Eating disorders are a group of medical conditions which, if left untreated, not only
threaten the health and well-being of their sufferers, but can also kill them.
More frightening is that some people with eating disorders, especially those with anorexia
nervosa, maintain secrecy about their problem. We must, therefore, be more vigilant and
learn how to spot symptoms of eating disorders.
Eating disorders are more common than you may think. Schlundt and Johnson (1990) concluded
that between 6%-8% of young women, especially college women, suffered from bulimia
nervosa. Bushnell and colleagues (1990) found a prevalence rate of 4.5% among women aged
18-24---significantly higher than among the other age groups. Eating disorders are most
common in females, but can also afflict males.
Fatality rates are startling: Ratnasuriya and colleagues (1991) suggested that 20% of
those with anorexia nervosa die as a result of the illness, and as many as half those
deaths are caused by suicide (Agras 1987). Some studies show a six-fold increase in death
rates in the bulimic population compared to the normal population (Patton 1988; Crisp et
al. 1992). At least 2% of the general population, and 30% of those in medically supervised
weight-control programs may suffer from binge eating disorder (National Institute of
Mental Health 1994).
In anorexia nervosa, individuals refuse to maintain an appropriate body weight (they are
at least 15% below the appropriate weight for their age and height). Some anorexics are
convinced they are overweight, even when it's obvious they are very much underweight
and as such, they may be severely afraid of gaining weight. Many anorexics deny they have
a problem.
What anorexics think and feel of themselves is often directly related to their weight and
shape. They may become obsessed with food and weight, may carry out bizarre eating
rituals, and often may refuse to eat in front of others.
The causes of anorexia are varied and tend to interact with one another. No doubt, our
culture's belief that "thin is beautiful" prompts some people to go to extreme
lengths to change their body image-even at the expense of their health (Boskind-White
& White 1986).
But to say that society and our media are the sole causes of eating disorders is
misleading, for anorexics may also have certain personality traits which predispose them
to be particularly sensitive to our culture's growing obsession with perfect body shape
and weight. For instance, some anorexics are extreme perfectionists (for numerous reasons
beyond the scope of this brief article) and maintain very high standards for both
behaviour and image (e.g., Bastiani et al. 1995).
Furthermore, family forces are often implicated: anorexics may have
overprotective/controlling parents, particularly mothers who insist their daughters be
high achievers and accepted socially by maintaining a certain body image (Pike & Rodin
1991). Because of these expectations, an anorexic may even be angry that s/he's not
accepted as an individual, and use excessive dieting as a way to express such anger (e.g.,
Troop et al. 1994). It's as if the anorexic feels this is the way to regain control of
his/her own body and life.
Some suggest that developing anorexia is a way of returning to a once youthful self and
time-when less was expected of the individual (Maloney & Kranz 1991).
Biochemical abnormalities (including neurotransmitter irregularities) may also be
implicated in anorexia, as well as other eating disorders. Several studies have also
looked at the possibility for hereditary predisposition to this and the other eating
disorders, which, given the right environment, can lead to a full-blown disorder.
To ensure no weight gain, anorexics may starve themselves, exercise excessively, orbinge
and/or purge (using self-induced vomiting, laxatives, diuretics, or enemas). Most bingeing
anorexics also purge. Some anorexics don't binge, but purge after eating even a small
amount of food.
Bulimia shares two major symptoms with anorexia: bulimics are very concerned with weight
gain and their self-evaluation is overly influenced by body shape and weight. But in
bulimia nervosa, individuals eat abnormally large amounts of food during a given period of
time and then purge the food (by self-induced vomiting, excessive use of laxatives,
diuretics, or enemas) or fast or exercise excessively. They tend to feel out of control
during a binge, and very depressed and/or guilty after a binge.
Unlike anorexics, bulimics are able to maintain weight at or above normal levels (since
starvation is not a hallmark of this particular disorder).
A related illness is binge-eating disorder, which is the same as bulimia nervosa, except
that sufferers don't purge, fast, or use excessive exercise to rid themselves of food and
its effects. Binge-eaters are often obese, have problems losing weight, and have often had
a history of weight fluctuations.
The medical complications of eating disorders are very serious. Starvation, the hallmark
of anorexia, can cause heart and brain damage. When the body loses energy as a result of
starvation, its systems enter an energy-conserving "down mode" whereby
menstruation ceases, breathing, blood pressure, and pulse rates decrease, and thyroid
function slows. Reduced muscle mass, light-headedness, and bone fragility may occur.
