Eating Disorders

This entry is actually by request...a friend of mine has two daughters who have struggled with eating disorders. Since one of her daughters is still bulimic, my friend is still looking for answers as to how to best deal with this difficult affliction.

I have had past experience with someone with an eating disorder as well. My roommate in college freshman year became anorexic soon after we started living together. Her parents were divorced, she lived with her mother and stepfather; she did have a good relationship with her biological father but he lived far away, in California, as he was in the film industry. Her mother had gone to private school in New York City when she was growing up and had been quite the social butterfly. But her daughter, my roommate (we'll call her Cindy), was not the same type. She was serious and studious; her forte was to study hard and get good grades. A little bit on the chunky side, she was not beautiful but not homely either. But no matter how good her grades were, her mother always asked about her social life, which was nonexistent.

When we first met, we got along fine, as I too was not a social phenomenon. I was glad to have been paired with someone on my own level socially. So we went to a couple of mixers together, had some good times, and studied in our rooms together. But shortly after the beginning of the school year, Cindy decided to go on a diet and really change her life. She was still trying to live up to what her mother wanted her to accomplish - being popular.

Cindy started out dieting in a fairly normal way: eating salads, tuna, fruit, etc. But gradually it became more and more pathological. Eventually she was eating nothing but iceberg lettuce. No tuna. No chicken. No fruit. After awhile she had lost enough weight that she could put on her old jeans and button them and pull them down without unbuttoning them.

She lost all interest in anything; she didn't have the energy to go out and go to mixers anymore. She would come back from class, do her homework, and lie on her bed staring at the ceiling. It didn't help that the college we attended was all women and the only way to meet anyone of the opposite sex was to actually make an effort; there were no men in our classes. So her social life did not flourish despite her weight loss, and she continued to want to lose more.

Luckily for Cindy, after freshman year when she went home, her family must have realized there was a problem. She did not return to school in the fall; instead she transferred to the University of South Florida, where her beloved older brother was already a student. The last I heard of her, she had done well there, apparently was eating in a healthier way, and by senior year was engaged to be married.

Not all people with eating disorders have such happy endings. There were two other girls I was acquainted with in college who were seriously anorexic, to the point of needing hospitalization to prevent them from starving themselves to death. Cindy, although she qualified for the definition of anorexia, never got to that point.

Many people know someone who they suspect suffers from some kind of eating disorder; you may have someone in your family who has one. Others may have told you that you have one. This article will help you understand what constitutes an eating disorder, what types there are, why people develop them, and what can be done to help those who suffer from this illness.

Eating Disorders: What are they?

Eating disorders are serious, but treatable, medical illnesses. People suffering from eating disorders typically become obsessed with food and their body weight. Eating disorders afflict several million people at any given time, most often girls/women between the ages of 12 and 35. In fact, over 90% occur in an even narrower age range of girls/women 12-25, according to the National Alliance of the Mentally Ill. However, these disorders can occur in boys and men as well, and in people of any age. Eating disorders are often associated with other forms of psychiatric illness such as depression, obsessive-compulsive disorder, bi-polar disorder, and others.

These illnesses come in three main types:

Anorexia Nervosa, which is the type of disorder Cindy had: Self starvation and excessive weight loss. The person with anorexia can be rail-thin and still think they are fat.

Another form of disorder is Bulimia, also called Bulimia Nervosa, where the person binges on food and then forces themselves to vomit. Sometimes they use laxatives to purge as well. Often these people have a normal appearance in terms of body weight. The word "bulimia" comes from a Greek word meaning "extreme hunger."

There are also Binge Eaters, who are compulsive overeaters, who eat beyond the point of feeling comfortably full. While there is no purging, there may be fasts or repetitive diets and often feelings of shame or self-hatred after a binge.

There are other combinations of eating disorders, with aspects of more than one. Someone who is anorexic can become bulimic and vice-versa. All eating disorders involve an unhealthy relationship with food and try to use food and weight as a way to deal with emotional problems and issues of control.

What are the symptoms?
Anorexia:

• Deliberate self-starvation with weight loss to 15% or more below normal body weight
• Fear of gaining weight
• Refusal to eat
• Denial of hunger
• Constant exercising
• Sensitivity to cold temperatures
• Absent or irregular periods
• Loss of scalp hair, eyebrows
• A self-perception of being fat when the person is really too thin
• Anxious or ritualistic behavior at mealtimes
• Fatigue
• Depression
• Irregular heart rate
• Baby-fine hair covering the body (a condition known as lanugo)
• Mild anemia
• Brittle nails and hair
• Low blood pressure

Bulimia Nervosa:

Although they may frequently diet and vigorously exercise, individuals with bulimia nervosa are often of normal weight, although some can be slightly underweight, others overweight or even obese. But they are never as underweight as anorexia nervosa sufferers. Those with bulimia nervosa binge eat frequently, often consuming thousands of calories by eating foods that are high in carbohydrates and fat. They can eat very rapidly, sometimes gulping down food without even tasting it.

