summary of Issues, Statistics and Resources." Available from <http://www.renfrew.org>

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Ansel, Karen. "Eating Disorders." Nutrition and Well-Being A to Z. 2004. Encyclopedia.com. 26 May. 2016 <http://www.encyclopedia.com>.

Ansel, Karen. "Eating Disorders." Nutrition and Well-Being A to Z. 2004. Encyclopedia.com. (May 26, 2016). http://www.encyclopedia.com/doc/1G2-3436200086.html

Ansel, Karen. "Eating Disorders." Nutrition and Well-Being A to Z. 2004. Retrieved May 26, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3436200086.html

Eating Disorders

Eating disorders

Eating disorders are psychological conditions that involve either overeating, voluntary starvation, or both. The best-known eating disorders are probably anorexia nervosa, anorexic bulimia, and obesity. Researchers are not sure what causes eating disorders, although many believe that family relationships, biochemical (physical) abnormalities, and society's preoccupation with thinness all may contribute to their onset.

Eating disorders are virtually unknown in parts of the world where food is scarce. They also are rarely seen in less prosperous groups in developed countries. Although these disorders have been documented throughout history, they have gained attention in recent years. This attention has come, at least in part, because some famous people have died as a result of their eating disorders.

Young people are more likely than older people to develop an eating disorder. The condition usually begins before the age of 20. Although both men and women can develop the problem, it is more common in women. Only about 5 percent of people with eating disorders are male. In either males or females, eating disorders are considered serious and potentially deadly health problems. Many large hospitals and psychiatric clinics have programs designed especially to treat these conditions.

Anorexia nervosa

The word anorexia comes from the Greek adjective anorektos, which means "without appetite." But the problem for people with anorexia is not that they aren't hungry. They starve themselves out of fear of gaining weight, even when they are severely underweight. The anorectic's self-image is so distorted that he or she sees himself or herself as "fat" even when that person looks almost like a skeleton. Some anorectics refuse to eat at all; others nibble only small portions of fruit and vegetables or live on diet drinks. In addition to fasting, anorectics may exercise strenuously to keep their weight abnormally low. No matter how much weight they lose, they always worry about getting fat.

This self-imposed starvation takes a heavy toll on the body. Skin becomes dry and flaky. Muscles begin to waste away. Bones stop growing and may become brittle. The heart weakens. With no body fat for insulation, the anorectic has difficulty staying warm. Downy hair starts to grow on the face, back, and arms in response to lower body temperature. In women, menstruation stops and permanent infertility may result. Muscle cramps, dizziness, fatigue, even brain damage and kidney and heart failure are possible. An estimated 10 to 20 percent of people with anorexia die, either as a direct result of starvation or by suicide.

Researchers believe that anorexia is caused by a combination of biological, psychological, and social factors. They are still trying to pinpoint the biological factors, but they have discovered some psychological and social triggers of the disorder. Many people with anorexia come from families in which parents are overprotective and have unrealistically high expectations of their children. Also, the condition seems to run in families, which leads researchers to believe it may have a genetic basis. Anorexia often seems to develop after a young person goes through some stressful experience, such as moving to a new town, changing schools, or going through puberty. Low self-esteem, fear of losing control, and fear of growing up are common characteristics of anorectics. The need for approval, combined with American culture's idealization of extreme thinness, also are believed to contribute to the disorder.

The obvious cure for anorexia is eating. But that is typically the last thing a person with anorexia wants to do. It is unusual for the person himself or herself to seek treatment. More commonly, a friend, family member, or teacher initiates the process. Hospitalization, combined with psychotherapy and family counseling, is often needed to control the condition. Force-feeding may be necessary if the person's life is in danger. About 70 percent of anorexia patients who are treated for about six months

return to normal body weight. About 15 to 20 percent can be expected to relapse, however.

Anorexic bulimia

Anorexic bulimia gets its name from the Greek term boulimos, meaning "great hunger," or, literally, "the hunger of an ox." The condition is commonly known simply as bulimia. People with bulimia go on eating binges, often gorging on junk food and then forcing their bodies to get rid of the food, either by making themselves vomit or by taking large amounts of laxatives.

Like anorexia, bulimia results in starvation. But there are behavioral, physical, and psychological differences between the two conditions. Bulimia is much more difficult to detect because people who have the disorder tend to be of normal weight or may even be overweight. They tend to hide their habit of binge eating followed by purging by vomiting or using laxatives. In fact, bulimia was not widely recognized, even among medical and mental health professionals, until the 1980s.

Words to Know

Binge-eating: Unrestrained eating.

Euphoria: A feeling of elation.

Laxative: A chemical that is designed to relieve constipation, often used by bulimics to rid the body of digested food.

Morbid: Having the tendency to produce disorder or disease.

Pinch test: A method of estimating the percent of fat in a person's body by grabbing a small area of skin between the fingers.

Risk factor: Any habit or condition that makes a person more susceptible to a disease.

Serotonin: A naturally occurring chemical that affects nerve transmissions in the brain and influences a person's moods, among other emotions.

Unlike anorectics, bulimics are aware that their eating patterns are abnormal, and they often feel remorse after a binge. For them, overeating offers an irresistible escape from stress. Many suffer from depression, repressed anger, anxiety, and low self-esteem, combined with a tendency toward perfectionism. About 20 percent of bulimics also have problems with alcohol or drug addiction, and they are more likely than nonbulimics to commit suicide.

Many people overeat from time to time but are not considered bulimic. According to the American Psychiatric Association's definition, a bulimic binges on enormous amounts of food at least twice a week for three months or more.

Bulimics plan their binges carefully, setting aside specific times and places to carry out their secret habit. They may go from restaurant to restaurant, to avoid being seen eating too often in any one place. Or they may pretend to be shopping for a large dinner party, when actually they intend to eat all the food themselves. Because of the expense of consuming so much food, some resort to shoplifting.

During an eating binge, bulimics favor high-carbohydrate foods, such as donuts, candy, ice cream, soft drinks, cookies, cereal, cake, popcorn, and bread, consuming many times the amount of calories they normally would consume in one day. No matter what their normal eating habits, they tend to eat quickly and messily during a binge, stuffing the food in their mouths and gulping it down, sometimes without even tasting it. Some bulimics say they get a feeling of euphoria during binges, similar to the "runner's high" that some people get from exercise.

The self-induced vomiting that often follows eating binges can cause all sorts of physical problems, such as damage to the stomach and esophagus, chronic heartburn, burst blood vessels in the eyes, throat irritation, and erosion of tooth enamel from the acid in vomit. Excessive use of laxatives can be hazardous, too. Muscle cramps, stomach pains, digestive problems, dehydration, and even poisoning may result. Over time, bulimia causes vitamin deficiencies and imbalances of critical body fluids, which in turn can lead to seizures and kidney failure.

Some researchers believe that bulimia, as well as other types of compulsive behavior, is related to an imbalance in the brain chemical serotonin. The production of serotonin, which influences mood, is affected by both antidepressant drugs and certain foods. But most research on bulimia focuses on its psychological roots.

Bulimia is not as likely as anorexia to reach life-threatening stages, so hospitalization usually is not necessary. Treatment generally involves psychotherapy and sometimes the use of antidepressant drugs. Unlike anorectics, bulimics usually admit they have a problem and want help overcoming it. Estimates of the rates of recovery from bulimia vary widely, with some studies showing low rates of improvement and others suggesting that treatment usually is effective. Even after apparently successful treatment, however, some bulimics relapse.

Obesity

A third type of eating disorder is obesity. Obesity is caused by excessive overeating. Being slightly overweight is not a serious health risk. But being severely over one's recommended body weight can lead to many health problems.

Doctors do not entirely agree about the definition of obesity. Some experts classify a person as obese whose weight is 20 percent or more over the recommended weight for his or her height. But other doctors say standard height and weight charts are misleading. They maintain that the proportion of fat to muscle, measured by the skinfold pinch test, is a better measure of obesity.

The causes of obesity are complex and not fully understood. While compulsive overeating certainly can lead to obesity, it is not clear that all obesity results from overindulging. Recent research increasingly points to biological, as well as psychological and environmental, factors that influence obesity.

In the United States, people with low incomes are more likely to be obese than are the wealthy. Women are almost twice as likely as men to have the problem, but both men and women tend to gain weight as they age.

In those people whose obesity stems from compulsive eating, psychological factors seem to play a large role. Some studies suggest that obese people are much more likely than others to eat in response to stress, loneliness, or depression. As they are growing up, some people learn to associate food with love, acceptance, and a feeling of belonging. If they feel rejected and unhappy later in life, they may use food to comfort themselves.

Just as emotional pain can lead to obesity, obesity can lead to psychological scars. From childhood on, many obese people are taunted and shunned. They may even face discrimination in school and on the job. The low self-esteem and sense of isolation that typically result may contribute to the person's eating disorder, setting up an endless cycle of overeating, gaining more weight, feeling even more worthless and isolated, then gorging again to console oneself.

People whose obesity endangers their health are said to be morbidly obese. Obesity is a risk factor in diabetes, high blood pressure, arteriosclerosis (hardened arteries), angina pectoris (chest pains due to inadequate blood flow to the heart), varicose veins, cirrhosis of the liver, and kidney disease. Obesity can cause complications during pregnancy and in surgical procedures. Obese people are about one-and-one-half times more likely to have heart attacks than are other people. Overall, the death rate among people ages 20 to 64 is 50 percent higher for the obese than for people of normal weight.

Since compulsive eating patterns often have their beginnings in childhood, they are difficult to break. Some obese people get caught up in a cycle of binging and dietingsometimes called yo-yo dietingthat never results in permanent weight loss. Research has shown that strict dieting itself may contribute to compulsive eating. Going without favorite foods for long periods makes people feel deprived. They are more likely, then, to reward themselves by binging when they go off the diet. Other research shows that dieting slows the dieter's metabolism. When the person goes off the diet, he or she gains weight more easily.

The most successful programs for dealing with overeating teach people to eat more sensibly and to increase their physical activity (exercise) to lose weight gradually without going on extreme diets. Support groups and therapy can help people deal with the psychological aspects of obesity.

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Eating Disorders

EATING DISORDERS

The term "eating disorders" encompasses a group of problems that fall into two broad categoriesovereating (binging), and undereating (anorexia)sometimes referred to as "starving or stuffing." Eating disorders are most commonly found in young females during early adolescence. However, eating disorders affect both males and females at many stages in the life cycle. Although the conditions create physical problems, the causes are usually psychological.

Eating disorders have been recognized by health experts for many years. Bulimia symptoms were described by the Egyptians, Hebrews, and Greeks; and anorexia nervosa was first described in the 1600s. However, it was not until 1980 that these conditions were categorized as psychiatric disturbances.

Eating disorders are marked by extreme dissatisfaction and preoccupation with body size and shape. People with these disorders may see themselves as overweight when their weight is actually lower than normal, or they may measure their self-worth by their weight. Emotional disturbance accompanies disordered eating, including self-loathing over amounts eaten or panic about possible weight gain. In addition to overeating or undereating, individuals with eating disorders engage in "compensatory behaviors," such as purging (self-induced vomiting or inappropriate use of laxatives, enemas, or diuretics), fasting, excessive exercise, and restricting (overly strict limiting of calories or food types).

Eating disorders can be distinguished from dieting by the psychological distress that accompanies the concern about weight; by the interference with everyday responsibilities and pleasures; and by the danger of causing medical problems, possibly even death.

