Two stories which could be set in any community across the
nation:
Anne
She started with a diet. But she almost died.
At age 16, Anne weighed 110 pounds. But a boy told her she wasn't
asked to a school dance because she was fat. He was teasing. But she
was inclined to take it seriously. And she started counting
calories.
First, Anne skipped lunch. When swimming suit fashions appeared
in stores, she dropped breakfast. She obsessively weighed her food
and calculated the calories she consumed. By summer, her daily
intake had plummeted to some 300 calories a day. Anne weighed 93
pounds. Her knees, elbows and fingers often swelled uncomfortably;
she complained that her fingernails broke easily and her hair had
split ends. When her friends and parents deplored her emaciated
frame, Anne deplored the "ripples of fat" on her legs and
stomach.
She adamantly refused to see a doctor until she fainted while
boarding the school bus. In the fall, she cut her forehead; her
parents took her to the emergency room. Appalled by her emaciation,
the physician said Anne suffered from anorexia nervosa and
immediately admitted her to the hospital.
Laurie
Laurie, a ninth-grader, loved parties, especially when she
"discovered" her own answer to weight control. After
gulping down several donuts and cupcakes and an entire bag of chips,
she slipped into the bathroom and made herself throw up. It was the
ideal compromise between her inability to control her eating and her
desire to lose weight.
But after several months of binge eating followed by self-induced
vomiting,
Laurie's throat hurt constantly and her dentist urged her to
brush more thoroughly because her teeth were in poor condition.
Worse, she could neither stop her binges nor keep food in her
stomach after a normal meal.
When she developed a serious ulcer, she finally admitted her
binge-purge routine to her doctor. He diagnosed bulimia nervosa and
sent Laurie to a psychiatrist, who created a treatment plan that
would help her return to healthful, normal eating habits.
These young women suffered from eating disorders, psychological
illnesses in which victims become obsessed with food and with their
body weight. People suffering from eating disorders have an
extremely distorted body image; they "feel fat," and see
themselves as overweight, despite even life-threatening emaciation.
And their intense fear of gaining weight or being fat adds to their
denial of the problem. But without treatment of both the emotional
and physical symptoms of these illnesses, victims can suffer from
malnutrition, heart problems, and other conditions that are
potentially fatal.
Eating disorders, which affect some half-million people at any
given time, are most common among middle to upper middle-class
females. Statistics show that 95 percent of those who have eating
disorders are young women between the ages of 12 and 25, however
there is growing evidence that eating disorders are also a serious
problem among males.
People with anorexia nervosa or bulimia nervosa tend to be
perfectionists who suffer from low self-esteem and are extremely
critical of themselves or some aspect of their physical make-up.
Studies have found that those with bulimia nervosa are often
impulsive and are statistically at higher risk for other disorders
such as depression and alcohol or other drug abuse.
Anorexia nervosa patients, however, have often been described as
"model children" who were very obedient, kept their
feelings to themselves, and were good students and athletes .
For complete eating disorders
information go to the Healthyplace.com
Eating Disorders Website.
Anorexia Nervosa
Anorexia nervosa afflicts as many as one in every 100 girls and
young women. Its victims can literally starve themselves to death.
Others may suffer from cardiac arrest as a result of malnutrition,
while still others commit suicide.
Psychiatrists diagnose anorexia nervosa when a patient weighs at
least 15 percent less than expected. People with anorexia nervosa
don't maintain a normal weight because they refuse to eat enough,
often exercise obsessively and sometimes use laxatives or force
themselves to vomit as well.
Over time, those with anorexia nervosa develop all the symptoms
of starvation. As their bodies conserve resources, monthly menstrual
periods stop. With the stop of menstrual periods the body also
starts to lose calcium from the bones. If anorexia nervosa becomes
severe, its victims will develop osteoporosis (thinning of the
bones), an irregular heartbeat and heart failure. Breathing, pulse
and blood pressure rates fall. Victims' hair and nails become
brittle, their skin dries and becomes yellow, and they may develop a
layer of soft hair called "lanugo."
