Eating Disorders

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Eating Disorders

Eating disorders are psychological conditions that involve either overeating, voluntary starvation, or both. No one is sure what causes eating disorders, but researchers think that family dynamics, biochemical abnormalities, and society’s preoccupation with thinness may all contribute. Eating disorders are virtually unknown in parts of the world where food is scarce and within less affluent socioeconomic groups in developed countries. Although these disorders have been known throughout history, they have gained attention in recent years, in part because some celebrities 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 age 20. Although both men and women can develop the problem, it is more common in women. Only about 5% of people with eating disorders are male. In either sex, eating disorders are considered serious and potentially deadly. Many large hospitals and psychiatric clinics have programs specially designed to treat these conditions.

Anorexia nervosa, anorexic bulimia, and obesity are the most well known types of eating disorders. The word anorexia comes from the Greek word meaning “lack of appetite.” But the problem for people with anorexia is not that they are not hungry. They starve themselves out of fear of gaining weight, even when they are severely underweight. The related condition, anorexic bulimia, literally means being “hungry as an ox.” People with this problem go on eating binges, often gorging on junk food. Then they force their bodies to get rid of the food, either by making themselves vomit or by taking large amounts of laxatives. A third type of eating disorder is obesity caused by uncontrollable overeating. Being slightly overweight is not a serious health risk. But being 25% or more over one’s recommended body weight can lead to many health problems.

Anorexia

People with anorexia starve themselves until they look almost like skeletons. But their self-images are so distorted that they see themselves as fat, even when they are emaciated. Some refuse to eat at all; others nibble only small portions of fruit and vegetables or live on diet drinks. In addition to fasting, they 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, it’s hard to keep 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, kidney and heart failure are possible. An estimated 10-20% of people with anorexia die, either as a direct result of starvation or by suicide.

Researchers believe anorexia is caused by a combination of biological, psychological and social factors. They are still trying to pinpoint the biological factors, but they have zeroed in on 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. 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 (people with anorexia). The need for approval, combined with our culture’s idealization of extreme thinness, also contributes.

The obvious cure for anorexia is eating, but that is the last thing a person with anorexia wants to do. It is unusual for the person himself or herself to seek treatment—usually a friend, family member, or teacher initiates the process. Hospitalization, combined with psychotherapy and family counseling, is often needed to get the condition under control. Force feeding may be necessary if the person’s life is in danger. Some 70% of anorexia patients who are treated for about six months return to normal body weight. About 15–20% can be expected to relapse, however.

Bulimia

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 it tend to be of normal weight or overweight, and they hide their habit of binge eating followed by purging, vomiting, or using laxatives. In fact, bulimia was not widely recognized, even among medical and mental health professionals, until the 1980s.

Unlike anorectics, bulimics (people with bulimia) 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% of bulimics also have problems with alcohol or drug addiction, and they are more likely than other people to commit suicide.

Many people occasionally overeat, 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 much 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 a binge, bulimics favor high carbohydrate foods, such as doughnuts, 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 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 an imbalance in the brain chemical serotonin underlies bulimia, as well as other types of compulsive behavior. 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 lifethreatening stages, so hospitalization is not usually 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 is effective. Even after apparently successful treatment, some bulimics relapse.

Obesity

Obesity is an excess of body fat. But the question of what constitutes an excess has no clear answer. Some doctors classify a person as obese whose weight is 20% 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. A person who is overweight, they point out, is not necessarily obese. A very muscular athlete, for example, might have very little body fat, but still might weigh more than the recommended weight for his or her height.

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 menand 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,

KEY TERMS

Morbid— From the Latin word for sick, pertaining to or inducing disease.

Risk factor— Any habit, condition, or external force that renders an individual more susceptible to disease. Cigarette smoking, for example, is a significant risk factor for lung cancer and heart disease.

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, 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 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, angina pectoralis (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 20-64 is 50% 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 dieting—sometimes called yo-yo dieting—that never results in permanent weight loss. Research has shown that strict dieting itself may contribute to compulsive eating. Going without their 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 to lose weight gradually without going on extreme diets. Support groups and therapy can help people deal with the psychological aspects of obesity.

Resources

BOOKS

Epstein, Rachel. Eating Habits and Disorders. New York: Chelsea House Publishers, 1990.

Matthews, John R. Eating Disorders. New York: Facts On File, 1991.

Porterfield, Kay Marie. Focus on Addictions. Santa Barbara: ABC-CLIO, 1992.

PERIODICALS

Berry, Kevin. “Anorexia? That’s a Girls’ Disease.” Times Educational Supplement (16 April 1999): D8.

Dansky, Bonnie S., Timothy D. Brewerton, and Dean G. Kilpatrick. “Comorbidity of bulimia nervosa and alcohol use disorders: results from the National Women’s Study.” The International Journal of Eating Disorders 27, no. 2 (1 March 2000): 180.