Shame and secrecy often accompany eating disorders, and the problem may go undetected for years. Recognition of these disorders is necessary to begin the long process of treatment. Unlike other addictive or habit problems, food cannot be avoided, and recovery requires developing a healthier relationship to food and to one's own body, as well as improved coping skills.

TYPES OF EATING DISORDERS

Mental health professionals recognize three main types of eating disorders, anorexia nervosa, bulimia nervosa, and binge eating.

Anorexia. Although the word "anorexia" literally means "without appetite," the condition is better described as "restricted eating" or "self-starvation." The person with anorexia has an appetite, and food tastes good; however, food is seen as "the enemy." One authority terms anorexia "food phobia." The disorder is characterized by a refusal to maintain a minimal normal body weight, an intense fear of gaining weight, a disturbance in the self-perception of body size and shape, and (in women) an absence of menstrual periods for three or more consecutive months. Anorexia may be further classified as a restricting type or binge-eating/purging type.

Bulimia. Bulimia (Greek for "ox hunger") is characterized by recurrent episodes of binge eating. Binging (eating an extreme amount of food) is accompanied by a sense of lack of control over amounts eaten, and a feeling of being unable to stop. The disorder is further classified as either purging or nonpurging bulimia depending on whether the individual uses fasting or exercise instead of purging to "compensate" for binging.

Binge Eating. Binge eating is sometimes termed "stress eating" or "emotional overeating." It is characterized by compulsive overeating, usually in secret and without purging, followed by guilt or remorse for the episode. It has been estimated that up to 40 percent of people with obesity may be binge eaters. The term "binge eating disorder" was officially introduced in 1992. Unlike nonpurging bulimia, there is no attempt to "compensate" for the binge by fasting or overexercising.

CAUSATION

Eating disorders can be considered biologically based alterations filtered through cultural pressures and individual psychology. The psychological aspects of anorexia are frequently thought to include conflicts between mothers and adolescent daughters over perfection. Bulimia is often thought to involve conflicts over dependence and loneliness. Binging may share causal factors with obsessive-compulsive behavior.

PREVALENCE AND RISK FACTORS

Since people commonly deny or try to hide their disordered eating behaviors, it is difficult to accurately estimate the number of people affected by these problems. Nonetheless, experts report approximately 1.2 million women in the United States are affected by anorexia or bulimia.

Anorexia is more present in developed societies, especially in societies where being attractive is linked to being thin. The prevalence of anorexia has been estimated to be 0.5 to 1 percent of the population, and rates appear to be increasing. The condition usually begins in early adolescence (1318 years) and 90 percent of the cases are female. Occasionally, but rarely, the disorder may begin in someone over age forty. Stressful life events (e.g., leaving home for college) occasionally trigger the onset of the problem. Long-term death rates from anorexia approach 10 percent, with death usually resulting from starvation, suicide, or electrolyte imbalance.

The chances of developing an eating disorder are higher among females (female cases outnumber male cases 10 to 1), among those pressured by society or family to be thin, and among athletes. Athletes for whom weight control and/or thinness provides an advantage (e.g., gymnastics, wrestling) are particularly susceptible to eating disorders. Psychological factors that put a person at risk for disordered eating include low self-esteem, poor coping ability, perfectionism, and body image distortion. Genetics may also play a role. Risk increases among those with a close relative (a parent or sibling) with an eating disorder, especially with binging/purging.

IMPACT

Eating disorders cause an array of medical problems ranging from fatigue to illness, and occasionally death. Even when eating disorders do not reach this level of severity they can be significant sources of suffering for the patient and family members. Mild complications include lack of energy, cavities, cold intolerance, irregular periods, constipation and diarrhea, and difficulty with concentration. Serious complications include electrolyte instability, irregular heartbeat, suicidal tendencies, and death. Between 5 to 18 percent of those with anorexia or bulimia will die from complications of the disorder.

Malnourishment and self-starvation affect the heart, thyroid, and the digestive and reproductive systems, as well as seriously decreasing bone density. Specific problems seen in athletes with eating disorders include impaired athletic performance and an increased risk of injuries and stress fractures. Female athletes with an eating disorder may be considered to have the "female athlete triad" if they manifest symptoms of: (1) disordered eating (which leads to decreased body fat causing a lower estrogen level); (2) amenorrhea (not having a period for three consecutive cycles because of low estrogen); and (3) osteoporosis (fragile bones because of low estrogen).

Although eating disorders are not contagious, the culture in which the person lives can contribute to the spread of an eating disorder, particularly in cultures that glorify thinness. Although obesity may be a consequence of binge eating, it does not typically result from the major eating disorders. Prevention efforts may help, and early detection efforts are essential as patients do not typically request treatment for themselves. Psychological consequences of semistarvation include depressed mood, social withdrawal, insomnia, irritability, and loss of libido, as well as obsessive thoughts about food.

TREATMENT

The most important factor in treating people with eating disorders is the recognition of the disorder. Disordered eating is usually not self-diagnosed because of associated denial and embarrassment. Anorexics usually do not even realize there is a problem with their behavior, and bulimics usually realize the problem but try to hide their behavior. Family, friends, or health care professionals are often the people who recognize the problem. A team treatment approach is frequently employed, consisting of a physician, a nutritionist, and a psychologist. Medically, antidepressants may be needed, and complications may require treatment or hospitalization if the situation is severe enough. Nutritionally, people with disordered eating need to learn how to eat in a healthful way. Psychologically, modification of inappropriate food-related behavior and development of improved coping mechanisms are necessary. In addition, changes in body image and ideal body image may be necessary.

Treatment, especially for anorexia, can be a long drawn-out affair, and it can take a big toll on family resources and on the social productivity of the person. Recovery from these disorders is difficult, and estimates of 50 percent relapse rates for anorexia and 33 percent for bulimia are common. A difficulty in the control of disordered eating behaviors is the need to continue to eat. This it is in contrast to other disorders of habit or addiction in which treatment involves total avoidance of the abused substance.

RESOURCES

The Academy of Eating Disorders (http://www.acadeatdis.org) is a multidisciplinary professional group devoted to the improved detection and treatment of these conditions. Efforts to expand screening are promoted through eating disorders awareness week on U.S. college campuses, and this has now been expanded to high school and the general public (http://www.nmisp.org/eat.htm).

Other valuable resources include the following:

Leonard J. Haas

Trisha Palmer

(see also: Anorexia; Menstrual Cycle; Mental Health; Nutrition; Social Determinants )

Bibliography

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: Author.

American Psychiatric Association (2000). "Practice Guideline for the Treatment of Patients with Eating Disorders (Revision)." American Journal of Psychiatry 157 (January Supp.):1.

Browell, K. D., and Fairburn, C. G., eds. (1995). Eating Disorders and Obesity. New York: Guilford Press.

Christensen, L. (1996). Diet-Behavior Relationships: Focus on Depression. Washington, DC: American Psychological Association Books.

Danowski, D., and Lazora, P. (2000). Why Can't I Stop Eating? Recognizing, Understanding, and Overcoming Food Addiction. Center City, MN: Hazelden Information Education Services.

Fairburn, C. G. (1995). Overcoming Binge Eating. New York: Guilford Press.

Natenshon, A. H. (1999). When Your Child has an Eating Disorder: A Step-by-step Workbook for Parents and Other Caregivers. San Francisco: Jossey Bass Publishers.

Siegel, M.; Brisman, J.; and Weinshel, M. (1997). Surviving an Eating Disorder: New Perspectives and Strategies for Family and Friends. New York: Harper Collins.

Stunkard, A. J., and Wadden, T. (ed.) 1993. Obesity: Theory and Therapy. Lancaster, CA: Raven Press.

Thompson, A. K., ed. (1996). Body Image, Eating Disorders and Obesity: An Integrated Guide to Assessment and Treatment. Washington, DC: American Psychological Association Books.

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Eating Disorders

Eating Disorders


Eating disorders have become a major health problem in Western society, and there is evidence of their emergence in most parts of the world. The most common eating disorders are anorexia nervosa and bulimia nervosa, with a number of variations on these, including binge eating disorder. What they have in common, besides an excess preoccupation with weight and shape, is poor self-esteem. Indeed, they might equally be called disorders of self-esteem because self-esteem in this population is based on weight and shape.

In anorexia nervosa, people refuse to maintain a minimally normal body weight, engage in a relentless pursuit of thinness, have a distorted body image, and suffer physical side effects such as amenorrhoea (loss of menstrual cycle), poor blood circulation, low blood pressure, muscle wasting, and osteoporosis.

People with bulimia nervosa tend to maintain a normal weight, but engage in overeating (bingeing) and purging (use of laxatives, self-induced vomiting, and diuretics). Bulimia also results in serious medical complications such as cardiac abnormalities, gastro- and intestinal problems, tooth erosion, and damage to the ovaries.

Binge eating disorder is characterized by consuming an excessive amount of food, accompanied by a lack of control and marked distress, but no purging or distortion of body image.

In each of these conditions, eating gives rise to shame, disgust, fear, and self-loathing. Purging leads to a sense of relief.

In childhood and early adolescence, other eating disorders may occur in addition to anorexia nervosa and bulimia nervosa. These include food avoidance emotional disorder (FAED) in which there is determined food avoidance but without the intense preoccupation with weight and shape seen in anorexia and bulimia; selective eating, in which there is a very limited number of foods consumed, although the total calorie intake is sufficient to maintain a normal weight; and functional dysphagia, in which the child is frightened of swallowing for fear of vomiting or choking.


Who Develops Eating Disorders

The majority of eating disorders are far more likely to occur in females than males, the ratio being around 10:1. Conservative estimates suggest that between 1 and 4 percent of older adolescent females and young women in Western society suffer from anorexia nervosa or bulimia nervosa (Brownell and Fairburn 2001). Food avoidance emotional disorder, selective eating, and functional dysphagia affect boys and girls equally (Lask and Bryant-Waugh 2000).

Previously, eating disorders were most likely to occur in white middle-class young women. However, incidence patterns are now changing and eating disorders may be found in any race, ethnicity, social class, culture, age, or sex, although prevalence data are not available.

Specific risk factors for the development of eating disorders include:

  1. Poor self-esteem;
  2. Family history of eating disorders;
  3. Participation in sports or other pursuits that emphasize low body weight, for example, modeling, ballet, gymnastics, cheerleading, athletics;
  4. Past history of sexual abuse; and
  5. Perfectionist and conscientious personality types, who have a need to please others and have difficulty in expressing negative feelings.

How Culture Contributes

Although eating disorders are clearly multifactorial in their origin—in other words, there are many different components to their development including genetic predisposition, biological vulnerability, entry into puberty, and stress (Lask and Bryant-Waugh 2000)—cultural influences do seem to be particularly important (Wolf 1991). The barrage of social and cultural messages about maintaining a low weight, and equating thinness with beauty, exerts enormous pressure on young women (Fallon, Katzman, and Wooley 1993). For those who have particularly low self-esteem, one means of feeling better about themselves is to conform to what society maintains as "looking good." This is exemplified by the fact that in the 1970s the average fashion model weighed 8 percent less than the average U.S. woman. In the 1990s the difference rose to 23 percent. In the twenty-first century, images of models are computer modified to the point where the idealized body shape and size is virtually impossible to achieve. Nonetheless, the vulnerable strive to do so.

The Family's Role

The role of the family in eating disorders is complex and unclear. There is increasing evidence that genetic factors play a major part (Brownell and Fairburn 2001). The emphasis within a family upon the value of thinness exerts strong temptations upon young females to maintain a low body weight. The tendency to overemphasize the importance of appearance at the cost of other features such as kindness, intelligence, and creativity enhances the risk. Furthermore, what family members do is as important as what they say. Thus, mothers who diet or who have eating disorders are more likely to have children who ultimately develop eating disorders.