Without adequate amounts of water, the victims will suffer from
constipation. As their bodies lose fat, their internal temperature
falls, making them less tolerant of cold weather. Mild anemia and
swollen joints often develop, and muscles waste away.
As their bodies struggle to survive, people with anorexia nervosa
can suffer from lethargy, loss of interest, increased feelings of
worthlessness and hopelessness, and other symptoms of depression
that discourage them from seeking treatment.
Some medical researchers have developed two categories for
anorexia nervosa. The first, called the "restrictor"
group, are those who refuse to eat food. The second, called the
"bulimic" group, attempt to restrict their food intake,
but suffer from bouts of the binge-eating and purging cycles that
are part of bulimia nervosa. Given their already weakened and
emaciated condition, an episode of purging could prove fatal to
people in this group. Abuse of drugs that cause vomiting, strong
laxatives that cause bowel movements, or diuretics to induce
urination can also increase the risk of cardiac arrest.
Bulimia Nervosa
Though it may accompany anorexia nervosa, bulimia nervosa can
strike alone. Patients with bulimia nervosa repeatedly diet or
vigorously exercise. People with bulimia nervosa differ from those
with anorexia nervosa in that they frequently have severe eating
binges at least twice a week for at least three months in a row.
During a binge, people with bulimia nervosa may eat an astounding
amount of food in a short time. They may consume thousands and
thousands of calories in soft foods that are high in sugars and
carbohydrates. They often eat so quickly that they may not bother to
chew. Instead, they may gulp down the food without even tasting it.
Their binges end only when they are interrupted by another person,
they fall asleep, or their stomach hurts from over-extension. At
that point, either pain or the fear of weight gain prompt the
bulimia nervosa sufferer to purge by throwing up, using a laxative
or taking a diuretic. The person with bulimia nervosa may repeat
this cycle several times a week or, in serious cases, several times
a day.
Many people don't know when a family member or friend suffers
from bulimia nervosa. Victims binge behind closed doors, and unlike
those with anorexia nervosa, they often don't lose significant
amounts of weight. They may have a normal weight, weigh slightly
less than or just over an ideal weight for their height and build.
But bulimia nervosa does have symptoms that should raise red
flags. A bulimia nervosa victim who purges by vomiting often suffers
from a chronically inflamed and sore throat that may bleed. Salivary
glands in the neck and below the jaw may become swollen and the
cheeks and face may become puffy--even appearing much fatter than
usual. After being exposed constantly to stomach acid, tooth enamel
may wear off and teeth--especially the front teeth--begin to decay
badly. In severe cases, those with bulimia nervosa who binge on and
vomit sugary foods can cause their pancreas to release large amounts
of insulin. When the insulin has no sugar on which to act, it can
cause what is known as an "insulin dump," which can in
turn lead to hypoglycemia.
People with bulimia nervosa who abuse laxatives may develop
intestinal problems due to constant irritation of the colon and
depletion of important minerals from the body. Kidney problems may
result from abuse of diuretics. In serious cases, bulimia nervosa
causes dehydration and imbalances of the electrolytes and minerals
that are essential to nerve and muscle function, increasing risk of
irregular heart beat and palpitations. More rarely, bulimia nervosa
patients have ruptured their stomachs or esophagi--and died from
peritonitis.
Theories About Causes
There are several theories about the causes of eating disorders,
and researchers draw elements from each in approaching these
diseases. Some psychiatrists believe people suffering from eating
disorders are trying to gain some measure of control in their lives.
The extremely compliant and obedient young woman with anorexia
nervosa may be trying to control one small part of her life, or may
be "rebelling" by refusing to eat, despite pleas from her
loved ones. Another with bulimia nervosa may be coping through
eating with anxiety, anger or stress related to family problems,
romantic relationships, school or career.
