Eating Disorders Require Medical Attention

For reasons that are unclear, some people--mainly young women--develop potentially life-threatening eating disorders called bulimia nervosa and anorexia nervosa. People with bulimia, known as bulimics, indulge in bingeing (episodes of eating large amounts of food) and purging (getting rid of the food by vomiting or using laxatives). People with anorexia, whom doctors sometimes call anorectics, severely limit their food intake. About half of them also have bulimia symptoms.

The National Center for Health Statistics estimates that about 9,000 people admitted to hospitals were diagnosed with bulimia in 1994, the latest year for which statistics are available, and about 8,000 were diagnosed with anorexia. Studies indicate that by their first year of college, 4.5 to 18 percent of women and 0.4 percent of men have a history of bulimia and that as many as 1 in 100 females between the ages of 12 and 18 have anorexia.

Males account for only 5 to 10 percent of bulimia and anorexia cases. While people of all races develop the disorders, the vast majority of those diagnosed are white.

Most people find it difficult to stop their bulimic or anorectic behavior without professional help. If untreated, the disorders may become chronic and lead to severe health problems, even death. Antidepressants are sometimes prescribed for people with these eating disorders, and, in November 1996, FDA added the treatment of bulimia to the indications for the antidepressant Prozac (Fluoxetine).

About 1,000 women die of anorexia each year, according to the American Anorexia/Bulimia Association. More specific statistics from the National Center for Health Statistics show that "anorexia" or "anorexia nervosa" was the underlying cause of death noted on 101 death certificates in 1994, and was mentioned as one of multiple causes of death on another 2,657 death certificates. In the same year, bulimia was the underlying cause of death on two death certificates and mentioned as one of several causes on 64 others.

As to the causes of bulimia and the causes of anorexia, there are many theories. One is that some young women feel abnormally pressured to be as thin as the "ideal" portrayed by magazines, movies and television. Another is that defects in key chemical messengers in the brain may contribute to the disorders' development or persistence.

The Bulimia Secret

Once people begin binge eating and purging, usually in conjunction with a diet, the cycle easily gets out of control. While cases tend to develop during the teens or early 20s, many bulimics successfully hide their symptoms, thereby delaying help until they reach their 30s or 40s. Several years ago, actress Jane Fonda revealed she had been a secret bulimic from age 12 until her recovery at 35. She told of bingeing and purging up to 20 times a day.

Many people with bulimia maintain a nearly normal weight. Though they appear healthy and successful--"perfectionists" at whatever they do--in reality, they have low self-esteem and are often depressed. They may exhibit other compulsive behaviors. For example, one physician reports that a third of his bulimia patients regularly engage in shoplifting and that a quarter of the patients have suffered from alcohol abuse or addiction at some point in their lives.

While normal food intake for women and teenagers is 2,000 to 3,000 calories in a day, bulimic binges average about 3,400 calories in 1 1/4 hours, according to one study. Some bulimics consume up to 20,000 calories in binges lasting as long as eight hours. Some spend $50 or more a day on food and may resort to stealing food or money to support their obsession.

To lose the weight gained during a binge, bulimics begin purging by vomiting (by self-induced gagging or with an emetic, a substance that causes vomiting) or by using laxatives (50 to 100 tablets at a time), diuretics (drugs that increase urination), or enemas. Between binges, they may fast or exercise excessively.

Extreme purging rapidly upsets the body's balance of sodium, potassium, and other chemicals. This can cause fatigue, seizures, irregular heartbeat, and thinner bones. Repeated vomiting can damage the stomach and esophagus (the tube that carries food to the stomach), make the gums recede, and erode tooth enamel. (Some patients need all their teeth pulled prematurely). Other effects include various skin rashes, broken blood vessels in the face, and irregular menstrual cycles.

Complexities of Anorexia

While anorexia most commonly begins in the teens, it can start at any age and has been reported from age 5 to 60. Incidence among 8- to 11-year-olds is said to be increasing.

Anorexia may be a single, limited episode with large weight loss within a few months followed by recovery. Or it may develop gradually and persist for years. The illness may go back and forth between getting better and getting worse. Or it may steadily get more severe.

Anorectics may exercise excessively. Their preoccupation with food usually prompts habits such as moving food about on the plate and cutting it into tiny pieces to prolong eating, and not eating with the family.

Obsessed with weight loss and fear of becoming fat, anorectics see normal folds of flesh as "fat" that must be eliminated. When the normal fat padding is lost, sitting or lying down brings discomfort not rest, making sleep difficult. As the disorder continues, victims may become isolated and withdraw from friends and family.

The body responds to starvation by slowing or stopping certain bodily processes. Blood pressure falls, breathing rate slows, menstruation ceases (or, in girls in their early teens, never begins), and activity of the thyroid gland (which regulates growth) diminishes. Skin becomes dry, and hair and nails become brittle. Lightheadedness, cold intolerance, constipation, and joint swelling are other symptoms. Reduced fat causes the body temperature to fall. Soft hair called lanugo forms on the skin for warmth. Body chemicals may get so imbalanced that heart failure occurs.

Anorectics who additionally binge and purge impair their health even further. The late recording artist Karen Carpenter, an anorectic who used syrup of ipecac to induce vomiting, died after buildup of the drug irreversibly damaged her heart.

Getting Help

Early treatment is vital. As either disorder becomes more entrenched, its damage becomes less reversible.

Usually, the family is asked to help in the treatment, which may include psychotherapy, nutrition counseling, behavior modification, and self-help groups. Therapy often lasts a year or more--on an outpatient basis unless life-threatening physical symptoms or severe psychological problems require hospitalization. If there is deterioration or no response to therapy, the patient (or parent or other advocate) may want to talk to the health professional about the plan of treatment.

There are no drugs approved specifically for bulimia or anorexia, but several, including some antidepressants, are being investigated for this use.

If you think a friend or family member has bulimia or anorexia, point out in a caring, nonjudgmental way the behavior you have observed and encourage the person to get medical help. If you think you have bulimia or anorexia, remember that you are not alone and that this is a health problem that requires professional help. As a first step, talk to your parents, family doctor, religious counselor, or school counselor or nurse.

Disorders' Definitions

According to the American Psychiatric Association, a person diagnosed as bulimic or anorectic must have all of that disorder's specific symptoms:

Bulimia Nervosa

• recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
• a feeling of lack of control over eating during the binges
• regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
• persistent over-concern with body shape and weight.

Anorexia Nervosa

• refusal to maintain weight that's over the lowest weight considered normal for age and height
• intense fear of gaining weight or becoming fat, even though underweight
• distorted body image
• in women, three consecutive missed menstrual periods without pregnancy.

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