Families can also set the stage for how children relate to food, regardless of issues related to weight. For example, parents may use food to reward, punish, placate, or distract. Children then learn that food is more than a substance of nourishment. It can also be a source of comfort or a source of distress. Some parents ignore their children's cues and feed them according to parental needs, schedules, or beliefs about how much the child should eat. This does not allow the individual to develop an awareness of appetite, hunger, or fullness, thus setting the tone for the development of eating disorders.

Pre-teenage girls often have a very close relationship with their fathers. As they progress into puberty, fathers may have difficulty in coping with their daughters' emerging sexuality, and consequently reduce their closeness. Alternatively, they may try to maintain the same level of contact as previously. Either of these can be a source of distress for the teenage girl, who may subconsciously start trying to return to an earlier stage of development by dieting (Maine 1991).

Regardless of whether or not a family may have contributed in some inadvertent way to the development of an eating disorder, the way in which they manage the problem can be extremely influential. A positive approach can quickly resolve the problem whilst confused, inconsistent, or negative approaches can exacerbate it. Arguments between parents about how best to proceed when their child or teenage daughter develops an eating disorder can exacerbate the problem. The teenager becomes caught up in parental conflict, feels worse, and delves deeper into the eating disorder. Sometimes the individual with the eating disorder can serve as a peacemaker, best friend, or confidante to one or both parents. Although the eating disorder symptoms may emerge for a number of different reasons, it may ultimately serve the purpose of helping family stability. As the individual becomes increasingly ill, parents often pay attention to the individual in a way that is reassuring and comforting. A couple in conflict may work together to try to help their child, especially when they see how serious are the side effects of the illness. This can exacerbate the illness by giving the subconscious message that illness equates with parental harmony.


Treatment

Because the eating disorders are complex, serious and varied, there can be no one simple approach to treatment (Lask and Bryant-Waugh 2000; Brownell and Fairburn 2001). For children and adolescents who live at home, working with the parents as well as the child is essential. Focusing on the factors that appear to maintain the problem is an essential part of the treatment program. Whether this is achieved through parental counseling and individual therapy for the child, or family therapy, or a combination of these, matters less than the family's involvement. For young adults, individual therapy/counseling is of undoubted help, so long as it focuses on the "here and now" problems that the individual is experiencing. There is no evidence that therapy focused on "subconscious" material or the distant past is of particular value. A problem-solving approach that looks at why it is necessary to maintain an eating disorder and that helps to enhance self-esteem is far more likely to work.

Many of these comments also apply to the treatment of bulimia nervosa, although in addition, medication can be valuable. Fluoxetine or related drugs do seem to reduce the urge to binge and can improve mood. Antidepressants can also be useful when there is marked mood lowering.

For the other eating disorders that occur in childhood, a combination of working through the parents and various individual approaches is usually helpful (Lask and Bryant-Waugh 2000). Medication that is chosen judiciously and monitored carefully may also have value.

Whichever condition is being treated, the involvement of family members and open exploration of issues and problems that contribute to and maintain the eating disorder will help people with eating disorders to feel less guilty, less abnormal, and will enhance their self-worth and self-confidence. Thus, although families may be part of the problem, they are equally part of the solution. A number of self-help and parent guides are available (Bryant-Waugh and Lask 1999; Schmidt and Treasure 1993; Siegel, Brisman, and Weinshel 1988).


Conclusion

Eating disorders are potentially life threatening, resulting in death for as many as 10 percent of those who develop them. They can also cause considerable psychological distress and major physical complications. Important relationships are eroded as the eating disorder takes up time and energy, brings about self-absorption, and impairs self-esteem. Treatment should be initiated as quickly as possible, focus upon the immediate distress experienced by the individual, and aim to help the patient and family become powerful enough to overcome the eating disorder.


See also:Childhood, Stages of: Adolescence; Depression: Children and Adolescents; Food; Health and Families; Self-Esteem; Sexuality in Adolescence; Therapy: Family Relationships; Therapy: Parent-Child Relationships


Bibliography

brownell, k., and fairburn, c. (2001). eating disorders and obesity: a comprehensive handbook, 2nd edition. new york: guilford press.

bryant-waugh, r., and lask, b. (1999). eating disorders:a parent's guide. london: penguin.

fallon, p.; katzman, m.; and wooley, s. (1993). feministperspective on eating disorders. new york: guilford press.

lask, b., and bryant-waugh, r. (2000). anorexia nervosa and related eating disorders in childhood and adolescence. hove, uk: psychology press.

maine, m. (1991). father hunger: fathers, daughters andfood. carlsbad, ca: gurze books.

pate, j. e.; pumariega, a. j.; hester, c.; and garner, d. m.(1992). "cross-cultural patterns in eating disorders: a review." journal of the american academy of child and adolescent psychiatry 31:802–808.

schmidt, u., and treasure, j. (1993). getting better bit(e) by bit(e): a survival guide for sufferers of bulimia nervosa and binge eating disorders. hove, uk: psychology press.

siegel, m.; brisman, j.; and weinshel, m. (1988). surviving an eating disorder: strategies for families and friends. new york: harper and row.

wolf, n. (1991). the beauty myth: how images of beauty are used against women. new york: william morrow.

bryan lask

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"Eating Disorders." International Encyclopedia of Marriage and Family. 2003. Encyclopedia.com. 26 May. 2016 <http://www.encyclopedia.com>.

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eating disorders

eating disorders The modern term that covers all forms of the conditions known as anorexia nervosa and bulimia nervosa. It also sometimes includes obesity. The recorded prevalence of all three has increased during the past 40 years.

Anorexia nervosa, a form of food refusal, is mostly found in young girls, though 1 in 20 cases is a boy. Sometimes it improves spontaneously and sometimes it continues throughout life. The sufferers are usually intelligent high achievers and are often ambitious, and come from families who have ample food. Some have markedly ‘hysterical’ personalities, tending to be dramatic, to overreact, and to manipulate those in their environment. Others are more obsessional, ruminate constantly about food, and develop rituals connected with it. Anorexia means a lack of appetite, but the condition is misnamed because sufferers control rather than lose their appetite. It has been called ‘the relentless pursuit of thinness’. Sufferers rigorously suppress their desire for food in order to be thinner, avoiding all food that they think contains more than the minimum of calories. They often tell lies about the food they do or do not eat, perhaps hiding it or disposing of it secretly to give the impression that it has been eaten. They think about food constantly, weigh themselves several times a day, and have distorted ideas about their bodies, believing that they look fat when they are actually dangerously thin. They tend to wear many layers of loose clothes, partly to hide their condition and partly because they suffer from the cold. Many exercise obsessively and constantly in an attempt to lose further weight. Some, like sufferers from bulimia, have episodes of binge-eating, after which they make themselves vomit to get rid of the food. The most severe cases are medical emergencies and require the most skilled care of a physician in hospital to avoid death. The underlying condition, and the full care of less severe cases, is usually managed by psychiatrists.

Bulimics, who are usually of normal weight, gorge food, but then induce vomiting, sometimes several times a day. They deliberately vomit, at least initially, in order to become thinner. However, it frequently becomes a habit that is hard to break and their whole lives may be concentrated on bingeing and vomiting. Frequent vomiting leads to unpleasant mouth odour and can promote tooth decay, so sufferers tend to be secretive, to avoid close contact with other people, and to clean their teeth several times during the day. Famous bulimics have included Princess Diana and Audrey Hepburn.

Anorexia nervosa and bulimia nervosa are sometimes regarded clinically as different forms of the same illness.

A number of ‘causes’ are believed to underlie these conditions. Those most discussed are disturbed family relationships and social pressures to be thin. Some sufferers also use their obsession with food as a means of controlling their families, perhaps by creating parental anxiety or by insisting that they do all the family cooking and preventing their parents going away because they are doing this. Some have very dominant mothers and feel that the only way in which they can gain power themselves is by controlling their intake of food.

A theory has arisen that anorexia and bulimia are ‘caused’ by sexual abuse in childhood. Sometimes there is an association between the two. However, therapists of doubtful training and repute have suggested that those with eating disorders have invariably been abused in childhood. In pursuit of this belief they may have used persuasive techniques to elicit many apparent ‘memories’ of sexual abuse of which the patient was previously unaware. This has given rise to what has been labelled ‘false memory syndrome’, which has disrupted many otherwise intact families. The current view among most psychiatrists is that true memories of sexual abuse in childhood are seldom if ever repressed and that ‘memories’ which emerge for the first time during treatment, especially with a therapist who believes that they must be there, should be treated with great caution.

Anorexia nervosa was identified by William Gull in the nineteenth century. It has certainly existed for much longer, perhaps throughout the history of civilization, wherever there was ample food. It used to be regarded as a rare condition, partly because doctors tended to believe what their patients told them, and to look for physical disease. Many cases in the past were probably misdiagnosed as tuberculosis, endocrine disease (such as Simmond's disease, a failure of the pituitary gland), or loss of weight from unknown cause. The secretiveness and deceptiveness of the patients made the diagnosis difficult for those who were unaware of this tendency. Since then doctors have realized that anorexia nervosa is usually not difficult to identify and that bulimia is much more common than was supposed.

The recorded incidence of anorexia nervosa increased greatly during the 1950s and 1960s, and it became a worrisome epidemic, especially in girls' boarding schools. This rise was undoubtedly partly due to the increasing recognition of the condition by doctors, but partly because of the fashion for thinness, which became popular and was accompanied by hostility to plumpness and fear of gaining weight. Those responsible for the care of young girls have shown hostility towards the fashion trade's flaunting of skeletal models to display and advertise clothes, but the custom persists, as does the epidemic of anorexia, which is found at ever younger ages, even as young as 6 or 7. Some of the youngest sufferers are the children of anorexics and bulimics, many of whom raise their families with bizarre attitudes towards food. Doctors have expressed anxiety about the threat to health in children who are fed on skimmed milk and high fibre food, virtually free of sugar and fat. Such a diet is unsuitable for growing bodies and can cause long-term damage. The fact that eating disorders tend to run in families may not be entirely due to parental feeding practices: it seems likely that there is a genuine genetic factor in their causation.

The ‘epidemic’ of anorexia may now have peaked as the incidence seems no longer to be rising. According to figures from the Eating Disorders Unit in the University of London, during 1988–93 the incidence of anorexia remained stable at about 20 cases per 100 000 of the population, whereas the incidence of bulimia rose from 15 to 50 cases per 100 000. This apparent dramatic rise in bulimia can be at least partly explained by the fact that the disease was first described in 1979: doctors and the public have only gradually become aware of it. Probably it was common before it was identified. Since the sufferer usually looks normal, the condition is unlikely to be diagnosed unless the sufferer admits to having the problem or their behaviour is noticed by others.

Some people with these conditions recover spontaneously but many need help, which they are often reluctant to seek. Various treatments have been tried, including incarceration with ‘rewards’ (such as having visitors) for weight gain, sedatives (to suppress activity), and various forms of psychotherapy. Antidepressant drugs are often quite effective and many clinicians believe that there is considerable overlap between eating disorders and depression.