Other theories blame a distorted body image. Western culture
emphasizes a thin physique that, for many who are not necessarily
overweight, is unattainable. When a vulnerable person tries--but
fails--to meet societal standards, he or she may suffer from guilt,
anxiety, fear and loss of control over dieting behavior. These
emotional reactions, in turn, encourage him or her to try--again--to
diet, and a cycle is set in motion.
Some models focus on biochemical imbalances associated with
eating disorders and depression. People suffering from bulimia
nervosa and anorexia nervosa also are more likely to suffer from
depression. Research suggests that there may be imbalances in
certain brain chemicals, called neurotransmitters, in the parts of
the brain that control appetite, mood and sleeping patterns. These
imbalances may explain the link between eating disorders and
depressive illness, and may also shed light on why people with
anorexia nervosa can refuse food despite their hunger or why those
with bulimia nervosa lose control of their eating.
A low level of the neurotransmitter serotonin, which is
associated with depression, has also been linked to bulimia nervosa.
Researchers believe an imbalance could contribute to the depression
and poor impulse control that bulimia nervosa victims suffer.
Likewise, psychiatric researchers have found that those with
anorexia nervosa have a lower level of the neurotransmitter
norepinephrine, which regulates mood, alertness and ability to react
to stress.
As they learn more about the relationship between brain chemicals
and eating disorders, scientists hope to identify more precisely the
cause of anorexia nervosa and bulimia nervosa. Today, researchers
aren't sure whether the biochemical imbalances cause the eating
disorder or are the result of the poor nutrition that is an
outgrowth of the disorders.
Treatments
Eating disorders clearly illustrate the relationship between
emotional and physical health. The psychological disorders of
anorexia nervosa and bulimia nervosa directly affect physical
health, leading to physical problems that, in turn, worsen the
patient's emotional problems. Simply restoring a person to normal
weight or temporarily ending the binge-purge cycle does not address
the underlying emotional problems that caused or are exacerbated by
the abnormal eating behavior. As a result, people suffering from
eating disorders must receive a thorough physical and psychiatric
evaluation before treatment can be prescribed.
Many patients can successfully overcome their eating disorders
with treatment in a doctor's office or clinic. However, some need to
be hospitalized because they are severely under weight, have a
problem with metabolism, suffer from serious depression, are at high
risk of suicide or suffer from severe binge-and-purge behavior.
In addition to addressing any physical complications that result
from eating disorders, treatment focuses on correcting the patient's
distorted body image, improving self-confidence and self-esteem,
treating underlying depression, establishing normal eating habits
and preventing relapse. Success depends on tailoring each treatment
to the individual's needs. Generally, a treatment plan will include
a combination of physical interventions as well as individual,
group, or family psychotherapy, cognitive therapy, behavior therapy
and medications.
Because successful treatment relies so heavily on appropriate
psychological intervention, patients most often work with a
psychiatrist--a medical doctor who is specially trained to treat
psychological and emotional problems such as anorexia nervosa or
bulimia nervosa. As a physician, the psychiatrist can identify,
refer for treatment, and monitor the physical complications that
accompany eating disorders.
Nutritional Counseling
Because of the physical effects of the illnesses, it is important
that any treatment plan for a person with anorexia nervosa or
bulimia nervosa include nutritional management and nutritional
counseling to begin to rebuild physical health and establish healthy
eating practices.
Psychotherapy
Psychotherapy helps patients to understand the emotions that
trigger eating disorders, to correct distorted self-image, to
overcome the morbid fears of weight gain, to change the
obsessive-compulsive behaviors related to food and eating, and to
learn appropriate eating behaviors.
During individual psychotherapy patients learn how to recognize
thinking patterns that contribute to distorted body image. Through
approaches in individual therapy such as cognitive therapy, patients
learn to recognize feelings, such as anxiety or depression, that
trigger abnormal eating behaviors. Through behavior therapy, people
with eating disorders learn new responses to those feelings.
Psychotherapy also focuses on helping eating disorder sufferers to
develop strong self-confidence and self-esteem about their abilities
that are unrelated to appearance; helping them to learn to develop
interests that prevent feelings of isolation and boredom.