Eventually, anorexics' heart muscle may shrink (e.g., Gottdiener et al. 1978).
Drugs used to purge can cause heart failure; purging can cause esophageal tears,
electrolyte imbalances, and heart failure.
But eating disorders are treatable, and the effects of the disorders can
eventually be reversed. Treatment is often facilitated by an entire team of medical and
mental health professionals, including psychiatrists, psychotherapists, social workers,
and dieticians. The faster any of these illnesses are caught, the better the chances for
treatment success.
If an eating disorder is suspected, a physical exam is conducted to rule out any physical
problems. Once these are ruled out, psychotherapeutic treatment can begin.
Individual psychotherapy, including cognitive-behavioural therapy (which attempts to alter
maladaptive, abnormal thinking patterns) and family psychotherapy (which focuses on family
problems which may be contributing to the eating disorder), along with group therapy with
other eating disorder patients are often effective (note that Health Services offers a
special psychoeducational program, Turning Points, for people with eating
disorders; for more information, call 978-8030). Patients are also taught how to eat
properly and take care of themselves. Certain drugs may be used in combination with these
treatments.
Approaching Someone You Think Has an Eating Disorder
The following tend to be telltale signs of an eating disorder:
Many people have some of these symptoms but do not necessarily have an eating disorder.
But keep in mind that the more of these symptoms a person has (especially from the first
group of symptoms) the more vigilant you should be.
If you think you or someone you know might have an eating disorder, contact your family
physician or Health Services for advice on warning signs and intervention.
In the interim, read as much as possible on eating disorders, just so you can get a better
feel for the behaviours and, if the person does indeed have a problem, so you can help the
understand his/her problem.
After this, you should approach the person carefully and informally express your concerns
about his/her health, but avoid mentioning body image or weight. Make sure you know about
all the resources the person may need. Give the person names, addresses, phone numbers of
places they can go to for treatment, of people s/he can call in emergencies. If you think
you can do it, try to get the person to go with you to the family doctor or to Health
Services.
At first, s/he may deny having a problem (perhaps an accurate reflection on his/her part),
may become angry, or may not react at all. Regardless of the reaction, just make sure the
person knows you are concerned and are available for further discussion, and that if the
person really does have a disorder, help is available.
REFERENCES
Agras, WS: Eating disorders: Management of obesity, bulimia, and anorexia nervosa.
Elmsford, NY, Pergamon Press, 1987
Bastiani AM, Rao R, Weltzin T, Kate WH: Perfectionism in anorexia nervosa. Int J Eating
Disorders 17:147-152, 1995
Boskind-White M, White WC Jr: Bulimarexia: A Historical-Sociocultural Perspective. In
Brownell KD, Foreyt JP (eds): Handbook of Eating Disorders, pp 353-366. New York, Basic
Books, 1986.
Bushnell JA, Wells JE, Hornblow AR, Oakley-Browne MA, Joyce P: Prevalence of three bulimia
syndromes in the general population. Psychological Medicine 20:671-680, 1990
Crisp AH, Callender, JS Halek C, Hsu LKG: Long-term mortality in anorexia nervosa: A
20-year follow-up of the St. George's and Aberdeen cohorts. Br J Psychiatry 161:104-107,
1992
Gottdiener JS, Gross HA, Henry WL, Borer JS, Ebert MH. Effects of self-induced starvation
on cardiac size and function in anorexia nervosa. Circulation 58:425-433, 1978
Maloney M, Kranz R, 1991: Straight talk about eating disorders. New York, Facts on File,
1991
National Institute of Mental Health: Eating Disorders. 1994
Patton, GC: Mortality in eating disorders. Psychological Medicine 18(4):947-951, 1988
Pike KM, Rodin J: Mothers, daughters, and disordered eating. J Abnormal Psychology
100:198-204, 1991
Ratnasuriya RH, Eisler L, Szmukler, GI, Russell, GF: Anorexia nervosa: Outcome and
prognostic factors after 20 years. Br J Psychiatry 158:495-502, 1991
Schlundt OG, Johnson WG: Eating disorders: Assessment and treatment. Boston, Allyn &
Bacon, 1990
Troop NA, Holbrey A, Trowler R, Treasure JL: Ways of coping in women with eating
disorders. J Nerv Ment Dis 182:535-540
Copyright © 1996, by Eddy M. Elmer
Permanent URL: http://www.eddyelmer.com/articles/edut.htm