Obesity represents the other end of the eating disorders spectrum. Classically, it is a problem of middle age, but its incidence has been rising, even among young children, especially in the developed world. It affects women more than men and lower social classes more than upper. It is associated with higher than average morbidity and mortality. Heart disease, high blood pressure, diabetes, and even accidents are much more common in overweight people than in those of normal weight. Obesity is commonest where food is ample but protein is expensive and it is particularly likely to develop in people whose diet is high in processed foods, since these often contain many ‘hidden’ calories in the form of fat and sugar. The recent increase in obesity is thought to be related to the sedentary and labour-saving characteristics of modern life in the developed world. People drive cars rather than walk, guide the vacuum cleaner rather than scrub the floor, and spend much time watching television. A sedentary lifestyle makes it difficult to lose weight. Many people control any tendency to gain weight by deliberately taking exercise, perhaps joining a gym or playing an energetic game regularly, but others dislike taking exercise. It is often harder to persuade a patient to take exercise than to keep to a slimming diet.

Ann Dally


See also dieting; development and growth; obesity.

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Eating Disorders

EATING DISORDERS

EATING DISORDERS are a group of psychological ailments characterized by intense fear of becoming obese, distorted body image, and prolonged food refusal (anorexia nervosa) and/or binge eating followed by purging through induced vomiting, heavy exercise, or use of laxatives (bulimia). The first American description of eating disorders appeared in 1859, when the asylum physician William Stout Chipley published a paper on "sitomania," a type of insanity consisting of an intense dread or loathing of food. Clinical research in Great Britain and France during the 1860s and 1870s replaced sitomania with the term "anorexia nervosa" and distinguished the disorder from other mental illnesses in which appetite loss was a secondary symptom and from physical "wasting" diseases, such as tuberculosis, diabetes, and cancer.

Eating disorders were extremely rare until the late twentieth century. Publication of Hilde Bruch's The Golden Cage (1978) led to increased awareness of anorexia nervosa, bulimia, and other eating disorders. At the same time, a large market for products related to dieting and exercise emerged, and popular culture and the mass media celebrated youthful, thin, muscular bodies as signs of status and popularity. These developments corresponded with an alarming increase in the incidence of eating disorders. Historically, most patients diagnosed with eating disorders have been white, adolescent females from middle-and upper-class backgrounds. This phenomenon suggests that eating disorders are closely linked with cultural expectations about young women in early twenty-first century American society.

BIBLIOGRAPHY

Brumberg, Joan Jacobs. Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease. Cambridge, Mass: Harvard University Press, 1988.

Vandereycken, Walter, and Ron van Deth. From Fasting Saints to Anorexic Girls: The History of Self-Starvation. Washington Square: New York University Press, 1994.

Heather MunroPrescott/c. w.

See alsoDiets and Dieting ; Mental Illness ; Women's Health .

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eating disorders

eating disorders, in psychology, disorders in eating patterns that comprise four categories: anorexia nervosa, bulimia, rumination disorder, and pica. Anorexia nervosa is characterized by self-starvation to avoid obesity. People with this disorder believe they are overweight, even when their bodies become grotesquely distorted by malnourishment. Bulimia is characterized by massive food binges followed by self-induced vomiting or use of diuretics and laxatives to avoid weight gain. Some anorexic patients combine bulimic purges with their starvation routine. These disorders generally afflict women—particularly in adolescence and young adulthood—and are much less common among men. Some researchers believe that anorexia and bulimia are caused by chemical imbalances in the brain; one study has linked bulimia to deprivation of tryptophan, an amino acid used by the body to make the neurotransmitter serotonin. Others contend that these disorders are rooted in societal ideals that value slenderness. Rumination disorder generally occurs during infancy, and involves repeated regurgitation accompanied by low body weight. Infants suffering from rumination disorder may re-ingest the regurgitated food. Pica, also found primarily among infants, is characterized by eating various non-nutritive substances like plaster, paint, or leaves. Obesity is not generally considered an eating disorder, since its causes tend to be physiological.

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Eating Disorders

Eating disorders

Eating disorders are characterized by an obsessive preoccupation with food and/or body weight.

Eating disorders are rooted in complex emotional issues that center on self-esteem and pervasive societal messages that equate thinness with happiness. Eating disorders usually surface in adolescence , and more than 90% of sufferers are female, although the incidence among males appears to be growing. Because eating disorders are neither purely physical nor purely psychological, effective treatment must include both medical management and psychotherapy . The earlier a diagnosis is made and treatment is started, the better the chances of a successful outcome.

The two most common types of eating disorders are anorexia nervosa and bulimia , which are covered separately in this book.

Gail B. Slap, M.D.

Further Reading

Maloney, Michael and Rachel Kranz. Straight Talk About Eating Disorders. New York: Facts on File, 1991.

Further Information

National Association of Anorexia Nervosa and Associated Disorders (ANAD). P.O. Box 7, Highland Park, IL 60035,(847) 8313438.

National Eating Disorders Organization. 6655 Yale Avenue, Tulsa, OK 74136, (918) 4814044.

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Eating Disorders

Eating Disorders

Eating disorders are dangerous psychological (relating to the mind) illnesses that affect millions of people, especially young women and girls. The most widely known eating disorders are anorexia nervosa and bulimia nervosa, which will be discussed further in this chapter.

Officially recognized by the medical community only since 1980, eating disorders were first brought to the public's attention when pop singer Karen Carpenter (195383) died from complications resulting from anorexia. People suffering from eating disorders battle life-threatening obsessions with food and unhealthy thoughts about their body weight and shape. If untreated, these disorders can lead to death. Researchers have found many factors that are probable causes of eating disorders. Recovery from an eating disorder is possible, though it is a difficult process that should not be done alone. The first steps toward recovery are for the sufferer to accept that there is a problem and to show a willingness to focus on his or her feelings rather than on food and weight.

This chapter will discuss the types of eating disorders that have been identified, the causes, the consequences of an eating disorder on the mind and body, and the treatment and prevention of eating disorders.

TYPES OF EATING DISORDERS AND THEIR CHARACTERISTICS


Anorexia Nervosa

Anorexia nervosa is a condition in which a person refuses to maintain a healthy body weight (persons whose weight is at least 15 percent below their normal body weight might fall into this category). The term anorexia nervosa means literally "nervous lack of appetite." However, this name is misleading as people with anorexia do not lack an appetite; rather, they battle hunger every day. Anorectics, as people who suffer from anorexia are referred to, are extremely afraid of gaining weight or becoming what they perceive to be fat.

Typically, what accompanies this fear of becoming fat is an anorectic's faulty perception of her body. Some anorectics may realize that they are indeed thin but will still view a particular part of their bodies, such as the stomach or thighs, as being fat and out of proportion. In fact, an anorectic's self-esteem is closely tied to this distorted view of her body. Continued weight loss is considered by anorectics to be a sign of achievement and self-discipline while any weight gain, even if it brings them closer to a healthy body weight, is considered a sign of weakness or a lack of self-control.

Eating Disorders: Words to Know

Adrenaline:
A hormone that is released during times of stress and fear.
Amenorrhea:
The absence of menstrual cycles.
Anorexia nervosa:
A term meaning "lack of appetite"; an eating disorder marked by a person's refusal to maintain a healthy body weight through restricting food intake or other means.
Binge-eating disorder:
An eating disorder that involves repetitive episodes of binge eating in a restricted period of time over several months.
Bingeing:
When an individual eats, in a particular period of time, an abnormally large amount of food.
Body set-point theory:
Theory of weight control that claims that the body will defend a certain weight regardless of factors such as calorie intake and exercise.
Bulimia nervosa:
A term that means literally "ox hunger"; an eating disorder characterized by a repeated cycle of bingeing and purging.
Depression:
Common psychological problem characterized by intense and prolonged feelings of sadness and hopelessness.
Diuretic:
A drug that expels water from the body through urination.
Edema:
Swelling.
Endorphin:
Any of a group of natural proteins in the brain known as natural painkillers that make people feel good after exercising.
Enema:
A process that expels waste from the body by injecting liquid into the anus.
Epidemiology:
The study of disease in a population.
Exercise addiction:
Also known as compulsive exercise, a condition in which participation in exercise activities is taken to an extreme; an individual exercises to the detriment of all other things in his or her life.
Hypertension:
High blood pressure.
Lanugo:
Fine hair that grows all over the body to keep it warm when the body lacks enough fat to accomplish this.
Laxative:
A drug that induces bowel movements.
Obesity:
The condition of being very overweight.
Purging:
When a person gets rid of the food that she has eaten by vomiting, taking an excessive amount of laxatives, diuretics, or enemas or engaging in fasting and/or excessive exercise.
Russell's sign:
Calluses, cuts, and sores on the knuckles from repeated self-induced vomiting.

Anorexia is often difficult to diagnose and treat because of the secretive nature of this illness. Anorectics are usually good at concealing their self-starvation with excuses, or they may even engage in purging (vomiting) if forced to eat. Furthermore, anorectics will often wear heavy clothes that both camouflage (hide) their excessive weight loss from others and keep them warm. (Due to their dangerously low weight and lack of insulating body fat, anorectics are often cold.)

In addition to avoiding eating whenever possible, anorectics will often display high levels of energy that seem at odds with their frail physical conditions. Anorectics may also develop odd oral habits, including chewing gum throughout the day, drinking an excessive amount of coffee or diet soda, and chain-smoking. Finally, many anorectics become obsessed with food, despite their unwillingness to consume any.

Bulimia Nervosa

Bulimia nervosa means literally "ox hunger." This term is appropriate on many levels as bulimia is characterized by a repeated cycle of binge eating and purging. A binge is when an individual eats, in a particular period of time, an abnormally large amount of food. (Of course, this doesn't refer to special occasions, such as holiday meals, when it is acceptable to eat more than usual.)

The binge is then followed by an episode of purging. Purging is when a person gets rid of the food that she has eaten by either making herself vomit, taking an excessive amount of laxatives (drugs that induce bowel movements), diuretics (drugs that expel water from the body through urination), or enemas (a process that expels waste from the body by injecting liquid into the anus), or engaging in fasting and/or excessive exercise. People with bulimia, known as bulimics, engage in such behaviors at least two times a week for a period of six months or more.

A particularly stressful event or depression often triggers an episode of binge eating, intense hunger that follows restricted food intake, or a variety of feelings tied to body weight, body image, and food. The binge eating may temporarily relieve a bulimic's feelings of depression or stress, but often deeper feelings of depression, disappointment, and anxiety may follow. This will then trigger an episode of purging. Many bulimics report feeling out of control when bingeing and use similar terms to describe their need to purge their bodies of the food they just consumed.

Bulimics, like anorectics, are usually ashamed of their behavior and will attempt to hide their illness from others. Because of this and the fact that many bulimics maintain a normal body weight, it is often hard to recognize that a person is, in fact, bulimic.

Many bulimics suffer from low self-esteem and may even have suicidal thoughts. Often they are rigid perfectionists who think in absolutes ("I am bad because I ate that"). Like anorectics, bulimics will make negative statements about their appearance and experience extreme guilt over eating even normal portions of food. They will begin to withdraw from social activities, particularly those that will make it difficult for them to purge without suspicion.

Other Types of Disordered Eating

There are those individuals whose behavior does not fall under the categories of anorexia or bulimia; rather, these people can exhibit a wide range of disordered eating and unhealthy weight management symptoms. Since they cannot be diagnosed as anorexic or bulimic, these individuals will typically receive a diagnosis of an "eating disorder not otherwise specified." An example of disordered eating includes a person of normal weight who eats no fat and occasionally purges. She would not be considered bulimic because she is not bingeing, and she also is not anorectic because she is not dangerously underweight. She would therefore be diagnosed with an eating disorder not otherwise specified.