Family therapy also has an important role. It teaches loved ones
about anorexia nervosa and bulimia nervosa, helps parents to learn
more effective parenting skills, enables family members to
understand their relationships and offers emotional support. In
addition, family therapy helps the patient develop a sense of
individuality that is crucial to a healthy self-image.
Group therapy supplements other interventions by letting patients
with anorexia nervosa and bulimia nervosa help one another and
themselves. Through group interactions, patients realize they are
not alone as they express their feelings in a situation that is
accepting, understanding and supportive.
Medications
Psychiatrists commonly prescribe antidepressant medications for
patients who suffer from both eating disorders and depression.
Studies report that bulimia nervosa patients who take antidepressant
medications feel better about themselves, have improved self-esteem
and sense of control, and markedly reduce their binge-and-purge
behavior. Patients recovering from anorexia nervosa may better
retain their weight gain and reduce their obsessional thinking and
compulsive behaviors when treated with certain medications.
The reduced depression that comes with a course of treatment with
heterocyclic antidepressants can also mean improved eating behaviors
among those with serious anorexia nervosa.
Eating disorders are complex illnesses that require intensive
treatment. However, people suffering from eating disorders have an
excellent chance for complete recovery, especially if their illness
is recognized early.
For complete eating disorders
information go to the HealthyPlace.com
Eating Disorders Website.
(c) Copyright 1993 American Psychiatric Association
Produced by the APA Joint Commission on Public Affairs and the
Division of Public Affairs. This document contains text from a
pamphlet developed for educational purposes and does not necessarily
reflect opinion or policy of the American Psychiatric Association.
Additional Resources
American Anorexia/Bulimia Association, Inc
(212) 734-1114.
Center for the Study of Anorexia and Bulimia
(212) 595-3449
National Anorexic Aid Society, Inc.
(212) 595-3449
National Assn. of Anorexia Nervosa and Associated Disorders
(312) 831-3438
National Institute of Mental Health Eating Disorders Program
(301) 496-1891
Other Resources
Bulimia: Psychoanalytic Treatment and Theory , Harvey J.
Schwartz, Ed. Madison, CT: International Universities Press,1988.
Diagnostic Issues in Anorexia Nervosa and Bulimia Nervosa ,
Garfinkel and Garner, Eds. New York: Brunner/Mazel, 1988.
Eating Behavior in Eating Disorders , by B. Timothy Walsh.
Washington, DC: American Psychiatric Press, Inc., 1988.
The Eating Disorders: Medical and Biological Bases of Diagnosis
and Treatment , Bliner, Chaitin, Goldstein, Eds. New York: PMA
Publishing Corporation, 1988.
Family Approaches in Treatment of Eating Disorders , Woodside and
Shekter-Wolfson, Eds. Washington, DC: American Psychiatric Press,
Inc., 1991.
Fasting Girls: The Emergence of Anorexia Nervosa as A Modern
Disease , by Joan Jacobs Brumberg. Cambridge, MA: Harvard University
Press, 1988.
Group Psychotherapy for Eating Disorders , Harper-Giuffre and
MacKenzie, Eds. Washington, DC: American Psychiatric Press, Inc.,
1992.
Handbook of Psychotherapy for Anorexia Nervosa and Bulimia ,
Garner and Garfinkel, Eds. New York: Guilford Press, 1985.
The Role of Drug Treatments for Eating Disorders , Garfinkel and
Garner, Eds. New York: Brunner/Mazel, 1987.
Special Problems in Managing Eating Disorders , Yager, Gwirtsman,
Edelstein, Eds. Washington, DC: American Psychiatric Press, Inc.,
1991.
Surviving an Eating Disorder: New Perspectives and Strategies for
Families and Friends , Siegel, Brisman, Weinshel, Eds. New York:
Harper and Row, 1988.
Unlocking the Family Door: A Systematic Approach to the
Understanding and Treatment of Anorexia Nervosa , Helm Stierlin and
Gunthard Weber. New York: Brunner/Mazel, 1989.
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