After a binge, feelings of loss of control, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative or diuretic (which removes water from their system). This cycle is usually repeated at least several times a week or, in serious cases, several times a day.

The signs and symptoms of bulimia include:

• Recurrent episodes of binge eating
• Feeling a lack of control over eating behavior
• Eating much more food in a binge episode than in a normal meal or snack
• Following a binge with efforts to prevent weight gain — such as self-induced vomiting, using laxatives or other medications, fasting or excessive exercise
• Unhealthy focus on body shape and weight
• Dehydration
• Fatigue
• Depression
• Constipation
• Damaged teeth and gums from gastric acid contained in vomit
• Swollen cheeks from regular vomiting
• Irregular heartbeat

Binge Eating:

Binge eaters lack control over their eating habits, and binge at least twice a week for at least six months in order to be diagnosed as a binge eater. Binge eating is one form of eating disorder that males and females are equally likely to develop, according to the Mayo Clinic.

The signs and symptoms of binge-eating disorder include:

• Recurrent episodes of compulsive overeating not followed by purging
• No control over eating behavior
• Feelings of shame or guilt
• Fatigue
• Joint pain
• Gallbladder disease
• Increased blood pressure and cholesterol levels

Many kids and teens who develop eating disorders often manage to hide them from their parents. Warning signs to watch out for are if the child avoids eating with the family, excessive preoccupation with weight and body appearance, wearing baggy clothes, and long visits to the bathroom shortly after eating.

What causes eating disorders?

There are a number of theories about the cause of eating disorders. There may be a genetic component. Research has shown that in some cases the areas of the brain governing appetite and digestion aren't functioning properly. Family behavior, culture and the effect of the media's preoccupation with thin celebrities and models have all been identified as possible causes. Certainly our culture's focus on the importance of being thin has resulted in many young girls growing up with a distorted view of what is normal and desirable in society.

Risk factors for developing an eating disorder include:

• Gender (more women than men)
• Age (younger, as mentioned above)
• Family influence (feelings of insecurity within the family, stemming from overcritical parents or siblings, or teasing about appearance)
• Heredity (more common if another family member also has had an eating disorder)
• Other emotional disorders (depression, obsessive-compulsive disorder, etc.)
• Participation in highly competitive athletic activities

Beyond genetic and cultural co-factors, there tends to be a pattern in the families of those suffering from eating disorders. Eating disorders can be related to problems during upbringing, resulting in low self-esteem; there may be over controlling parents (particularly mothers and distant fathers), and sometimes sexual abuse. Those with eating disorders often fear sexual maturation, have trouble coping with stress, and tend to behave in a non-assertive manner. They try to avoid conflict and seldom resolve conflicts with others in a mature way.

These families are often over protective, and there may be alliances of the anorexic daughter with one parent or another (called triangulation). The family overall tends to have difficulty coping with stress; the parents may have an unacknowledged problem in their relationship, and enlist the daughter to balance an otherwise unhealthy situation. Parents are often affectionate and intrusive, but may be neglectful and controlling.

Anorexics usually are perfectionists. They set very high standards for themselves and feel they always have to prove their competence. A person with anorexia may also feel the only control they have in their lives is in the area of food and weight. If they can't control what is happening around them, they can control their weight.

Sometimes focusing on calories and losing weight is their way of blocking out feelings and emotions. Because of their low self-esteem they sometimes feel they don't deserve to eat. The anorexics usually deny that anything is wrong.

Bulimics also do not feel secure about their own self worth. They usually strive for the approval of others and hide their own feelings. Food becomes their source of comfort. Bulimia also serves as a function for blocking or letting out feelings. they tend to be impulsive rather than perfectionists. Unlike anorexics, bulimics do realize they have a problem and are more likely to seek help.

Binge eaters use food as a way to cope with or block out feelings and emotions they do not want to feel. IThey may use food as a way to numb themselves, to cope with daily life stressors, to provide comfort to themselves or fill a void.

Complications

People with anorexia have a greater variety of health complications and a greater risk of death (either from weight loss complications or suicide) than do people with bulimia. However, both eating disorders can result in serious health problems.

Anorexia can cause heart problems, particularly due to irregular heart rhythms and reduced size of the heart muscles. (Karen Carpenter, the singer, died of heart problems related to her history of anorexia.) In addition, changes in reproductive hormones and in thyroid hormones can cause absence of menstruation, infertility, bone loss and retarded growth. Disruption of the body's levels of fluids and minerals can create an electrolyte imbalance. Unless restored, this imbalance can be life-threatening. Anorexia may cause brain and nerve damage, seizures and loss of feeling.

Bulimia does not cause as severe health problems as anorexia, since bulimics tend to maintain a more normal weight. Complications may include: Teeth and gum problems, low potassium levels (which can lead to weakness and heart arrhythmias), irritation of the walls of the esophagus and rectum.