There are other disorders, such as binge-eating disorder and exercise addiction, that are not yet official psychological diagnoses but which are becoming more and more prevalent. These problems are often diagnosed as "eating disorder not otherwise specified" as well. They often occur in conjunction with anorexia and bulimia. However, they can also occur independently of other disordered eating and may soon have their own official diagnoses.

EATING DISORDERS NAMED

English physician Richard Morton first documented cases of self-starvation in the seventeenth century. The term anorexia nervosa was later coined by French neurologist Charles Lasegue and English physician Sir William Gull in the mid-1870s. The symptoms of bulimia (bingeing and purging) were not recognized as a separate condition from self-starvation until the 1940s. English physician Gerald Russell formally named bulimia nervosa in 1979.

BINGE-EATING DISORDER. Like bulimia, binge-eating disorder involves repetitive episodes of binge eating in a restricted period of time over several months. This illness is different from bulimia, however, because people suffering from binge-eating disorder do not purge after a binge. This disorder has more to do with an absolute lack of control over eating than with the conciliatory acts (purging) that follow a bulimic's binge.

Binge eaters will eat very rapidly, usually until they are uncomfortably full. They will eat big portions of food even if they are not actually hungry. Because of this, many binge eaters engage in binges secretively as they are embarrassed by how much they have eaten and feel guilty and depressed following these episodes. Similar to the binges experienced by bulimics, binge eaters report that depression and anxiety usually trigger their binges. During the binge itself, sufferers often feel out of control or disconnected from their actions.

EATING DISORDER STATISTICS

Eating disorder organizations qualify that eating disorder statistics are estimates because the illnesses are often hidden and difficult to diagnose. It is likely that the actual figures are higher than they appear due to the secretive nature of eating disorders.

  • About 8 million people in the United States suffer from an eating disorder. Among young women, it is estimated that 15 percent suffer from some kind of disordered eating behavior.
  • Females make up 90 to 95 percent of the people who suffer from anorexia.
  • 1 percent of young women between the ages of ten and twenty have anorexia.
  • 85 percent of the time, anorexia starts between the ages of thirteen and twenty.
  • 10 to 15 percent of anorectics will die from the disease.
  • 2 to 5 percent of anorectics will commit suicide.
  • About 1,000 women die from anorexia each year.
  • 30 to 50 percent of anorectics in treatment show signs of bulimia as well.
  • 4 percent of college-aged women have bulimia.
  • 10 to 15 percent of people with bulimia are male.
  • Of psychological disorders, eating disorders have the highest rate of deaths.
  • About 60 percent of eating disorder sufferers recover with treatment.

These statistics are based on information from the following organizations: Anorexia Nervosa and Related Eating Disorders, Inc.; American Anorexia/Bulimia Association, Inc.; and National Depressive and Manic-Depressive Association.

Binge eaters usually suffer from obesity (being very overweight). Furthermore, many have been "yo-yo" dieters (experiencing large fluctuations in weight from a cycle of dieting) their entire lives. Both of these effects can cause binge eaters to feel worse about their inability to control their eating habits. (Not everyone who is obese suffers from binge-eating disorder. Rather, obesity must be paired with certain behaviors for it to be evidence of binge-eating disorder.)

Other signs of binge-eating disorder can include food disappearing from cabinets and cupboards at a rapid rate, or even finding an excessive amount of food wrappers concealed under someone's bed or in her trash. The consumption of odd foodstuffs such as raw cookie dough or condiments can also point to binge-eating disorder.

EXERCISE ADDICTION. Exercise addiction, or compulsive exercise, seems like a strange term as most people consider exercise to be good for their health. Exercise is a fun way to relieve stress and increase energy levels. It releases endorphins (the body's natural painkillers, which make people feel good after exercising). However, when a person's interest and participation in exercise activities are taken to extremes, exercise can turn into an addiction that must be performed each day; the act of exercising provides that person with a temporary high. If an exercise-addicted person cannot exercise, he or she will experience a great deal of guilt and anxiety over the inactivity.

Exercise-addicted individuals will exercise to the detriment of everything else in their lives. Someone who is addicted to exercise will exercise with serious physical injuries, pass up opportunities to spend time with loved ones in favor of exercise, and even miss work or school to spend time exercising. Depression, low self-esteem, and repressed anger are all characteristics of exercise-addicted individuals because no matter how much they exercise or achieve in other areas of their lives, they believe they should do more.

Because some sports demand a certain body type (such as gymnastics or ice skating) or depend on how much a person weighs (such as wrestling or horse racing), exercise addiction often develops in elite athletes like dancers, ice skaters, gymnasts, jockeys, and wrestlers, in their quest to perform the best in their sport. Exercise addiction can also be linked to those suffering from anorexia or bulimia because they feel unsatisfied with their bodies and think excessive exercise can help them get thin. Bulimics will often use compulsive exercise as a method of purging.

CAUSES OF EATING DISORDERS


A number of factors contribute to the development of eating disorders. Some are biological and genetic in nature, while others are a direct result of the cultural and familial environment in which an individual is raised.

MALES WITH EATING DISORDERS

Although eating disorders affect women more than men, a large number of males suffer from anorexia nervosa and bulimia nervosa as well as binge-eating disorder and exercise addiction. In fact, 5 to 10 percent of people suffering from anorexia are male, and approximately 10 to 15 percent of people with bulimia are male. The percentages may even be higher as some experts suspect that few men actually seek help because they are ashamed and embarrassed that they have what has come to be viewed as a "female" problem.

Many male eating-disorder sufferers participate or have participated in a sport that demands a certain body type, such as wrestling and running. Wrestlers are a notoriously high-risk group because many try to lose additional pounds rapidly just prior to a match. This allows the wrestler to compete in a lower weight-class while having developed the skill and strength for a higher weight-class in practice. To accomplish this rapid weight loss, unhealthy weight reduction methods, such as fasting and purging, are often used.

Being overweight in childhood can also influence the development of an eating disorder in males. And dieting, a well-known trigger for eating disorders, can start the development of disordered eating in males.

Biological Factors

There are factors contributing to the development of eating disorders that are biological, or genetic. For example, if a person has a relative in her immediate family with an eating disorder, she is at a higher risk to develop an eating disorder.

Additional biological factors contributing to disordered eating can be triggered by the initial act of starving, binge-eating, or purging. This is because these behaviors can change an individual's chemical balance, particularly brain chemistry. Starvation and overeating lead to the production of brain chemicals that induce feelings of peace and euphoria (happiness). These good feelings mask feelings of anxiety and depression, both of which are commonly experienced by people suffering from eating disorders. This has caused certain researchers to conclude that some people with eating disorders use (or do not use) food as a relief when they are feeling poorly about themselves.

Of note is the fact that certain researchers believe that depression, which is also genetic, can be the cause of an eating disorder. (See section on depression later in this chapter.)

Psychological Factors

People suffering from eating disorders share many of the same personality traits. For example, eating-disordered people lean toward being perfectionists. Furthermore, many of them suffer from feelings of low self-esteem, despite their accomplishments and perfectionist ways. Extremist thinking, too, is present in many people with eating disorders. These individuals assume that if being thin is "good" then being even thinner is better. This leads to the thought that being the thinnest is the absolute best; it is this thinking that pushes some anorectics to plummet to body weights of fifty or sixty pounds.

Often, people who live with eating disorders have no sense of self. They simply do not feel that they know who they are or what their place in the world is. An eating disorder, however, offers a sense of identity to these individuals in that it enables them to say, "I am thin," and "I am dieting." This eventually leads them to define themselves solely on their appearance and their dangerous actions rather than with positive, healthy accomplishments.

Social Factors

Eating disorders, in general, occur primarily in industrialized societies, such as the United States, Australia, Canada, Europe, and Japan. In all of these places, the media (TV, movies, magazines) bombard people with the virtues and importance of being thin. It is endlessly implied in television

shows, movies, and advertisements that thinness will bring a person success, power, approval, popularity, friends, and romantic relationships. Women, in particular, are held to an almost-impossible-to-achieve standard of physical fitness and beauty, the height of which is being slender and thin. (In fact, female fashion models now weigh an average of 25 percent less than an average

woman.) Because of these media messages, and correlating comments from young women about their weight and body shape, a link between eating disorders and social pressures can be established.

Family Factors

People are shaped in part by their experiences with their families. Families contribute to an individual's emotional growth. If someone is raised in a dysfunctional family, she may have feelings of abandonment and loneliness. Certain families have dynamics in which rigidity, overprotectiveness, and emotional distance are commonplace. If parents make all of a child's decisions for her, when she gets to adolescence and needs to make decisions for herself, she may find she doesn't have the tools to do so. All of these dynamics can promote the development of eating disorders in the future.

Families in which unrealistically high expectations are placed on the children can also lead these individuals to develop disordered eating. The disordered eating is used as a way to cope with feelings of inadequacy and as a way to control at least one area of their lives. Children also receive their first messages about their bodies from their families. If parents place too much emphasis on physical appearance, it can lead to low self-esteem in those children, placing them at risk for developing eating disorders when they are older.

Most children learn their eating habits and food preferences from their families. Often times, cleaning one's plate or not eating too much or even parents' close control of what their child eats can lead to disordered eating later in life. Parents' attitudes toward food and their own bodies greatly affect children's attitudes toward food and how they will feel about themselves.

FAMOUS PEOPLE WHO HAVE BATTLED EATING DISORDERS

Paula Abdul, Singer

Justine Bateman, Actor

Karen Carpenter, Singer*

Nadia Comaneci, Gymnast

Susan Dey, Actor

Diana, Princess of Wales

Jane Fonda, Actor/Activist

Zina Garrison, Tennis Player

Tracy Gold, Actor

Heidi Guenther, Ballet Dancer*

Margaux Hemingway, Actor

Christy Henrich, Gymnast*

Daniel Johns, Musician

Kathy Johnson, Gymnast

Gelsey Kirkland, Ballet Dancer

Lucy Lawless, Actor

Gilda Radner, Actor/Comic

Cathy Rigby, Gymnast

Joan Rivers, Comic

Ally Sheedy, Actor

* indicates death resulting from the eating disorder

Triggers

Triggers are items or events that spark the beginning of other events. Eating disorders are often triggered by an event or a circumstance in the life of an individual who is already prone to developing such a condition. A period of adjustment, such as leaving home to attend summer camp, prep school, or college, can easily trigger disordered eating in an individual with such tendencies already in place. A traumatic event in someone's life, such as sexual abuse, can also trigger the development of an eating disorder. Other triggers can seem harmless yet represent large life changes, such as moving, starting a new school or job, graduation, and even marriage. Whatever the trigger is, it is usually closely tied to the end of a valued relationship or a feeling of loneliness.

The most common trigger of an eating disorder, however, is dieting. Very often dieting can lead people to disordered eating of some sort, including anorexia or bulimia.

THE PHYSICAL AND PSYCHOLOGICAL CONSEQUENCES OF EATING DISORDERS


An eating disorder can have serious physical and psychological consequences. How serious these consequences are depends on how early an eating disorder is identified and treated. With help, the effects of an eating disorder can be treated; however, if an eating disorder is left untreated for years, some of the effects are irreversible and life-threatening. For these reasons, early detection and treatment is essential and can save a person's life.

The different types of eating disorders are often connected. In fact, 30 to 50 percent of people with anorexia exhibit signs of bulimia as well. Therefore, the consequences of the disorders are also connected. In other words, bulimia and anorexia often share physical, as well as psychological, consequences.

How Anorexia Nervosa Affects the Body

Anorexia causes many physical problems. For instance, it upsets the normal functions of hormones. For girls, this means the body is unable to produce enough of the female hormone estrogen because it does not have enough fat. This will cause an absence of menstrual cycles, called amenorrhea. For boys, anorexia causes a decrease in the production of the male hormone testosterone, which results in a loss of sexual interest.

An anorectic body lacks the protective layer of fat it needs to stay warm. To compensate for the lack of fat, lanugo (fine hair) will grow all over the body to keep it warm. Another problem anorexia causes is a decrease in bone mass. The body needs calcium for strong bones. Since an anorectic is not eating enough food, which is the source of calcium, the body's bones suffer and weaken. Later in life, this could result in a dangerous bone disease called osteoporosis.

Additionally, without the fuel it needs, an anorectic's body will respond as if it is being assaulted and begins to fight back in order to survive. To survive the body must have energy, but because the body has no food to turn into energy, it seeks out the muscles, and eventually, the organs (heart, kidney, and brain) for sustenanceoften causing permanent damage to the organs in the process. This is the most serious consequence of anorexia and can possibly lead to cardiac arrest and/or kidney failure, both of which can result in death.

How Bulimia Nervosa Affects the Body

The frequent purging that occurs with bulimia does serious damage to the body. Self-induced vomiting can severely damage the digestive system. Repeated vomiting also damages the esophagus (throat) and eventually it may tear and bleed. Vomiting brings stomach acids into the mouth, causing the enamel on the teeth to wear away. As a result, the teeth may become weakened and appear ragged. There will also be an increase in cavities from vomiting.

Other consequences include swollen salivary glands, which gives some bulimics the appearance of having chipmunk cheeks, and cuts and sores on the knuckles from repeatedly sticking one's fingers down the throat to induce vomiting (known as "Russell's sign"). Stomach cramps and difficulty in swallowing are also common.

If laxatives (drugs that induce bowel movements) are abused, constipation will result because the body can no longer produce a bowel movement on its own. Abuse of laxatives and diuretics (drugs that expel water from the body through urination) can also cause bloating, water retention, and edema (swelling) of the stomach. Because the body is constantly being denied the nutrients and fluids it needs to survive, the kidneys and heart will also suffer. Specifically, a lack of potassium will result in cardiac abnormalities and possible kidney failure, which can also result in death.

How Binge-Eating Disorder Affects the Body

The physical effects of binge eating are not as severe as with anorexia and bulimia, namely because the body is not denied food or put through the painful process of purging. Nevertheless, there are some potentially serious consequences for binge eaters.

Since binge eaters may suffer from obesity, health complications such as diabetes or heart problems can develop. Health problems from yo-yo dieting can include hypertension (high blood pressure) and long-term damage to major organs, such as the kidney, liver, heart, and other muscles.

How Exercise Addiction Affects the Body

Many anorectics and bulimics exercise compulsively (constantly) in order to lose weight. Compulsive exercise is extremely dangerous and can cause many painful injuries, including stress fractures, damaged bones and joints, as well as torn muscles, ligaments, and tendons. Even worse, the injuries may become more serious as many compulsive exercisers will continue their routines despite their injuries.

When an eating disorder is successfully treated, the body can heal and return to normal. Sometimes, however, the eating disorder has continued for so many years that there is too much damage for a full recovery to occur. A person may have to live with a weak heart or kidney for the rest of her life. A woman may be unable to conceive a child because her reproductive system cannot function properly (due to the absence of menstruation). Also, a person may have to live with the debilitating bone disease osteoporosis.

How Eating Disorders Affect the Mind

The psychological consequences of an eating disorder are complex and difficult to overcome. An eating disorder is often a symptom of a larger problem in a person's life. The disorder is an unhealthy way for that person to cope with the painful emotions tied to the problem. For this reason, the emotional problems that triggered the eating disorder in the first place can worsen as the disorder takes hold.

An eating disorder can also cause more problems to surface in a person's life. Eating disorders make it difficult for people to perceive things normally because certain chemical changes take place when the body is deprived of nutrients. As a result, the body relies on adrenaline (a hormone that is normally released during times of stress and fear) instead of food for energy. Adrenaline naturally makes makes someone excited, which makes it more difficult to deal with painful emotions.

Research has shown that many people suffering from an eating disorder also suffer from other psychological problems. Sometimes the eating disorder causes other problems, and sometimes the problems coexist with the eating disorder. Some of the psychological disorders that can accompany an eating disorder include depression, obsessive-compulsive disorder, and anxiety and panic disorders.

In addition to having other psychological disorders, a person with an eating disorder may also engage in destructive behaviors as a result of low self-esteem. Just as an eating disorder is a negative way to cope with emotional problems, other destructive behaviors, such as self-mutilation, drug addiction, and alcoholism, are similar negative coping mechanisms.

Not everyone who has an eating disorder suffers from additional psychological disorders; however, it is very common. For this reason, psychological counseling is an essential part of recovery (see Chapter 15: Mental Health Therapies).

DEPRESSION. Depression is one of the most common psychological problems related to an eating disorder. It is characterized by intense and prolonged feelings of sadness and hopelessness. In its most serious form, depression may lead to suicide (the taking of one's own life). Considering that an eating disorder is often kept a secret, a person who is suffering feels alienated and alone. A person may feel that it is impossible to openly express her feelings. As a result, feelings of depression will worsen the effects of an eating disorder, making it difficult to break the cycle of disordered eating.

With counseling and support, it is possible to combat these negative feelings and prevent them from progressing over time. Recently, doctors have begun to prescribe antidepressant drugs, such as Prozac, to address the problems of depression resulting from an eating disorder. Prozac can help ease feelings of depression, which in turn gives a person better tools with which to fight an eating disorder. [For more information on depression, see Chapter 12: Mental Illness.]

OBSESSIVE-COMPULSIVE BEHAVIOR. Obsessions are constant thoughts that produce anxiety and stress. Compulsions are irrational behaviors that are repeated to reduce anxiety and stress. People with eating disorders are constantly thinking about food, calories, eating, and weight. As a result, they show signs of obsessive-compulsive behavior. If people with eating disorders also show signs of obsessive-compulsive behavior with things not related to food, they may be diagnosed with Obsessive-Compulsive Disorder (OCD).

Some obsessive-compulsive behaviors practiced by eating disorder sufferers include storing large amounts of food, collecting recipes, weighing themselves several times a day, and thinking constantly about the food they feel they should not eat. These obsessive thoughts and rituals worsen when the body is regularly deprived of food. Being in a state of starvation causes people to become so preoccupied with everything they have denied themselves that they think of little else.

FEELINGS OF ANXIETY, GUILT, AND SHAME. Everyone experiences feelings of anxiety (fear and worry), guilt, and shame at some time; however, these feelings become more intense with the onset of an eating disorder. Eating disorder sufferers fear that others will discover their illness. There is also a tremendous fear of gaining weight.

As the eating disorder progresses, body image becomes more distorted and the eating disorder becomes all-consuming. Some sufferers are often terrified of letting go of the illness, which causes many to protect their secret eating disorder even more.

Eating disorder sufferers have a strong need to control their environment and will avoid social situations where they may have to be around food in front of other people or where they may have to change their behavior. The anxiety that results causes people with eating disorders to be inflexible and rigid with their emotions.

SYMPTOMS OF DEPRESSION

  • Extreme mood swings
  • Inability to experience pleasure in anything
  • Feelings of worthlessness
  • Withdrawal from family and friends
  • Constant fatigue (exhaustion)
  • Insomnia (sleeplessness) or sleeping too much
  • Loss of appetite or compulsive eating
  • Inability to concentrate or make decisions
  • Poor memory
  • Unexplained headaches, backaches, or stomachaches

Bulimics and binge eaters, specifically, experience guilt and shame with their disorders. This is mainly because, unlike anorectics, they are not usually in denial and they do realize that there is a problem. Bulimics will feel anxiety before, during, and after a binge and can only relieve this anxiety through purging. Purging, however, brings on overwhelming feelings of guilt and shame.

Binge eaters also feel anxiety during a binge, but because they do not purge, they feel ashamed over their lack of control around food.

EATING DISORDERS AND OTHER DESTRUCTIVE BEHAVIORS


Drug Addiction and Alcoholism

It is common for people with eating disorders also to struggle with drug and alcohol addiction. In fact, research shows that one-third of bulimics have a substance-abuse problem, particularly with stimulants (drugs that excite the nervous system) and alcohol. This may stem from the fact that people with eating disorders have difficulty coping with their emotions and use negative means, such as drugs, to mask their problems. Drugs and alcohol provide temporary escapes from reality but, similar to eating disorders, can progress into serious problems that require treatment to overcome. [For more information on drug addiction and alcoholism, see Chapter 14: Habits and Behaviors.]

Self-Mutilation

Self-mutilation is practiced by many eating disorder sufferers. It is also known as self-inflicted violence (SIV) or "cutting." The most common forms of self-mutilation include cutting, burning, head-banging, hitting, and biting oneself. The reasons people self-mutilate stem from an inability to handle overwhelming feelings or a state of emotional numbness. Many sufferers explain that they hurt themselves in order to distract themselves from emotional pain because it is easier to deal with physical pain than to address uncomfortable emotions, such as fear or anger. They may also hurt themselves in order to feel something which gives them an escape from feelings of loneliness. [For more information on self-mutilation, see Chapter 14: Habits and Behaviors.]

EATING DISORDERS AND SEXUALITY


Eating disorders often develop around puberty, when the body is changing and maturing. This time of change can produce anxiety and confusion for both boys and girls because puberty is the beginning of sexual maturity. Girls develop breasts, start menstruating, grow taller, and develop more body hair. Boys' sexual organs (the penis and testicles) grow. Boys also grow taller, get more body and facial hair, and develop bigger muscles.

The sexual feelings that accompany puberty are new, and what they are feeling or experiencing may embarrass some young people. When someone is suffering from an eating disorder, issues surrounding sexuality can become even more complicated. Some people may seek out sexual relationships to feel close to someone and ease feelings of isolation. Others may avoid sexual relationships altogether because they feel ashamed of their bodies.

In some cases, an eating disorder is triggered by sexual abuse (when a person is forced to engage in sexual activities against his or her will). In these instances, an eating disorder sufferer is usually acting out in response to a painful event. She may gain or lose weight in an attempt to make herself sexually undesirable. She may avoid sexual relations as a way to take control over her body and prevent painful feelings from resurfacing. The anger and distrust felt toward the opposite sex may result in complete rejection of the opposite sex. On the other hand, some eating disorder sufferers may have many sexual partners in an attempt to erase the past and gain acceptance from the opposite sex.

TREATMENT AND RECOVERY FROM EATING DISORDERS

Treatment and recovery go hand in hand. It is very hard to stop an eating disorder without any treatment. Recovery is a long process in which an eating disorder sufferer may have to enter treatment more than once. Some people may even try different kinds of treatment programs during their recovery until they find one that works for them.

There may be obstacles to starting treatment. The fear of becoming fat and losing control, which drives most eating disorders, is very strong and hard to eliminate. Also, an eating disorder sufferer may be in denial about her condition and may be unwilling to consider treatment. These feelings may be based on a fear of letting go of the illness that she feels is part of her identity. The eating disorder sufferer must learn to refocus her thoughts from food and weight to her emotions so that she can deal with what is really bothering her. Since many feelings that need to be addressed have been buried by the disorder, professional counseling is important for a successful recovery.