Binge eaters may develop high blood pressure, high cholesterol, heart disease, gallbladder disease or type 2 diabetes.

How are eating disorders diagnosed?

Often a family will bring in the afflicted family member to the doctor when they realize there is a problem. Or, the person may realize themselves that they have a problem and go to the doctor.

In addition to finding out whether the person qualifies as being the victim of an eating disorder based on their eating behaviors and symptoms, the physician will also perform a complete physical examination to ascertain whether the person is experiencing any of the side effects of the particular eating disorder. He or she will record the patient's weight and then run a number of tests. These tests should include:

• Complete blood count (to check for anemia and other health problems)
• Blood chemistry (to check for performance of various organs)
• Electrocardiogram (to identify heart damage or irregular rhythms)
• Chest X-Ray (to see whether the heart size has changed)
• CT scan of brain, digestive tract
• Bone density test

If any of the tests show effects from the eating disorder, these problems need to be addressed along with the underlying cause, which is the eating disorder itself.

How are eating disorders treated?

For severe anorexia nervosa, hospitalization is sometimes required to rehydrate the body, balance the electrolytes and begin bringing nutrition back into the body.

If the situation is not as dire, the patient can be treated at home, and a nutritional program prescribed to lead to a gradual weight gain.

For all types of eating disorders, a combination of various therapies is needed, including nutritional education, psychotherapy and family counseling. Medications may be prescribed to reduce vomiting, anxiety and associated depression.

Psychological counseling must address both the eating disordered symptoms and the underlying psychological, interpersonal, and cultural forces that contribute to, or maintain, the eating disorder. The person needs to change their relationship with food.

Some feel that cognitive behavioral therapy is particularly helpful in eating disorders. Cognitive-behavior therapy directly targets the binge cycle. The therapist and patient work together to change eating behaviors, to stop purging, and re-establish natural and healthy eating patterns. Adoption of more flexible eating patterns and learning coping skills are central to preventing binges. Education about meal-planning, nutrition and the ineffectiveness of purging techniques are often a part of treatment. Treatment also targets thoughts and feelings that can trigger binge-eating, including perfectionism and “all-or-nothing” thinking.

Nutritional counseling is also necessary and should incorporate education about nutritional needs and planning for and monitoring rational choices of the individual patient.

Many people with eating disorders respond to outpatient therapy, including individual, group, or family therapy and medical management by their primary care provider. Support groups, nutritional counseling, and psychiatric medications under careful medical supervision have also proven helpful for some individuals.

These disorders often respond to antidepressant medications in conjunction with therapy. Doctors often prescribe selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine. Other antidepressant medications may include venlafaxine (Effexor) and tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin). These drugs also help with anxiety.

Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. Other therapies that may be tried include dialectical behavior therapy, which helps people regulate their emotions; drug therapy with the anti-seizure medication topiramate; weight loss surgery; exercise used alone or in combination with cognitive-behavioral therapy; and self-help.

The Bulimia Nervosa Resource Guide has a wealth of information on Bulimia specifically. http://www.bulimiaguide.org/index/category.aspx?lid=465

Will you get an eating disorder?

It depends. If you have some of the risk factors, and are still young, you could become one of the 10 million girls or women, or the million or so boys/men in the U.S. who suffer from an eating disorder such as anorexia or bulimia. However, if you've reached a relatively mature age without any significant issues with food, you will probably not develop one of these illnesses later on.

Perhaps the more important question would be, do you HAVE an eating disorder? Think about your own eating habits and behaviors. Anorexics are often in denial that they have a problem. Be sure that you aren't one of them.

One thing is certain, when there is a person with an eating disorder within a family, it is not just about that person. It is about the family. Not only can family dynamics be a co-factor in the development of the disorder, but once a family member has the disorder, their affliction affects everyone else in the family as well. So it can perpetuate or worsen the family dynamics, and in order to address these issues, the family must all be involved.

For more information please see the links below - there are a myriad of information sources about this subject and this article has only skimmed the surface.

Information taken from the following sites:
http://www.nlm.nih.gov/medlineplus/eatingdisorders.html http://www.minddisorders.com/Br-Del/Bulimia-nervosa.html
http://www.mayoclinic.com/print/eating-disorders/DS00294/DSECTION=all&METHOD=print
http://mentalhealth.samhsa.gov/publications/allpubs/ken98-0047/default.asp
http://www.edap.org/p.asp?WebPage_ID=337

http://atdpweb.soe.berkeley.edu/quest/Mind&Body/Carpenter.html
http://familydoctor.org/063.xml

http://www.hec.ohio-state.edu/bitf/etiology.htm

http://www.bulimiaguide.org/index/category.aspx?lid=465

http://www.mirror-mirror.org/anorexia.htm

http://www.cognitivetherapynyc.com/problems.asp?sid=251

http://www.anorexiasurvivalguide.com/anorexia_familysupport.htm

http://www.mayoclinic.com/health/eating-disorders/DS00294