In order for treatment to work, a person must be ready to be treated. Some sufferers may even say they are ready but really are not. They may pretend to change their attitude about food, but they are still starving themselves or bingeing and purging their food secretively. If a person does not fully commit to a treatment program, she will most likely continue suffering from the deadly illness even after completion of the program.

Treatment Basics

Treatment programs vary in the approach that they take. An eating disorder sufferer needs to find a program that best suits her and her condition. A program may work for one person but be ineffective for another. It is important that the person feels comfortable with and believes in the treatment.

Treatment usually begins with an assessment by a physician or mental health counselor. Depending on the severity of the eating disorder, the sufferer will either enter an inpatient or outpatient program. Inpatient programs, or hospitalization, are for the most severe cases. To be hospitalized, the sufferer is usually at a critical point in her illness where her life is in danger or she may have strong suicidal thoughts. Outpatient programs are conducted at a facility or doctor's office that the patient visits while still living at home.

WORDS OF RECOVERY

Mostly what happened was that my life took overthat is to say, that the impulse for life became stronger in me than the impulse for death. In me, the two impulses coexist in an uneasy balance, but they are balanced enough now that I am alive.

Looking back, I see that what I did then was pretty basic. I took a leap of faith. And I believe that has made all the difference. I hung on to the only thing that seemed real to me, and that was a basic ethical principle; if I was alive, then I had a responsibility to stay alive and do something with the life I had been given. And though I was not at all convinced, when I made that leap of faith, that I had any sensible reason for doing sothough I did not fully believe that there was anything that could possibly make as much sense as an eating disorderI made it because I began to wonder. I simply began to wonder, in the same way I had wondered what would happen if I began to lose weight, what would happen if I stopped. It was worth it.

It is worth it. It's a fight. It's exhausting, but it is a fight I believe in. I cannot believe, anymore, in the fight between body and soul. If I do, it will kill me. But more importantly, if I do, I have taken the easy way out. I know for a fact that sickness is easier.

But health is more interesting.

Excerpted from Marya Hornbacher, Wasted: A Memoir of Anorexia and Bulimia. New York: HarperFlamingo, 1998, p. 280.

Whether the program is inpatient or outpatient, it will usually include various forms of counseling and medical care to treat the physical effects of the illness. The most common forms of counseling include nutrition, individual, family, and group. Nutrition counseling teaches the patient about healthy eating habits and designs appropriate meals. Its goal is to slowly bring the sufferer's weight back up to a safe level that can be easily maintained without dieting or provoking obsessive behavior about food. The first few months of treatment for anorectics can be very dangerous if the eating disorder has gone on for a long time. This is due to the shock the body experiences from eating food after years of starvation.

Individual counseling is one-on-one counseling in which a therapist helps the sufferer deal with her emotions and take control of her body and life again. Family counseling is when the family of the eating disorder sufferer is involved. This type of counseling helps the family and the sufferer to establish better relationships and change any unhealthy dynamics of the family. In group counseling, a counselor leads meetings of a group of eating disorder sufferers to help them learn how to achieve and maintain strong relationships. It also helps sufferers learn that they are not alone.

In support groups, eating disorder sufferers meet to offer support, understanding, and hope to one another as they battle their disorders. Support groups, like group counseling, help sufferers to not feel so alone in their illnesses and learn from others' experiences.

Some eating disorder sufferers will be prescribed medication to ease depression and anxiety as part of their treatment.

[For more information on types of treatments and therapy, see Chapter 15: Mental Health Therapies.]

The Recovery Process

Recovery is not easy. Most eating disorder sufferers feel that they are not worthy of love or life. It takes time (months, even years) and a lot of support from friends, family, and medical professionals to change the sufferers' self-perceptions. They need to feel worthy again of love from others. However, recovery is not as simple as saying "I love you" to eating disorder sufferers. They need to build their self-esteem so that they can believe that they deserve the love of others. Some people are able to make an initial recovery, but many find recovery to be an ongoing, lifelong process.

An eating disorder sufferer has certain goals, both physical and psychological, that she needs to try to reach in recovery. The physical aims should include the ability to eat a variety of healthful foods (without bingeing and purging) and maintain a healthy weight. Females should start their menstrual periods either for the first time or again without the help of medication.

The psychological aims of recovery should include a noticeable decrease in the fear of food and becoming fat as well as the ability to establish strong relationships with family and friends again. Another goal should be to realize the role society and the media play in furthering disordered thinking about people's weights and body shapes. This realization will help sufferers learn to accept and like their bodies without having to live up to unrealistic standards of beauty and thinness. An eating disorder sufferer should also work to establish new, positive coping skills and engage in activities that do not involve food or weight control.

WHAT TO DO IF YOU THINK SOMEONE HAS AN EATING DISORDER

  • First, voice concerns to the person privately.
  • Listen carefully to what that person is saying.
  • Avoid using judgmental statements.
  • Let the person know that you are concerned about her health.
  • Be familiar with some resources, such as reading materials, web sites, or community centers, that can be introduced to that person.
  • If the person exhibits behaviors that are life-threatening, such as bingeing and purging several times a day, fainting, or expressing suicidal thoughts, tell a trusted adult immediately.

The goals for recovery should start small. Learning to meet modest goals first will provide a sense of accomplishment that will help push a person toward meeting larger goals. It is easy to become overwhelmed and fall back into familiar patterns of living. Eating disorder sufferers have taught themselves how to starve or binge and purge and are familiar with using the disorder to help them cope with life. They need time to relearn healthy eating habits and how to feel good about themselves again at a healthy weight.

PREVENTING EATING DISORDERS


Many eating disorder organizations focus on prevention in their programs. That is, stopping eating disorders before they even start. The belief is that awareness and education can go a long way in preventing the onset of these painful illnesses, which can become lifelong struggles. Many eating disorder experts promote teaching prevention at a young age since eating disorders usually begin in adolescence, although there are reported cases of eating disorders starting in children as young as eight years old.

There are a few main objectives that eating disorder organizations focus on in their prevention programs. These objectives help to provide people with the tools they need to cope with the problems that may contribute to an eating disorder.

Prevention means:

  • reordering thoughts on food and weight
  • focusing on health
  • understanding the dangers of dieting
  • developing a positive body image
  • rebelling against cultural and media messages that encourage unhealthy behaviors
  • explaining why fat is not the enemy
  • helping to end fat discrimination

Reordering Thoughts about Food and Weight

Since there is enormous pressure to be thin in many cultures, including the United States, many people are dissatisfied with how they look, believing that they are inadequate and unworthy of affection or love. As a result of a negative body image, many people go on strict diets and believe that food is the enemy. However, the body needs food to survive and going on restrictive diets will only lead to an intense preoccupation with food, calories, and weight.

The first step in preventing the development of eating disorders is to reorder feelings and thoughts about food and weight. Eating disorder experts recommend that people reject unhealthy messages about weight, body shape, and diet. Since body shape and weight are determined mostly from genetics, there is only so much a person can do to control or change weight and body shape. Trying to fight against or change the body's set point (the weight at which one's body naturally falls) is unhealthy and possibly dangerous because it creates a cycle of yo-yo dieting. Research has shown that while not every diet leads to eating disorders, 80 percent of eating disorders are initially triggered by a diet. [See Chapter 1: Nutrition, for more information on body set point.]

DEVELOPING A POSITIVE BODY IMAGE


Developing a positive body image is necessary to the prevention of eating disorders. Many people struggle with this issue and must work hard at accepting their bodies. Eating disorder experts emphasize the importance of exercising for health reasons rather than for burning calories and losing weight. The same experts also recommend becoming politically active in the fight against unhealthy cultural messages because it can be a source of positive feelings and empowerment.

HOW DOES DIETING AFFECT THE BODY AND MIND?

The body needs a certain amount of food to function properly. If caloric intake is restricted and the body falls below its set point, it will respond by lowering its metabolism. Metabolism is the rate at which the body burns energy. When the body doesn't get enough fuel to burn, it must learn to function on less. In response, the body will hold on to any food it gets and store fat more efficiently on fewer calories. Typically, when a person stops dieting, she will gain more weight than what was lost and be more likely to keep the extra weight because the body has made adjustments to compensate for a lack of food from the dieting.

The negative physical effects of dieting can include:

  • headaches
  • dizziness
  • stomach pain
  • iron deficiency that causes fatigue
  • possible menstrual irregularity
  • lack of estrogen
  • calcium deficiency
  • lack of growth from malnutrition

The negative psychological effects of dieting can include:

  • preoccupation with food, eating, and calories
  • increased irritability
  • increased stress and anxiety from semi-starvation
  • inability to determine hunger and fullness
  • negative body image that can lead to depression and low self-esteem
  • fear of food that can lead to isolation and alienation

Other suggestions include:

  • Avoid negative talk about food and weight.
  • Avoid referring to foods as "good" or "bad."
  • Don't participate in weight-loss programs or experiment with weight-loss products.
  • Exercise moderately; don't engage in unhealthy or excessive exercise programs.
  • Talk about body-image issues with close friends and family.
  • Don't criticize people for gaining weight.
  • Don't compliment people for losing weight.
  • Encourage family and friends to question cultural attitudes about weight and body shape.

Fat and Fit? The Obesity Question

Many people have been taught to fear fat, which leads to unhealthy dieting and intense struggles to lose weight. This thinking is based on the assumption that being fat is unhealthy and should therefore be avoided at all costs.

Now, however, many researchers are questioning the idea that being fat automatically puts a person at risk for health problems. The New England Journal of Medicine published an article in 1998, edited by Jerome P. Kassirer, M.D. and Marcia Angell, M.D., that confirms what many researchers have already suspected: treatments for obesity do not work, obesity treatments pose serious health risks, and the treatments are not justified because the health risks of obesity are not as high as once thought.

THE NATIONAL ASSOCIATION TO ADVANCE FAT ACCEPTANCE

The National Association to Advance Fat Acceptance (NAAFA) was founded in 1969. Its mission is to work to better the lives of fat people around the world. Through advocacy and education, the organization tries to eliminate the discrimination that fat people face in their lives. NAAFA also works to empower fat people and help them accept their bodies and live more fulfilling lives.

NAAFA's basic message is that a person's worth should not be based on his or her body size. NAAFA uses the word "fat" in the hopes that people will stop using it as an insult and remember it is just an adjective (descriptive word). In this way, the word will not cause shame or embarrassment.

The organization challenges ideas about the connection between obesity and health risks. It promotes research that accurately studies the different aspects of being fat. The goal is to move away from looking for ways to help fat people lose weight and, instead, help fat people be healthy.

NAAFA has more than fifty chapters across the United States that provide support groups for people to share their feelings. Since being fat can be emotionally painful and isolating in many societies, especially in the United States, the organization promotes programs that unite people with similar experiences.

Some researchers claim that obesity is dangerous to one's health when combined with a sedentary (non-active) lifestyle. It is possible to be fat and healthy. In fact, how healthy a person is depends more on how much a person exercises rather than how much a person weighs. Weight alone is not a proper indication of how healthy a person is, and it is more beneficial for a person to concentrate on fitness instead of fatness.

FOR MORE INFORMATION


Books

Bode, Janet. Food Fight: A Guide to Eating Disorders for Pre-Teens and Their Parents. New York: Simon and Schuster, 1997.

Cooke, Kaz. Real Gorgeous: The Truth About Body and Beauty. New York: W.W. Norton, 1996.

Hornbacher, Marya. Wasted: A Memoir of Anorexia and Bulimia. New York: HarperCollins, 1998.

Kolodny, Nancy. When Food's a Foe: How You Can Confront and Conquer Your Eating Disorder. Boston: Little Brown & Co., 1992.

Krasnow, Michael. My Life as a Male Anorexic. New York: Haworth Press, 1996.

Sacker, Ira M. Dying to Be Thin: Understanding and Defeating Anorexia Nervosa and BulimiaA Practical Lifesaving Guide. Warner Books, 1987.

Web sites

Eating Disorders Information. [Online] http://eatingdisorders.about.com (Accessed November 1, 1999).

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Eating Disorders

Eating Disorders

What Are Eating Disorders?

Who Develops Eating Disorders?

What Causes Eating Disorders?

What Medical Complications Are Caused By Eating Disorders?

How Do Doctors Diagnose Eating Disorders?

How Are Eating Disorders Treated?

Resources

Eating disorders are habits or patterns of eating that are out of balance and may involve major health and emotional problems.

Keywords

for searching the Internet and other reference sources

Anorexia nervosa

Binge eating disorder

Binge and purge Bulimia nervosa

Compulsive overeating

Food and nutrition

Weight loss

What Are Eating Disorders?

Eating disorders are not merely unhealthy eating habits; they involve patterns of eating too little or too much, and they may cause a variety of physical and emotional problems. Eating disorders usually develop during adolescence and usually affect girls, although boys can also be affected. Eating disorders include anorexia (an-o-REK-see-a), bulimia (bull-EE-me-a), binge eating disorder, and obesity (o-BEE-si-tee).

Anorexia

Anorexia is an eating disorder that involves fear of becoming or being fat, intensive dieting or exercise, and a distorted body image. People with anorexia see themselves as fat even though they may be dangerously underweight. They severely restrict their food intake and/or exercise to extremes in order to lose weight. Someone may be diagnosed with anorexia if she refuses to eat enough food to maintain a healthy weight, and has lost more than 15 to 20 percent of her healthy weight. For example, a girl with anorexia whose healthy weight is 125 pounds might weigh 105 pounds. She might eat as little as 500 calories a day (most healthy teenagers eat 2,000 or more calories a day).

Bulimia

Sometimes referred to as the binge-purge disorder, bulimia involves repeated episodes of binge eating (consuming large quantities of food while feeling little control over the behavior) followed by purging (trying to rid the body of the food by vomiting or by using laxatives or enemas). Some people with bulimia also exercise excessively. In bulimia, self-image is overly tied to body shape and weight, and people with this disorder are dissatisfied with these aspects of their body. However, unlike those with anorexia, people with bulimia usually stay at a fairly healthy weight.

Binge eating disorder

Binge eating disorder involves out-of-control overeating but lacks the purging that is seen with bulimia. Binge eaters often are obese or constantly dieting and they often feels guilty after a binge. Painful emotions or stress may trigger binges.

Obesity

Obesity is an excess of body fat. People are considered overweight if extra body fat causes them to weigh 20 percent more than the healthy weight for their height and obese if they if they weigh more than 30 percent above what is healthy for their height.

Who Develops Eating Disorders?

Most teenagers are concerned about how they look. After all, their appearance is changing very quickly. Girls are developing breasts and their hips are becoming rounded and curvy. Boys voices are deepening and body hair is increasing. Most teenagers have an ideal image in their minds about what they should look like, and images on television and in the movies reinforce the goal of thinness as perfection.

Many young people, particularly girls, go on diets to control their body weight. Dieting has been reported to start as early as elementary school. Dieting without guidance by a medical doctor can cause problems with growth and development for children and teens. Sometimes an earnest but misguided effort to control weight can evolve into an eating disorder.

Consider Diane, a 13-year-old seventh grader. Her diet began innocently enough. She thought she was 10 to 15 pounds overweight and switched her lunch from a sandwich and cookies to a salad. She lost a few pounds. She liked feeling thinner, got a lot of compliments, and pretty soon she reduced the salad at lunch to a carrot and a piece of cheese. Diane trimmed her dinner as well, telling her parents that she had eaten a big lunch and was not hungry. Before long, Diane had lost 20 pounds. But Diane was surprised that she did not feel happy; instead, she was obsessed with food and her weight (she still felt fat) and was embarrassed whenever anyone commented on her body. Diane continued dieting and also began to exercise two times a day to try to lose more weight.

Diane is not alone; experts say that more than five million American women and girls and one million men and boys suffer from eating disorders. About 1 in 100 girls between 12 and 18 years old has an eating disorder. As many as 1 in 10 college females has anorexia or bulimia. More than 1,000 young women die each year from the serious medical problems that develop because of eating disorders!

Young people who participate in sports that prize thinness are at particularly high risk of developing eating disorders. Female dancers, ice skaters, and gymnasts have a three times greater risk for developing an eating disorder than do girls not involved in such activities. Boys who participate in similar sports or in wrestling are also at higher risk. Girls who enter puberty early and girls who are overweight may also be more likely to develop eating disorders.

What Causes Eating Disorders?

There is no clear-cut, single cause for any of the eating disorders. Many factors seem to contribute, including influences from society and culture (such as the glorification of thinness by the mass media), emotional issues (such as a teenagers striving for perfection, exposure to intensely stressful situations, and fears of maturity, puberty, or sexuality), family factors (such as overly controlling parents, serious emotional conflicts, or problems expressing feelings), or poor childhood feeding and eating patterns. People who have an eating disorder usually do not set out to deliberately have this problem. Generally, eating disorders develop slowly, as do the signs and symptoms.

What Medical Complications Are Caused By Eating Disorders?

Eating disorders are serious problems and can cause a variety of medical complications. In anorexia, rapid weight loss can lead to blood chemical imbalances, failure to menstruate*, slow pulse, low blood pressure, and heart problems. In some cases, damage to vital organs is so serious that it can result in death. The frequent vomiting associated with bulimia can cause throat tears or sores, damaged tooth enamel, broken blood vessels in the eyes, and puffy cheeks from swollen salivary glands. With both anorexia and bulimia, bowel and intestinal problems can occur and serious vitamin and mineral deficiencies can cause serious and long-lasting problems. Binge eating often results in obesity, which in turn can lead to other health problems. People who are obese are at greater risk of developing diabetes*, heart disease*, high blood pressure*, osteoarthritis*, and other health problems.

* menstruate
(MEN-stroo-ate) means to discharge the blood-enriched lining of the uterus. Menstruation occurs normally in females who are physically mature enough to bear children. Because it usually occurs at four-week intervals, it is often called the monthly period. Most girls have their first period between the age of 9 and 16.
* diabetes
(dy-a-BEE-teez) is a disorder that reduces the bodys ability to control blood sugar.
* heart disease
is a broad term that covers many conditions that prevent the heart from working properly to pump blood throughout the body.
* high blood pressure
,or hypertension (hy-per-TEN-shun), is a condition in which the pressure of the blood in the arteries is above normal. Arteries are the blood vessels that carry blood from the heart through the en-tire body.
* osteoarthritis
(os-tee-o-ar-THRYtis) is a common disease that involves inflammation and pain in the joints (places where bones meet), especially those in the knees, hips, and lower back of older people.

How Do Doctors Diagnose Eating Disorders?

Teenagers with anorexia, bulimia, and binge eating disorder often try to hide the problem, so formal diagnosis can be delayed or difficult. Even when caring friends or family members ask about the weight loss or other symptoms, most teenagers with eating disorders are ashamed or embarrassed, especially by the purging that accompanies bulimia. Because of distorted body image, those with anorexia may not be able to recognize the seriousness of their extreme weight loss. Unbearable fear of being fat may cause people with anorexia to resist attempts to help them gain weight. A concerned health professional might ask questions about eating, body image, and exercise. Blood or other laboratory tests can help determine if a persons nutrition is adequate and if general body chemistry is balanced. A careful interview and health history may reveal concerns about body image or distorted opinions about body appearance.

A doctor can generally determine if adults are obese by measuring their body weight and height. Obesity in children can be similarly determined but these measurements should be considered more carefully because the child is still growing. Over the last decade, there has been a significant rise in obesity in children in the United States. This is likely in part a result of people eating more frequently in fast food restaurants, watching a lot of television, working or playing games on computers, and engaging in other activities that promote over-eating and a sedentary (sitting too much with little exercise) lifestyle.

Eating disorders have multiple causes, which may include social and cultural pressures, emotional issues, and family stressors. Chemical imbalances in the brain, shown here in crosssection, may also cause eating disorders. These imbalances affect the hypothalamus, which is believed to control appetite.

How Are Eating Disorders Treated?

Overcoming eating disorders may take a long time and lots of commitment and hard work. Most teenagers with eating disorders need the assistance of mental health and other health care professionals to manage the problem. Anorexia, bulimia, and binge eating disorder are treated most successfully with a combination of therapies. Behavior change programs, monitoring of diet and eating patterns, individual or group psychotherapy*, support groups, nutritional counseling, family counseling, and sometimes medication may all be part of treatment.

* psychotherapy
(sy-ko-THER-apea) is the treatment of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.

People with obesity can be helped by doctor-recommended weight-loss programs that teach healthy habits. To lose weight, people must take in fewer calories* than they use, and the best way to control weight is through exercising and eating a balanced diet. In some cases, doctors may also treat severe obesity by prescribing very low-calorie diets or medications. In rare cases, doctors may advise a surgical procedure that either limits the amount of food the stomach can hold or causes food to bypass the stomach or part of the intestines.

* calorie
(KAL-or-ee) is a unit of energy used to describe both the amount of energy in food and the amount of energy the body uses.

See also

Anorexia

Anxiety and Anxiety Disorders

Body Dysmorphic Disorder

Body Image

Bulimia

Depression

Emotions

Obesity

Peer Pressure

Stress

Resources

Books

Bennett, Cherie. Life in the Fat Lane. New York: Random House, 1999. A novel about the high school experiences of an overweight girl.

Berg, Frances M. Afraid to Eat: Children and Teens in Weight Crisis. Hettinger, ND: Healthy Weight Journal, 1997.

Folkers, Gladys, and Jeanne Engelmann. Taking Charge of My Mind and Body: A Girls Guide to Outsmarting Alcohol, Drugs, Smoking, and Eating Problems. Minneapolis: Free Spirit Publishing, Inc., 1997. For ages 11-18.

Siegel, Michele, Judith Brisman, and Margot Weinshel. Surviving an Eating Disorder: Strategies for Family and Friends. New York: Harper-Collins, 1997.

Organizations

U.S. Food and Drug Administration (FDA) posts the fact sheet On the Teen Scene: Eating Disorders Require Medical Attention at its website. http://www.fda.gov/opacom/catalog/eatdis.html

The American Psychological Association posts the fact sheet How Therapy Helps Eating Disorders at its website. http://helping.apa.org/therapy/eating.html

Eating Disorders Awareness and Prevention, Inc. (EDAP), 603 Stewart Street, Suite 803, Seattle, WA 98101. Telephone 800-931-2237 for toll-free information and referral hotline http://www.edap.org

www.KidsHealth.org, a website sponsored by the Nemours Foundation and the Alfred I. duPont Hospital for Children, Wilmington, DE, posts articles for kids, teens, and parents about eating disorders, obesity, nutrition, and related topics.

National Association of Anorexia Nervosa and Associated Disorders (ANAD), P.O. Box 7, Highland Park, IL 60035. Telephone 807-831-3438 http://anad.org

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eating disorders

eating disorders Range of disorders involving eating habits and appetites. The most common are anorexia nervosa and bulimia nervosa.

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